Day 022 - 12 Sep 94 - Page 39
1
2 Q. But you feel that you could put your hand on your heart
3 and say: "This is causing that"?
4 A. No, all I can say -----
5
6 Q. Genetically?
7 A. All I can say is that it is very likely that there is
8 a genetic relationship ---
9
10 Q. Right.
11 A. -- a genetic factor in the causation of bowel cancer.
12 I mean, ultimately, cancer, in fact, is a disease where
13 you have genetic abnormalities, otherwise the cell would
14 just carry on in a normal fashion. But something changes
15 in the essential makeup of the cell for it then to go on
16 and become a malignant cell which is beyond the control of
17 the normal control mechanisms of the body.
18
19 Q. Something that strikes me as you were talking is -- it is
20 a question I wanted to ask all along -- presumably, there
21 may be a compounding of three or four different factors
22 that have to come together to make a particular cancer.
23 So, for example, although you could say the genetic path
24 is the main one, that would not be possible without, for
25 example, the dietary component, the high fat in the diet
26 or something?
27 A. It is possible.
28
29 Q. Although it may not be the cause?
30 A. No. I mean, we talked about this when I gave evidence
31 before. There is the process of initiation which is,
32 presumably, the formation of the genetic abnormality which
33 one often cannot detect in the cell. It is not detected.
34 Then one has to have promotional of that. Then there is
35 the progression subsequently. Now, it may well be that
36 the factors which are involved in the promotion of this
37 abnormality are different from the factors which act when
38 you are getting progression of the cancer.
39
40 This is why it is so difficult in this question of diet
41 identifying, you know, what aspects of diet are important,
42 at what stage do they act in this process of initiation to
43 cancer progression.
44
45 Q. If there are two populations with very strongly different
46 cancer rates and strongly different dietary habits --
47 forget the dietary habits, strongly different cancer rates
48 -- but no obvious genetic link which could be backed up
49 by migration studies, presumably, that carry the genetic
50 genes with them but they change their cultural situation
51 or whatever, then the genetic -- you could not put your
52 hand on your heart and say -----
53
54 MR. JUSTICE BELL: Pause a moment. Start the question again
55 because long questions can not only leave the person who
56 is asking it (but more important the person listening to
57 them) confused, so collect your thoughts and then put the
58 question.
59
60 MR. MORRIS: It is not a trick question.
