Day 254 - 22 May 96 - Page 52


     
     1        and dietary".  Would you agree with that?
     2        A.  I think that one thing that is becoming clear in recent
     3        years is how important the genetic aspects may be.
     4
     5   Q.   But you agree with the statement there:  "The major risk
     6        factors for colorectal cancer are genetic and dietary"?
     7        A.  Yes.
     8
     9   Q.   Then in the conclusions about colorectal cancer on page 21:
    10
    11        "Although it is likely that dietary intervention will be
    12        justified for the prevention of colorectal cancer, the
    13        nature of that intervention is not yet clear.  It is likely
    14        to feature a low intake of saturated fat and high intakes
    15        of cereal, fibre, fruit and vegetables."
    16
    17        Would you agree with that?
    18        A.  I would have to say that that is his summary of the
    19        evidence and I think again he is using the word "likely"
    20        very carefully in that we all believe that it seems logical
    21        that there is a relationship perceived between some aspects
    22        of our diet and the development of colorectal cancer, but
    23        exactly what that relationship is, I think remains unclear,
    24        and, as I say, there is a growing feeling that genetic
    25        aspects may be more important than we have believed in the
    26        past.  What the problem is is relating diet to the genetic
    27        aspects.
    28
    29   Q.   Yes.  We probably cannot modify our genes very much but we
    30        modify our diets.  His conclusion is basically that the
    31        evidence is pointing that the sort of protective diet is
    32        going to feature a low intake of saturated fat and high
    33        intakes of cereal, fibre, fruit and vegetables; yes?
    34        A.  That is what he is saying.
    35
    36   Q.   Right.  Can I just ask about page 9 of your statement, the
    37        first paragraph about, "attempts to modify the development
    38        of adenomas and carcinomas in patients by direct
    39        modifications of diet". Would you agree that -- I presume
    40        you based this on what we have been discussing this
    41        morning, that, by that stage, it may be too late?
    42        A.  No, not necessarily so because there is what we call
    43        the "adenoma carcinoma sequence", and it is believed that
    44        in many instances, the development of an adenoma precedes
    45        the development of a carcinoma.
    46
    47   Q.   The point I am putting is just that.  You said that those
    48        which have included fibre supplements have not been
    49        noticeably successful.  You have not said what happened to
    50        the other studies that were evaluated, but even in if the 
    51        dietary modifications have not been successful in stopping 
    52        the further development of adenomas and carcinomas, that 
    53        would not mean it is not going to work as a preventative
    54        measure in the first place before they arrive?
    55        A.  No.  What these studies have tried to do is to look at
    56        the development of adenomas in the population, so they are
    57        in fact measuring the development of adenomas.
    58
    59   MR. JUSTICE BELL: I think all you are being asked about that
    60        paragraph is that it specifically deals with the

Prev Next Index