Day 035 - 12 Oct 94 - Page 45


     
     1
     2   Q.   No, I agree; it probably is not.
     3        A.  Because, well, when one looks at studies and one looks
     4        at the power of dietary recommendations, one is looking at
     5        the effect overall of fibre, fat and deficiencies in
     6        vitamins and minerals or their supplementation.  The
     7        degree to which those factors collectively might influence
     8        the risk of breast cancer has been described in various
     9        terms, but it is quite large, certainly much more than
    10        threefold, because that is the type of difference that one
    11        sees in international variations.
    12
    13   Q.   Again, I am afraid, a slight red herring:  Can I take it
    14        from something you have said earlier, Dr. Barnard, that
    15        you would accept at least the possibility that a diet
    16        which is high in fat but also high in the right kind of
    17        fibre may be perfectly satisfactory from the point of view
    18        of being protective against the risks of colon cancer?
    19        A.  No, that is not what I suggested.  I would say that
    20        fibre is protective.  However, that is not to say that it
    21        can totally undo the effects of a high-fat diet.
    22
    23   Q.   May we read on with -- we will come back to that question
    24        later -- Dr. Willett?
    25        A.  Please.
    26
    27   Q.   "Other data suggest that having a large number of children
    28        also independently reduces the risk.  The protective
    29        effect of early first full-term pregnancy may be due to a
    30        permanent differentiation of mammary stem cells, resulting
    31        in a reduced lifetime risk of breast cancer."   Do you
    32        accept that as what I call a respectable hypothesis?
    33        A.  I do not see it as being offered as a hypothesis
    34        necessarily; it is offered as a suggestion and a
    35        possibility and in that sense it is respectable, yes.
    36
    37   Q.   "Many studies show an association between early age at
    38        menarche and increased risk of breast cancer; typically
    39        early menarche confers about a 1.5-2 fold increase in risk
    40        compared with late menarche."   One notices there the 1.5
    41        to twofold increase.  To what extent, in your view,
    42        Dr. Barnard, is early menarche a function of diet and diet
    43        alone?
    44        A.  To what extent?
    45
    46   Q.   Yes.
    47        A.  Well, dietary factors do influence the age of menarche
    48        and the degree in change, the total change in the number,
    49        simply the number of years between the high end of
    50        menarche and the low end of menarche, if we look 
    51        internationally and across all different diets, is about 
    52        four and a half years.  One would presume that the maximal 
    53        affect that a diet could have on the age of menarche, say,
    54        from the highest fat/lowest fibre diet to the reverse
    55        might be about a five year difference in the age of
    56        menarche.
    57
    58   Q.   "Early menopause provides protection, removal of both
    59        ovaries before the age of 35 reduces the risk of disease
    60        by about 0.6 compared with natural menopause.  These

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