Day 034 - 11 Oct 94 - Page 37


     
     1        I have no other comments to make.
     2
     3   MR. JUSTICE BELL:  Let me have a look at the ----
     4        A.  The tabs indicate the pages that I was reading.
     5
     6   MR. JUSTICE BELL:  Thank you.
     7
     8   MR. MORRIS:  Could I have a quick look before I hand that to
     9        Mr. Rampton?  (Handed)  Then we come on to ----
    10        A.  May I make one brief summary sentence about this since
    11        we are moving on to a different topic with a final
    12        reference -- it will be very brief.  When we started this
    13        morning, looking at the Surgeon General's report, we noted
    14        that there is an overall association between fat and
    15        breast cancer reported in many, many studies, although not
    16        all.
    17
    18        We noted that the Surgeon General took this combined
    19        evidence along with animal studies to suggest that there
    20        is substantial evidence that dietary fat indeed may play a
    21        causative role.  What these other references have
    22        attempted to show is that the mechanisms by which they
    23        operate are already established and, in fact, are
    24        established in the Plaintiffs' documents (which I found
    25        very helpful), that an earlier age of menarche increases
    26        the risk of breast cancer; a higher fat diet increases
    27        oestrogen levels; a high fibre diet reduces oestrogen
    28        levels and can increase the age of menarche by protecting
    29        against breast cancer.  The second mechanism is that high
    30        fat diets increase body weight and also increase the risk
    31        of obesity, both of which are established risk factors for
    32        breast cancer.  So the mechanisms are clearly established,
    33        well accepted, and were somewhere in the 1980s.  Anyway,
    34        forgive me for being long winded with that.
    35
    36   Q.   If we move on to No. 42 in the Barnard references, which
    37        is entitled:  Meat, Cooking Methods and Colorectal Cancer:
    38        A Case-reference Study in Stockholm, Maria Gerhardsson.
    39        Would you like to -----
    40        A.  Yes.  The point I would like to refer to here is on
    41        page 524 which, I believe, is the fifth page of that
    42        document.  Midway down the left-hand column is a paragraph
    43        that starts with the words, "Fat tends to increase".
    44        I would like to read those two paragraphs which go to the
    45        question of heating meat and causing carcinogens to form
    46        on its surface and when that was known:
    47
    48        "Fat tends to increase frying temperature and results in
    49        increased production of mutagens during cooking".
    50        Mutagens are chemical substances -- M-U-T-A-G-E-N-S -- 
    51        which can damage DNA and can lead in some cases to 
    52        cancer:  "Therefore, even though adjusting for fat intake 
    53        reduced the associations between a heavily browned meat
    54        surface and colorectal cancer, it could be argued that it
    55        is inappropriate to adjust these associations for fat
    56        since this may adjust for the formation of the very
    57        mutagens that are the exposure of interest."
    58
    59        These comments are mainly suggesting that he is talking
    60        about statistics that he has adjusted in reporting his

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