Day 254 - 22 May 96 - Page 52
1 and dietary". Would you agree with that?
2 A. I think that one thing that is becoming clear in recent
3 years is how important the genetic aspects may be.
4
5 Q. But you agree with the statement there: "The major risk
6 factors for colorectal cancer are genetic and dietary"?
7 A. Yes.
8
9 Q. Then in the conclusions about colorectal cancer on page 21:
10
11 "Although it is likely that dietary intervention will be
12 justified for the prevention of colorectal cancer, the
13 nature of that intervention is not yet clear. It is likely
14 to feature a low intake of saturated fat and high intakes
15 of cereal, fibre, fruit and vegetables."
16
17 Would you agree with that?
18 A. I would have to say that that is his summary of the
19 evidence and I think again he is using the word "likely"
20 very carefully in that we all believe that it seems logical
21 that there is a relationship perceived between some aspects
22 of our diet and the development of colorectal cancer, but
23 exactly what that relationship is, I think remains unclear,
24 and, as I say, there is a growing feeling that genetic
25 aspects may be more important than we have believed in the
26 past. What the problem is is relating diet to the genetic
27 aspects.
28
29 Q. Yes. We probably cannot modify our genes very much but we
30 modify our diets. His conclusion is basically that the
31 evidence is pointing that the sort of protective diet is
32 going to feature a low intake of saturated fat and high
33 intakes of cereal, fibre, fruit and vegetables; yes?
34 A. That is what he is saying.
35
36 Q. Right. Can I just ask about page 9 of your statement, the
37 first paragraph about, "attempts to modify the development
38 of adenomas and carcinomas in patients by direct
39 modifications of diet". Would you agree that -- I presume
40 you based this on what we have been discussing this
41 morning, that, by that stage, it may be too late?
42 A. No, not necessarily so because there is what we call
43 the "adenoma carcinoma sequence", and it is believed that
44 in many instances, the development of an adenoma precedes
45 the development of a carcinoma.
46
47 Q. The point I am putting is just that. You said that those
48 which have included fibre supplements have not been
49 noticeably successful. You have not said what happened to
50 the other studies that were evaluated, but even in if the
51 dietary modifications have not been successful in stopping
52 the further development of adenomas and carcinomas, that
53 would not mean it is not going to work as a preventative
54 measure in the first place before they arrive?
55 A. No. What these studies have tried to do is to look at
56 the development of adenomas in the population, so they are
57 in fact measuring the development of adenomas.
58
59 MR. JUSTICE BELL: I think all you are being asked about that
60 paragraph is that it specifically deals with the
