Day 022 - 12 Sep 94 - Page 63


     
     1
     2   Q.   12, it says.
     3
     4   MR. RAMPTON:  My Lord, it is the early analysis one, it is the
     5        1987 one.
     6        A.  Yes, the first report.
     7
     8   MR. MORRIS:  Right.  "It is not likely that the difference is
     9        due chance.  However, two important findings of that study
    10        in our analysis are in agreement.  Total calorie intake is
    11        not associated with increased risk of breast cancer.
    12        Secondly, there is little evidence for an association
    13        between fat intake and increased risk of breast cancer in
    14        premenopausal women.  Our finding of an association
    15        between fat intake and post-menopausal breast cancer is
    16        important for two reasons.  First, if the association is
    17        causal, prevention of even a small percentage of breast
    18        cancer is important in terms of absolute numbers because
    19        of the high incidence of this cancer in a number of
    20        countries.  Secondly, if the association with adult and
    21        diet simply reflects an underlying causal association with
    22        dietary in adolescence, as has been suggested by a number
    23        of authors, identification of the latter association would
    24        directly affect the public health.
    25
    26        Therefore, it seems a matter of some urgency to acquire
    27        further analytic epidemiological data to help resolve the
    28        apparent difference between results of our analysis and
    29        those of the cohort studies performed by Willett and
    30        Jones.  Our identification of an inverse association with
    31        various markers of fruit and vegetable consumption, led
    32        support to the hypothesis that increased consumption of
    33        these foods may reduce breast cancer risk. A protective
    34        effect of fruit and vegetables has" -- I cannot read the
    35        word?
    36        A.  "... been observed".
    37
    38   Q.   ... "also been observed in a number of studies of other
    39        cancers, including cancer of the colon, lung and
    40        pancreas.  This appears to be one of the more consistent
    41        dietary findings from analytic epidemiological studies.
    42        Further investigation of such association seems urgent."
    43
    44        So, you may disagree with his conclusions based upon his
    45        analysis, but that was a survey anyway of all the
    46        pre-existing fat and breast cancer studies?
    47        A.  One of the problems of these so-called meta-analyses,
    48        in other words, looking at, lumping together a large
    49        numbers of trials, is something which statisticians argue
    50        about very strongly; to know whether these techniques 
    51        which have been in the past used mainly for looking at 
    52        clinical trials where you are comparing results of 
    53        treatment, for example, can they be applied to this kind
    54        of analysis?  There is great debate about whether, in
    55        fact, you are able to do that and produce what are
    56        meaningful results.  So, there is a great deal of
    57        criticism about this particular study and the way in which
    58        the trials were lumped together and analysed. But -----
    59
    60   Q.   Can we just go to one final -----

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