Day 034 - 11 Oct 94 - Page 25


     
     1        incorporate clinical and pathologic factors in the
     2        analysis, to distinguish between sources of dietary fat
     3        intake, and to ascertain dietary patterns subsequent to
     4        breast cancer diagnosis was noted."
     5
     6        What briefly this study showed was that women,
     7        particularly women with metastatic breast cancer  --
     8        cancer that has already spread at the time of diagnosis --
     9        the higher the fat intake, the more likely the individual
    10        was to have the disease to progress to the point of
    11        fatality, and that every 1000 grammes of fat increased the
    12        risk of death by about 40 per cent.
    13
    14        Now, 1000 grammes of fat can easily, over the course of a
    15        month, can easily be the difference between a low fat diet
    16        and a typical English or American diet.  The study itself,
    17        if I may read the first two or three paragraphs:
    18
    19        "The belief is widely held that altered hormone and
    20        immune states may initiate or enhance the growth of breast
    21        tumours"; perhaps it is worth emphasising the words
    22        "widely held".  "In particular, oestrogen, which
    23        influences normal breast tissue development, is a
    24        suspected risk factor in breast carcinogenesis";
    25        carcinogenesis again meaning the beginnings of cancer,
    26        including the causation of cancer:  "Laboratory studies
    27        show that tumour induction fails in ovariectomized mice"
    28        -- these are mice who have had ovaries removed -- "and a
    29        protective effect of artificial menopause in women has
    30        been reported".
    31
    32        What the author is saying is that when women have had
    33        their ovaries removed, typically in the course of a
    34        hysterectomy, their breast cancer risk drops.  This is
    35        used by the author to support the increased risk with
    36        increased oestrogen stimulation of the breast tissue.
    37        "Conversely, persistent oestrogenic stimulation in women
    38        increases their risk of disease."
    39
    40        I would want to highlight in that sentence, Dr. Gregorio
    41        does not say "persistent oestrogenic stimulation in women
    42        may increase" or "could increase"; he says that persistent
    43        oestrogenic stimulation in women increases their risk of
    44        disease.  This will become important as the effects of
    45        high fat diets and of obesity on oestrogen levels comes
    46        into the discussion.
    47
    48        In the next sentence he says:  "Indicators of potentially
    49        abnormal endo-connect activity - such as early age at
    50        menarche, low parity, late age at first pregnancy, and 
    51        late age at menopause - have been shown to increase a 
    52        woman's risk of developing breast cancer."   Again, 
    53        I would note the absence of qualifiers such as "may be" or
    54        "could have been"; he says "these indicators have been
    55        shown to increase a woman's risk of developing breast
    56        cancer".
    57
    58        "Circumstantial evidence points to the importance of
    59        estrone in the etiology of the disease."  Estrone is one
    60        form of oestrogen.

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