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
