Day 034 - 11 Oct 94 - Page 30


     
     1        A.  Very briefly, I simply want to note Dr. Kinlen's
     2        observations described on page 592, noting again the date
     3        of this report came out in ----.
     4
     5   Q.   Which page is 592?  I see, yes.
     6        A.  There is the title that says, No. 2, Over-nutrition.
     7
     8   Q.   Yes.  It is about four pages into our copies.
     9        A.  Yes.
    10
    11   MS. STEEL:  It is 416 of the bundle of pages.
    12        A.  If I may quote two paragraphs?  Prior to this point
    13        Dr. Kinlen has been saying, has been describing what he
    14        sees as some support but also inconsistencies for
    15        associations between dietary fat and cancer, and he is
    16        about to offer what he believes is a cogent explanation
    17        for that lack of consistency, which, in my reading,
    18        suggests that, in fact, dietary fat is linked in a causal
    19        way with breast cancer and that, in fact, that
    20        is supported by Dr. Kinlen's own comments.
    21
    22        Let me read those two paragraphs.  Under the heading
    23        Over-nutrition on page 592, Dr. Kinlen states:  "There is
    24        a way of resolving the differences between the
    25        international correlational and the individual-based
    26        studies - other than always attributing the negative
    27        findings of the latter to methodological defects - and
    28        which involves postulating no new risk factor for breast
    29        cancer.  The association with fat may be indirect and may
    30        reflect the effects of 'excess calories' and other
    31        fertility-linked risk factors.
    32
    33        There is much evidence for the role of 'overnutrition' in
    34        breast cancer etiology."   Etiology meaning the causation
    35        and origin of cancer.
    36
    37        "... and the more calorigenic nature of fat than either
    38        carbohydrate or protein suggests a connection.  In the
    39        large prospective study by the American Cancer Society" --
    40        he makes a reference there to the source --"a significant
    41        trend in relative risk was found with increases in weight,
    42        as in a smaller study in the Netherlands" -- to which he
    43        also makes reference.  "Case-control studies have also
    44        produced evidence of this effect at postmenopausal ages.
    45        Since nutritional status also influences age at menarche"
    46        -- let me draw the court's attention to his phrasing
    47        here.
    48
    49        He does not say since nutritional status "may influence"
    50        the age at menarche, he says, "Since nutritional status 
    51        also influences age at menarche, the effects of caloric 
    52        intake on the incidence of breast cancer are mediated". 
    53        Again, I would point out, he does not say "may be
    54        mediated", "could be mediated" or "suspected" of being
    55        mediated, but simply the effects of caloric intake on the
    56        incidence of breast cancer are mediated "not only by
    57        obesity but also by age at menarche, a much longer
    58        established risk factor for the disease."
    59
    60        So he is in agreement with what we have read from

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