Day 034 - 11 Oct 94 - Page 32


     
     1
     2        Again, not to labour the obvious, but there are no
     3        qualifiers in that declarative sentence. "Age at menarche
     4        is a well established risk factor for breast cancer and
     5        later menarche (and consequently lower risk like height)
     6        can reflect caloric restriction during the years of
     7        growth".  He is much briefer in this than in his earlier
     8        paper, but the comments are resonant with it entirely.
     9
    10        Flipping to page 466, so far we have talked about menarche
    11        in relation to the Kinlen study.  Here he talks about the
    12        other causal link with fat which he feels is important,
    13        and that is the fact that fat encourages obesity, that
    14        obesity is a risk factor for cancer.
    15
    16   MR. MORRIS:  Which part of that sentence?
    17
    18   MR. JUSTICE BELL:  Which page are you on?
    19        A.  I am now moving to page 466.
    20
    21   MR. MORRIS:  It is the next page in the document.
    22        A.  This is the next page, the very beginning of that
    23        page, the first complete sentence starting with the words
    24        "In contrast to".  Simply to put this in context ----.
    25
    26   Q.   Do you want to read it out?
    27        A.  Yes.  "In contrast to the findings at pre-menopausal
    28        ages, post-menopausal breast cancer has shown a positive
    29        relationship with body weight in nearly all the (more than
    30        20) studies of the subject.  This is probably an oestrogen
    31        effect since androstenedione is converted in adipose
    32        tissue to oestrone".  Dr. Kinlen is simply pointing out
    33        that studies have consistently shown that for
    34        postmenopausal breast cancer obesity is a risk factor.  He
    35        also offers a mechanism that links those in a causal way,
    36        that adipose tissue (meaning fat tissue) converts
    37        androstenedione, which is a hormone produced in the body,
    38        to oestrone and oestrogen; so that the high fat diet
    39        which, without doubt, encourages the growth of adipose
    40        tissue, encourages fat tissue and also then encourages the
    41        production of the oestrogen oestrone.
    42
    43        Dr. Kinlen is using these in his two papers to try to
    44        explain the fact that fat is, indeed, linked to breast
    45        cancer and that those links are causal in nature, but they
    46        are simply not direct where fat has some effect
    47        immediately elevating breast cancer risk.
    48
    49        In my reading of both studies, I am impressed by the fact
    50        that Dr. Kinlen seems to accept the links and to accept 
    51        them as being causal, that the preponderance of evidence 
    52        strongly suggests that dietary fat exerts its effect on 
    53        breast cancer risk in two ways, perhaps by lowering the
    54        age of menarche and by aggravating obesity.
    55
    56        I have no further comments on that except to note its
    57        date, 1991.
    58
    59   Q.   You have next on your list that you gave us one of the
    60        miscellaneous supplementary lists.  Then you have No. 42

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