Day 017 - 25 Jul 94 - Page 31
1 rather than necessarily dietary related.
2 Q. Then we go on to Overnutrition: "There is a way resolving
the differences between the international correlational
3 and the individual-based studies - other than always
attributing the negative findings of the latter to
4 methodological defects - and which involves postulating no
new risk factor for breast cancer. The associations with
5 fat may be indirect and may reflect the effects of 'excess
calories' and other fertility-linked risk factors".
6
Dr. Arnott, I suppose, you would that agree animal fat is
7 a ready source of energy, of calories?
A. Yes, indeed. I mean, weight for weight, fat is the
8 greatest source or a readily available source of energy.
9 Q. "There is much evidence for role of 'overnutrition' in
breast cancer aetiology, and the more calorigenic nature
10 of fat than either carbohydrate or protein suggests a
connection. In the large prospective study by the American
11 Cancer Society (Lew and Farfinkel, 1979), a significant
trend in relative risk was found with increases in weight,
12 as in a smaller study in the Netherlands (De Waard and
Baanders, 1974). Case-control studies have also produced
13 evidence of this effect at postmenopausal ages. Since
nutritional status also influences age at menarche, the
14 effects of caloric intake on the incidence of breast
cancer are mediated not only by obesity but also by age at
15 menarche, a much longer established risk factor for the
disease." As far as you are aware, is that a correct
16 statement?
A. I would say that is a fair statement, yes.
17
Q. "Mention has been made previously of the attempts to
18 adjust the geographic correlations for differences in
marital status, height, weight and age at menarche. As
19 these workers implied (Gray and others, 1979), these were
far from being an accurate adjustment for all known risk
20 factors for breast cancer. Thus, most of the data on
weight concerned young women aged under 30 in the period
21 1950-1973, whereas the majority of the women with breast
cancer in their analyses would have been aged 55-4 around
22 1965. Therefore, they relate to both a different age
group and a different cohort of women. This is of
23 particular importance, as countries differ in their
pattern of weight change with age. In addition, it was
24 not possible to adjust for other risk factors such as age
at first birth, still less for factors for which evidence
25 has emerged more recently, such as high parity." That
means lots of children?
26 A. That is lots of children.
27 Q. "It may be asked whether the geographic correlation",
pausing there -- "lots of children", I mean, would you say
28 to a patient: "Well, don't you worry, if you have lots of
children, you will not get breast cancer"?
29 A. There is nothing in life which is absolute. You can
never ever say to somebody: "You do this and you will
30 either (a) get it or not get it"; you can only advise
people.
