Day 035 - 12 Oct 94 - Page 52


     
     1        within that population, be it a national or a Continental
     2        population or whatever, are actually carrying cells in
     3        which the initiative process has already taken place but
     4        have not been developed into tumours?
     5
     6   MR. JUSTICE BELL:  Is that right?
     7        A.  No, not in my understanding.  I am trying to make sure
     8        I understand you.  One can  -----
     9
    10   Q.   How do you get anywhere near a realistic estimate of how
    11        many people during their lives have cancer initiators,
    12        I am trying to put it in lay terms, but not promoted?
    13        A.  Yes.  One can take samples of tissue.  For example,
    14        individuals who are killed in traffic accident; one can
    15        study their tissue and look for individual cells that are
    16        abnormal but have not begun to multiply.  Those studies,
    17        I believe I made reference to them with regard to ---
    18
    19   Q.   I understand that.
    20        A.  -- prostate cancer.
    21
    22   Q.   But how do you get from that to any half decent
    23        guesstimate of how many people in the population?  In this
    24        country we only have postmortems, generally speaking, in
    25        cases of violent death or such as your car accident or
    26        where there is no explanatory history of disease before
    27        death.  It is probably much the same in the States?
    28        A.  Yes.  The only really two sources would be traumatic
    29        death, because you would not necessarily want to use
    30        people who had died of some sort of metabolic disease, or
    31        the removal of an organ during surgery, for example, say
    32        breast reduction surgery or something like that, where
    33        there is no disease process.  That would be the only way
    34        that I could imagine that might be responsive to your
    35        question.
    36
    37   MR. RAMPTON:  It follows then, does it not, that it is not
    38        possible to make any sensible estimate of the number of
    39        people in the country that might be carrying cancers that
    40        have been initiated but not promoted?
    41        A.  As I mentioned earlier in my example of prostate
    42        disease, some people have made estimates that would go to
    43        that, yes.
    44
    45   Q.   Do you know of any work -- let us take it a stage further
    46        -- that has proposed what proportion of the population
    47        are carrying cancers of the colon or cancers of the breast
    48        that are awaiting promotion?
    49        A.  I do not recall; I do not know that literature.
    50 
    51   Q.   I paused at the top of page 52 of this British government 
    52        document.  I asked the question I did because this 
    53        committee, this panel, said:  "A number of mechanism
    54        whereby fat could be involved in cancer promotion has been
    55        suggested".  Would you agree that in the study of the
    56        aetiology of cancer it is important to distinguish between
    57        initiation and promotion?
    58        A.  In some context, yes, that is important.
    59
    60   Q.   It goes on ----

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