Epidemiology, like any branch of medical science, functions within a social and historical context. That context influences what questions are asked, how they are investigated, and how their conclusions are interpreted, both by researchers and by the public. The international debate over whether abortion increases breast cancer risk, which has been the subject of many studies and much heated controversy in recent decades, became so intensely politicized in the United States that it serves as a particularly stark illustration of how elusive the quest for scientific certainty can be. Although a growing interest in reproductive factors and breast cancer risk developed after the Second World War, it was not until the early 1980s, after induced abortion had been legalized in many countries, that studies began to focus on this specific factor. In the US these were the years following Roe v Wade, when anti-abortionists mounted their counterattack and pro-choice forces were on the defensive. As a result, epidemiologists found themselves at the centre of a debate which had come to symbolize a deepening divide in American culture. This paper traces the history of the scientific investigation of the alleged abortion-breast cancer link, against the backdrop of what was increasingly termed an “epidemic” of breast cancer in the US. That history, in turn, is closely intertwined with the anti-abortion movement's efforts, following the violence of the early 1990s, to regain respectability through changing its tactics and rhetoric, which included the adoption of the “ABC link” as part of its new “women-centred” strategy.

The lack of professional qualifications was felt keenly by some nineteenth-century medical and dental practitioners. In 1860, the Lancet highlighted a scheme “to avoid the operation of the Medical Act, and to enable uneducated and unprincipled men to defraud the public”. It quoted an advertisement from a daily newspaper. Mr T Vary had announced that “Doctors, Druggists, Chemists, or Dentists, who have no Medical Diploma, can hear of an easy method of obtaining one” by writing to him at Jones's Coffee House in London's Tottenham Court Road. In response to an enquiry, Vary told the Lancet that he had just come from America where a friend “had graduated … in 1857, with all the honours”. However, the latter “had to leave America without his diploma” because of a lack of money for his graduation fees, and so had asked him to pay off the debt and bring back the diploma to Europe. Vary said: “I have done so; but have been detained longer than was anticipated, and now find my friend dead”. Indicating that he did not want to lose the money which he had paid on behalf of his friend, Vary continued: “Fortunately, as is common in America, the space for the name is left blank, to allow the graduate to have it filled up to suit his fancy by some writing master”. He proposed to sell the diploma and supporting papers for £23, which, he pointed out, was “as good as if five years' labour and 1500 dollars had been given to obtain it”. Later in the same year, the Lancet stressed that the practice of buying a Continental degree of MD, without examination or residence, was clearly a “fraud upon the public … repugnant to professional honour and destructive of professional character”. It published details of a proposition sent to Mr Pound, a surgeon in Odiham, to obtain a degree “by simple purchase”. Enclosed was a printed circular: “If you wish to become a M.D. without absenting yourself from your professional duties, I can procure you the degree from a Continental University of the highest reputation, on terms more moderate than any hitherto known in this country”. The circular was accompanied by a letter addressed personally to Pound by a Dr H A Caesar, MD, FRCSI. There is no way of knowing how many doctors or dentists actually bought copies of that or similar false diplomas.

From the mid-nineteenth to the mid-twentieth century, specialist institutions such as sanatoria and asylums were established. In these, patients could be separated and isolated from the community and provided with the control and management of specific medical conditions such as tuberculosis and lunacy. At the start of this period, tuberculosis was a disease closely associated with the rapid growth of industrialization and a poorly nourished urban working class who lived in insalubrious, overcrowded conditions. By the early twentieth century, despite attempts by reforming socialist organizations such as the Garden City movement in England or the Life Reform movement in Germany to introduce healthier housing, these conditions had changed little. As the disease was more prevalent in younger men and women of working age, the financial drain on the European economy was considerable. By this time, research and treatment of the disease had coincided with the advent of modernism. This was a cultural movement that in architecture and applied design involved the integration of form with social purpose. It also attempted to create a new classless and hygienic lifestyle with socialist values.