Day 034 - 11 Oct 94 - Page 13


     
     1        But I raise it because these data, as reported here, were
     2        sufficient to convince the Surgeon General, in his words
     3        referred to on page 194:  "Despite some inconsistencies in
     4        the data relating dietary fat to cancer causation, animal
     5        studies show an effect on carcinogenesis and support a
     6        cancer-promoting role, and international epidemiologic
     7        studies have suggested that differences in dietary fat
     8        intake may provide a meaningful key to prevention of
     9        cancer".  As he said, strongly suggestive of the role for
    10        dietary fat in the etiology of some types of cancer.
    11
    12   MR. JUSTICE BELL:  Where is 4-7 referred to in the report?
    13        A.  It is referred to in paragraph 3 on page 194.
    14
    15   MR. MORRIS:  So, what is your conclusion from analysing this
    16        chart, 4-7?
    17        A.  When one looks at the overall data one has to agree
    18        with the Surgeon General that the links -- to characterise
    19        the links here, or the associations, dietary fat must be
    20        suspected of contributing to breast cancer risk.  The word
    21        "link", I know, is one that has been tossed around a
    22        great deal.  "Link" obviously does not mean "clearly
    23        causes".  "Link" also does not mean simply a random
    24        association.
    25
    26        In my mind, as a person who reads research reports and
    27        sees the word "link" quite frequently used in this
    28        context, the word "link" means something along the lines
    29        of "suspected of contributing to", although perhaps it
    30        means other things to other writers.  But, as I review
    31        these data, it is quite clear that dietary fat must be
    32        suspected of contributing in a significant and substantial
    33        way to the risk of breast cancer.
    34
    35   MR. JUSTICE BELL:  I am not sure how much issue there is about
    36        that last statement.  It is whether it may be important,
    37        whether it goes further than that.
    38
    39   MR. MORRIS:  This is just from this chart.
    40        A.  That is correct.
    41
    42   Q.   Whereas you are saying the link through obesity and
    43        through age of menarche, and all the other things you
    44        said, and, presumably, the animal studies which the
    45        Surgeon General also looks at?
    46        A.  Yes.
    47
    48   MR. JUSTICE BELL:  You were going to go on to those, were you
    49        not?
    50        A.  Yes.  By 1988 that link was clearly described. 
    51        I recognise that that word is a sensitive word.  But by 
    52        1988 the references to causation were already being made 
    53        several times in the introductory paragraphs where the
    54        Surgeon General says that again studies to date are
    55        "strongly suggestive of the role for dietary fat in the
    56        etiology of some types of cancer".  What he is referring
    57        to earlier in that paragraph started out as breast was
    58        No. 1, colon was No. 2.
    59
    60        So, again this does not mean that cause and effect has

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