Day 256 - 04 Jun 96 - Page 61
1 and breast, three of the four most common types around the
2 world, is suggested by many laboratory experiments and
3 hinted at by such epidemiological observations as the
4 positive correlation in different populations between the
5 incidence of cancers of the breast and large bowel and the
6 consumption of fat, the negative correlation between the
7 incidence of cancer of the large bowel and the consumption
8 of fibre and the resistance of starch and the negative
9 association between the incidence of gastric cancer and the
10 consumption of fresh fruit and green vegetables. The
11 evidence is however inconclusive. In so far as it varies
12 in strength, the strongest is that obtained from studies of
13 individuals which have suggested that the consumption of
14 fruit and green vegetables diminishes the risk of cancer of
15 stomach and that the consumption of large amounts of beta
16 carotene similarly protects against a wide range of
17 cancers, and the weakest is that relating to the role of
18 fat in the causation of cancer of the breast and to a
19 broadly protective effect of selenium and vitamin E."
20
21 Is there anything that I have so far read -- this is
22 written in 1988 -- which you would, in 1996, disagree with?
23 A. Yes, I would say it rather differently on a couple of
24 points. He points out that consumption of large amounts of
25 beta carotene similarly protect against a wide range of
26 cancers. He should have said -- in fact, it was actually
27 said before that; in fact, he himself said that -- that
28 beta carotene from foods, not beta carotene from
29 supplements. That is one point -- not dealing with our
30 issue here. But the second part of that sentence, where it
31 says "and the weakest is that relating to the role of fat
32 in the causation of cancer of the breast"; of course, in
33 1988, he was referring to the first four year report at
34 that time of the Nurses Health Study, as well as a few
35 other case controlled studies, because that is all that
36 were available at that time. Since that time, we now have
37 the eight year report of the Nurses Health Study; we also
38 have of course the China data and many other studies; and
39 so there is more, we have more information than was
40 available to Sir Richard at that time.
41
42 Q. Well, I am interested to hear you say that, because we
43 looked this morning only at a pooled analysis of seven of
44 those major cohort or prospective studies, did we not,
45 including the Nurses Health Study; and they are the seven
46 biggest that have probably ever been done on this topic,
47 are they not?
48 A. Yes.
49
50 Q. They produced no evidence of an association between the
51 ingestion of dietary fat and breast cancer; that is right,
52 is it not?
53 A. Right.
54
55 Q. So how is there a consensus (as you put it) that fat is
56 causative, dietary fat is causative of breast cancer?
57 A. That is one report that you just referred to, of
58 course. There are seven cohort studies. They are --
59 actually, there is one other piece of evidence I am really
60 not allowed to speak to here, quite frankly. It has to do
