Day 035 - 12 Oct 94 - Page 56


     
     1        A.  There was one point here that struck me as perhaps of
     2        interest and that was on page 51, the top, this is near
     3        where you asked me to begin reading and it caught my
     4        attention, the top paragraph is marked 3.5.4.1.
     5
     6   Q.   Yes?
     7        A.  In the middle way down, it says:  "There is an
     8        increased risk of post-menopausal breast cancer with
     9        obesity."   Then they say that possibly the reason has to
    10        do with oestrone production by adipose tissue.  I simply
    11        thought it was noteworthy that they said there is an
    12        increased risk, rather than "there may be" and "could be"
    13        and so forth.  I appreciated you are drawing that to my
    14        attention.
    15
    16   Q.   If you thought that was disputed on this side, it is not.
    17        It has already been given in evidence by our expert
    18        witnesses that, indeed, there is an increased risk in
    19        post-menopausal women who are obese; that is common
    20        ground.
    21
    22        Close that Grey Book, not forgetting that is 1991, and can
    23        we go back to Dr. Willett in 1990.  I think I had stopped
    24        at, if I did not I will read it again, about a third of
    25        the way down, the last paragraph on page 389 where you see
    26        Key and Pike at the end of the line?
    27        A.  Yes.
    28
    29   Q.   Do you have that?
    30        A.  Yes, I think so.
    31
    32   Q.   "Key and Pike concluded in a recent review that the data
    33        overall suggest a promoting effect of oestrogens and
    34        possibly also of progestagins.  For our enlightenment,
    35        what are "progestagins"?
    36        A.  The word comes from the word progesterone which unlike
    37        estrogens which is a group name of a variety of hormones,
    38        the principal ones are estrodiol estron and estriol,
    39        progesterone is a single hormone.  It is produced by the
    40        ovary.  Some writers use a very loose term which takes a
    41        variety of forms; sometimes progestin or progestogen.  The
    42        provice definition seems to vary from one author to
    43        another, but they usually seem to mean synthetic near
    44        copies of progesterone manufactured by pharmaceutical
    45        companies, and in some cases they include natural
    46        physiologic progesterone in that category.
    47
    48   Q.   You say "manufactured by pharmaceutical companies" would
    49        one find them in the contraceptive pill or something like
    50        that? 
    51        A.  Yes, you most likely would. 
    52 
    53   Q.   Please turn on to page 390 where Dr. Willett writes about
    54        risk factors for colon.  He has mentioned other factors
    55        for breast cancer.  He is talking about oral
    56        contraceptive, and so on, and radiation.  I do not want to
    57        read about those.
    58        "Risk factors for Colon Cancer.  Few specific risk factors
    59        for colon cancer have been established.  Inflammatory
    60        bowel diseases, such as ulcerative colitis and Crohn's

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