Day 035 - 12 Oct 94 - Page 44
1 If that be right, if that be right -- I have repeatedly
2 used the word "if", you will notice, Dr. Barnard -- if
3 that be right, that makes a very significant impact, does
4 it not, on any attempt to extract a causal relationship
5 from the epidemiological evidence about diet and breast
6 cancer?
7 A. Could I ask you to repeat the question?
8
9 Q. If it be right, that age of first parity ---
10 A. Right.
11
12 Q. -- is important and that a first birth after the age of 35
13 years increased the risk about threefold compared with a
14 first birth before the age of 20 -- I do not know what
15 proportion of American women have children before the age
16 of 20 -- that might make a serious dent in any theory
17 based upon the epidemiology of diet and breast cancer,
18 might it not?
19 A. That is a factor that should be taken into account.
20
21 Q. It certainly should, should it not, because it is nothing
22 to do with diet, that, is it, not at least directly; it is
23 a social factor?
24 A. Well, it does have the relation to diet which we have
25 discussed in that diet affects the age at which fertility
26 is possible.
27
28 Q. What is proposed here is not that having a child after the
29 age of 35 is dangerous, but that you reduce the risk if
30 you have your children before the age of 20. That is what
31 is suggested, is it not?
32
33 MR. JUSTICE BELL: You are not being asked at the moment to
34 accept what is said is true, but assume it is true, and
35 then you are being asked about the conclusion or one of
36 the conclusions you might draw from that.
37 A. Yes. What is being said here is that if the first
38 birth occurs after 35, that increases the risk or is
39 associated with ---
40
41 MR. RAMPTON: Yes, but not, if I may suggest ----
42 A. -- an increased risk.
43
44 Q. -- Dr. Barnard, because it is an increasing risk factor
45 after the age 35, it is because if you do not start until
46 35, you have denied yourself the chance of decreasing the
47 risk. That is what that sentence says?
48 A. It does say that if the first birth occurs after 35,
49 in those women there is a higher risk of breast cancer
50 compared to those who have their first birth at 20.
51
52 Q. Whatever its precise meaning, the figure suggested is very
53 striking, is it not?
54 A. Yes.
55
56 Q. A threefold increase in risk. What fold of increase in
57 risk, what multiplier of risk, do you impress upon your
58 thesis about diet and breast cancer, high-fat diet -- let
59 us leave fibre out of it for the moment?
60 A. I do not know if that is a reasonable question.
