Day 017 - 25 Jul 94 - Page 31


     
     1        rather than necessarily dietary related.
 
     2   Q.   Then we go on to Overnutrition:  "There is a way resolving
              the differences between the international correlational
     3        and the individual-based studies - other than always
              attributing the negative findings of the latter to
     4        methodological defects - and which involves postulating no
              new risk factor for breast cancer. The associations with
     5        fat may be indirect and may reflect the effects of 'excess
              calories' and other fertility-linked risk factors".
     6
              Dr. Arnott, I suppose, you would that agree animal fat is
     7        a ready source of energy, of calories?
              A.  Yes, indeed.  I mean, weight for weight, fat is the
     8        greatest source or a readily available source of energy.
 
     9   Q.   "There is much evidence for role of 'overnutrition' in
              breast cancer aetiology, and the more calorigenic nature
    10        of fat than either carbohydrate or protein suggests a
              connection. In the large prospective study by the American
    11        Cancer Society (Lew and Farfinkel, 1979), a significant
              trend in relative risk was found with increases in weight,
    12        as in a smaller study in the Netherlands (De Waard and
              Baanders, 1974).  Case-control studies have also produced
    13        evidence of this effect at postmenopausal ages.  Since
              nutritional status also influences age at menarche, the
    14        effects of caloric intake on the incidence of breast
              cancer are mediated not only by obesity but also by age at
    15        menarche, a much longer established risk factor for the
              disease."  As far as you are aware, is that a correct
    16        statement?
              A.  I would say that is a fair statement, yes.
    17
         Q.   "Mention has been made previously of the attempts to
    18        adjust the geographic correlations for differences in
              marital status, height, weight and age at menarche.  As
    19        these workers implied (Gray and others, 1979), these were
              far   from being an accurate adjustment for all known risk
    20        factors for breast cancer.  Thus, most of the data on
              weight concerned young women aged under 30 in the period
    21        1950-1973, whereas the majority of the women with breast
              cancer in their analyses would have been aged 55-4 around
    22        1965.  Therefore, they relate to both a different age
              group and a different cohort of women.  This is of
    23        particular importance, as countries differ in their
              pattern of weight change with age.  In addition, it was
    24        not possible to adjust for other risk factors such as age
              at first birth, still less for factors for which evidence
    25        has emerged more recently, such as high parity."  That
              means lots of children? 
    26        A.  That is lots of children. 
  
    27   Q.   "It may be asked whether the geographic correlation",
              pausing there -- "lots of children", I mean, would you say
    28        to a patient:  "Well, don't you worry, if you have lots of
              children, you will not get breast cancer"?
    29        A.  There is nothing in life which is absolute.  You can
              never ever say to somebody:  "You do this and you will
    30        either (a) get it or not get it"; you can only advise
              people.

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