Day 034 - 11 Oct 94 - Page 23
1 thought that both seemed to have an effect.
2
3 "A series of case-control studies reveals the higher risk
4 of breast cancer with the increase in body size especially
5 in postmenopausal women". We have had some comments about
6 the association and, I believe, in Dr. Kinlen's report
7 that was read in Dr. Arnott's testimony, obesity was
8 considered an established risk factor for breast cancer.
9 We see that this was known back in 1978, or at least
10 suspected.
11
12 MR. JUSTICE BELL: They distinguish between an increase in body
13 size and obesity, do they not?
14 A. Yes.
15
16 Q. Increase in body size may involve obesity but not
17 necessarily at all?
18 A. That is quite right. He finishes by saying: "The
19 recent breast cancer increase could therefore be a
20 reflection of the fact that women in Japan are becoming
21 heavier, especially after age 30". Rather like the
22 Surgeon General's report which appeared a decade after
23 this study, the researcher is pointing out that they are
24 finding associations between fat and cancer, particularly,
25 in this case, meat intake, not specifically fat, but meat
26 intake, with some reference to pork and to animal fat as
27 well as to body size. But what is in doubt was the
28 mechanisms by which the animal fat operates. Is it a
29 direct effect or is it in some way mediated by obesity?
30
31 Perhaps this is important because as consideration is
32 given to the use of the word "link" in the leaflet, the
33 researchers have been seen to suggest that there are
34 links, that those links appear to be causal in nature, and
35 if the word "link" means "suspected to contribute to" that
36 was true, apparently, as far back as 1978. What was in
37 doubt then, and is still a matter of discussion today, is
38 precisely what those mechanisms are and what the relative
39 importance is of multiple mechanisms, all of which seem to
40 be at work simultaneously.
41
42 I have no further comments on this report.
43
44 Q. When they talk of "the increase in body size", is that an
45 average?
46 A. Yes, I believe it is.
47
48 Q. The reason I ask that is, you can have a significant
49 increase in body size if a large proportion of the
50 population were not much bigger but a significant minority
51 had become obese, could you not?
52 A. Yes, you certainly could.
53
54 Q. So the increase in body size here is an average which may
55 signify that Japanese women had a tendency to be larger in
56 size and may also signify that a greater proportion of
57 them were obese than had been in the past?
58 A. Yes, my Lord. There is substantial literature that
59 might shed some light on that question which I have not
60 brought with me, but if I might summarise it in a couple
