Day 256 - 04 Jun 96 - Page 61


     
     1        and breast, three of the four most common types around the
     2        world, is suggested by many laboratory experiments and
     3        hinted at by such epidemiological observations as the
     4        positive correlation in different populations between the
     5        incidence of cancers of the breast and large bowel and the
     6        consumption of fat, the negative correlation between the
     7        incidence of cancer of the large bowel and the consumption
     8        of fibre and the resistance of starch and the negative
     9        association between the incidence of gastric cancer and the
    10        consumption of fresh fruit and green vegetables.  The
    11        evidence is however inconclusive.  In so far as it varies
    12        in strength, the strongest is that obtained from studies of
    13        individuals which have suggested that the consumption of
    14        fruit and green vegetables diminishes the risk of cancer of
    15        stomach and that the consumption of large amounts of beta
    16        carotene similarly protects against a wide range of
    17        cancers, and the weakest is that relating to the role of
    18        fat in the causation of cancer of the breast and to a
    19        broadly protective effect of selenium and vitamin E."
    20
    21        Is there anything that I have so far read -- this is
    22        written in 1988 -- which you would, in 1996, disagree with?
    23        A.  Yes, I would say it rather differently on a couple of
    24        points.  He points out that consumption of large amounts of
    25        beta carotene similarly protect against a wide range of
    26        cancers.  He should have said -- in fact, it was actually
    27        said before that; in fact, he himself said that -- that
    28        beta carotene from foods, not beta carotene from
    29        supplements.  That is one point -- not dealing with our
    30        issue here.  But the second part of that sentence, where it
    31        says "and the weakest is that relating to the role of fat
    32        in the causation of cancer of the breast"; of course, in
    33        1988, he was referring to the first four year report at
    34        that time of the Nurses Health Study, as well as a few
    35        other case controlled studies, because that is all that
    36        were available at that time.  Since that time, we now have
    37        the eight year report of the Nurses Health Study; we also
    38        have of course the China data and many other studies; and
    39        so there is more, we have more information than was
    40        available to Sir Richard at that time.
    41
    42   Q.   Well, I am interested to hear you say that, because we
    43        looked this morning only at a pooled analysis of seven of
    44        those major cohort or prospective studies, did we not,
    45        including the Nurses Health Study; and they are the seven
    46        biggest that have probably ever been done on this topic,
    47        are they not?
    48        A.  Yes.
    49
    50   Q.   They produced no evidence of an association between the 
    51        ingestion of dietary fat and breast cancer; that is right, 
    52        is it not? 
    53        A.  Right.
    54
    55   Q.   So how is there a consensus (as you put it) that fat is
    56        causative, dietary fat is causative of breast cancer?
    57        A.  That is one report that you just referred to, of
    58        course.  There are seven cohort studies.  They are --
    59        actually, there is one other piece of evidence I am really
    60        not allowed to speak to here, quite frankly.  It has to do

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