Day 034 - 11 Oct 94 - Page 31
1 Dr. Gregorio, that hormonal factors not "may cause" breast
2 cancer but do, that an earlier age at menarche is
3 associated or does -- is, in his words, an established
4 risk factor for the disease. He then states that the --
5 he also has stated that the nutritional status influences,
6 in a declarative sentence, the age at menarche; that
7 caloric intake on the incidence of breast cancer -- "the
8 effects of caloric intake on the incidence of breast
9 cancer are mediated not only by obesity but also by age at
10 menarche".
11
12 Forgive my laboured interpretation of this, but what I am
13 trying to point out is that if a central question in the
14 case is the nature of the association, is this in some way
15 causal, are these links -- can they be properly
16 characterised by the fact that dietary fat is at least
17 suspected as contributing for a cancer, I would suggest
18 that in the evidence that the Plaintiffs have brought (and
19 which was in existence in 1987) these links, which were
20 causal in nature, were already accepted and already well
21 known.
22
23 Let me, perhaps, digress for one moment to make a couple
24 of comments about elementary physiology.
25
26 MR. JUSTICE BELL: Yes.
27 A. A gramme of fat, simply to review something very
28 basic, a gramme of fat has nine calories. A gramme of
29 carbohydrate or of protein has only four calories, which
30 is the reason why it has been well known and long
31 established that high fat diets encourage obesity, and is
32 what Dr. Kinlen is referring to when he states that the
33 effects -- or it is very important, when one looks at the
34 discussion regarding caloric intake, high fat foods are,
35 by their very nature, much more calorie dense, higher in
36 calories on a per weight basis, than high carbohydrate
37 foods or high protein foods. There is simply no way
38 around that.
39
40 I have no further comments on that study, simply to
41 emphasise that these causal associations were already
42 known and already accepted at that time and, in fact,
43 offered into evidence by the Plaintiffs. Can I turn then
44 to Kinlen's other study?
45
46 MR. JUSTICE BELL: Certainly, if that is what you want to say
47 in relation to 87, so go back to 7 then. That is the 91
48 one.
49 A. Thank you, my Lord. In 1991, to look at Kinlen's
50 study to see whether he back tracks or contradicts himself
51 on whether or not menarche is an established risk factor
52 or whether caloric intake can affect it, if we look on
53 page 465 ----
54
55 MR. MORRIS: Which is page 406 in the bundle.
56 A. This is Kinlen's 1991 Study on Diet and Breast
57 Cancer. About two thirds of the way down the page is the
58 subtitle "Menarche", where Dr. Kinlen makes the statement:
59 "Age at menarche is a well established risk factor for
60 breast cancer".
