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
