Day 256 - 04 Jun 96 - Page 54
1 you can see some quite significant associations being
2 noted. Then there is a third way of adjusting for various
3 and sundry things in each case, and some of that
4 disappears. Some of that relative risk previously seen
5 tends to disappear, so then of course what are the
6 adjustments for to cause those low numbers suddenly to
7 appear, and if we examine that a little more closely, you
8 can see that there is an adjustment for example for energy
9 intake, this is note E, and some non-dietary risk factors
10 in Shanghai and Tianjin as listed above, and if we go and
11 examine what were those things we are were adjusting for.
12
13 MR. JUSTICE BELL: The C for Shanghai, the D for Tianjin, and
14 the E in the total are all the same, are not they?
15 A. I am not sure. Not quite the same but similar, not
16 quite the same.
17
18 Q. They are very ----
19 A. They are very similar.
20
21 Q. They are not exactly the same but they are very similar;
22 are they not?
23 A. They are. You are correct.
24
25 Q. I mean, C and D are not the same but they are quite
26 similar.
27
28 MR. RAMPTON: They are quite similar.
29
30 MR. JUSTICE BELL: And then E is all of them for whichever city.
31 Yes, I see.
32 A. One of the things they are adjusting for, or 2 or 3,
33 are those things that actually do have a rather significant
34 relationship with dietary fat intake, age at menarche, and
35 the things we discussed before, and so ----
36
37 MR. RAMPTON: Well, they may do, Professor, I grant you but, in
38 any event, that is an indirect route, is it not, an
39 indirect route you have to get past as with your passage
40 early about plasma cholesterol. You say there is a
41 correlation between intake of fat and serum cholesterol
42 levels and then a further correlation between that and the
43 cancer; is that right?
44 A. Right.
45
46 Q. Equally here, with age of menarche, you have got to get to
47 that before the age of menarche leads on perhaps to an
48 increased risk of cancer if it is early; is that right?
49 A. What really happens in that particular case is that a
50 child consuming a certain kind of diet tends to consume the
51 same kind of diet more or less the rest of theirs lives in
52 most cases. So, a child that is raised on a higher fat
53 diet, a diet higher in animal products grows faster,
54 slightly faster, often times incidentally immeasurable but
55 nonetheless reach age of menarche earlier. They stay on
56 that diet. As a result, they sustain higher levels, in
57 women at least, of oestrogen. So all of sudden you have
58 all these things coming into play that subsequently, when
59 examined, appear to have these independent effects on the
60 cancer risk but, nonetheless, they can all be placed with
