Day 033 - 10 Oct 94 - Page 29


     
     1   MR. MORRIS:  If we can move on to -- I believe you have touched
     2        upon the dietary fat and survival of patients diagnosed
     3        with cancer?
     4        A.  Yes, I think we have covered that.  Perhaps just one
     5        thing might be worth mentioning.  For survival of
     6        patients, obesity also can reduce survival in breast
     7        cancer.  A diet that is high in fat promotes obesity,
     8        partly because it is high in calories typically but also
     9        through other mechanisms.  So, a high fat diet can
    10        indirectly reduce survival of cancer patients.
    11
    12        The importance of this is not restricted to those
    13        individuals who have already been diagnosed with cancer,
    14        because cancer that arises on any particular day or week
    15        or month is not likely to be diagnosed, for example, on
    16        mammography, for eight to ten years.  In other words, any
    17        factor that affects survival of cancer patients is
    18        important not only to those individuals who are carrying a
    19        diagnosis of cancer, but for other individuals as well,
    20        because it takes eight to ten years for a cancer to grow,
    21        a breast cancer to grow, before it is visible on
    22        mammography or palpable on examination.
    23
    24        When I say that a high fat diet impairs survival, I would
    25        just caution against assuming that that is only important
    26        for those individuals who are going to a clinic for cancer
    27        treatment.  This is important for everyone, because a
    28        great many people have cancer cells now and they are not
    29        yet diagnosed with cancer.  If their diet is higher in
    30        fat, they are more likely to come to a cancer diagnosis,
    31        we presume, and almost certainly more likely to die of
    32        that cancer.  If their diet is quite low in fat their
    33        course will be improved, according to a variety of
    34        research studies.  That is partly, but not solely, because
    35        of the tendency of fat to cause obesity.
    36
    37   Q.   I seem to have read somewhere -- I can be corrected if I
    38        am wrong -- that in Britain something like 160,000 people
    39        develop cancers each year.  Presumably, in America that
    40        would be a far greater figure.  Do you happen to know?
    41        A.  Cancer is our second leading cause of death; one in
    42        three Americans develops cancer at some point in their
    43        lives.  So, it is a very substantial cause of death.
    44
    45   Q.   So we are talking about 70 million people, or something
    46        like that, in America develop cancer in their lives?
    47        A.  Well, at some point in their life, assuming that they
    48        live to a full life; yes, that is correct.
    49
    50   Q.   So at any one time, assuming that cancer developed over a 
    51        period of ten, 20 years -- I cannot remember the figures, 
    52        but they are very substantial. 
    53
    54   MR. JUSTICE BELL:  I am not sure you can do the figures from
    55        what you have been told.  The 70 million is over a
    56        lifetime period?
    57        A.  I did not mean to imply that everyone who is going to
    58        die of cancer has cancer yet started.  It begins at
    59        different times in different individuals.  All I was
    60        trying to say, with regard to the evidence that we have on

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