Day 022 - 12 Sep 94 - Page 40


     
     1        A.  No, I think I understand what you are trying to get
     2        at.
     3
     4   MR. JUSTICE BELL:  I did not which is why I am asking
     5        Mr. Morris to put it again.
     6
     7   MR. MORRIS:  I am trying to understand because I do not know
     8        that much about -----
     9
    10   MR. JUSTICE BELL:  Start the question again, Mr. Morris,
    11        please.
    12
    13   MR. MORRIS:  If there are widely different cancer rates in
    14        different countries, and the genetic component of that
    15        cannot be established as great because migration studies
    16        might show people from that country would act differently
    17        in a different environment, then the conclusion has to be
    18        that it is not genetics that is at issue in those
    19        populations with high or low cancer rates?
    20        A.  I think basically what it is it is an interplay
    21        between the two, that there is obviously some genetic
    22        factor there, but it is the interplay of other things.
    23        This is what I was saying, that you get the initiation
    24        where you set the process off, then it comes under
    25        modifying influences which is the promotion and, you are
    26        right, it is this interplay which actually eventually
    27        gives rise to cancer, and almost certainly during the
    28        phase of promotion the process may be reversible.
    29
    30   Q.   By, for example, dietary changes?
    31        A.  It may be, but I do not know that.
    32
    33   Q.   The dietary link may be on the promotional rather than
    34         -----
    35        A.  It may be or it may be on the progression side of
    36        things.  I think we just do not know but most -- well, it
    37        is likely to be at the promotional stage.
    38
    39   Q.   Just a little bit more on the genetic -----
    40
    41   MR. JUSTICE BELL:  So that is the middle of the three stages.
    42        Because of some genetic defect the cell is altered in some
    43        way and then it may be diet, it may be something else ---
    44        A.  Yes.
    45
    46   Q.   -- causes it to advance to disease?
    47        A.  It renders the cell more susceptible, you know,
    48        whatever it is that sets this change off in the gene, that
    49        renders the cell more susceptible to these other
    50        influences which then through time may give rise to a 
    51        cancer cell.  The cell may become truly malignant but that 
    52        process may be reversible. 
    53
    54   Q.   It may affect progression as well?
    55        A.  It may affect progression -----
    56
    57   Q.   As obesity might affect progression?
    58        A.  Yes, and it is probable that these process are
    59        reversible to a degree.  Probably by the time you get to
    60        progression the process is not reversible but promotion is

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