Day 034 - 11 Oct 94 - Page 23


     
     1        thought that both seemed to have an effect.
     2
     3        "A series of case-control studies reveals the higher risk
     4        of breast cancer with the increase in body size especially
     5        in postmenopausal women".  We have had some comments about
     6        the association and, I believe, in Dr. Kinlen's report
     7        that was read in Dr. Arnott's testimony, obesity was
     8        considered an established risk factor for breast cancer.
     9        We see that this was known back in 1978, or at least
    10        suspected.
    11
    12   MR. JUSTICE BELL:  They distinguish between an increase in body
    13        size and obesity, do they not?
    14        A.  Yes.
    15
    16   Q.   Increase in body size may involve obesity but not
    17        necessarily at all?
    18        A.  That is quite right.  He finishes by saying:  "The
    19        recent breast cancer increase could therefore be a
    20        reflection of the fact that women in Japan are becoming
    21        heavier, especially after age 30".  Rather like the
    22        Surgeon General's report which appeared a decade after
    23        this study, the researcher is pointing out that they are
    24        finding associations between fat and cancer, particularly,
    25        in this case, meat intake, not specifically fat, but meat
    26        intake, with some reference to pork and to animal fat as
    27        well as to body size.  But what is in doubt was the
    28        mechanisms by which the animal fat operates.  Is it a
    29        direct effect or is it in some way mediated by obesity?
    30
    31        Perhaps this is important because as consideration is
    32        given to the use of the word "link" in the leaflet, the
    33        researchers have been seen to suggest that there are
    34        links, that those links appear to be causal in nature, and
    35        if the word "link" means "suspected to contribute to" that
    36        was true, apparently, as far back as 1978.  What was in
    37        doubt then, and is still a matter of discussion today, is
    38        precisely what those mechanisms are and what the relative
    39        importance is of multiple mechanisms, all of which seem to
    40        be at work simultaneously.
    41
    42        I have no further comments on this report.
    43
    44   Q.   When they talk of "the increase in body size", is that an
    45        average?
    46        A.  Yes, I believe it is.
    47
    48   Q.   The reason I ask that is, you can have a significant
    49        increase in body size if a large proportion of the
    50        population were not much bigger but a significant minority 
    51        had become obese, could you not? 
    52        A.  Yes, you certainly could. 
    53
    54   Q.   So the increase in body size here is an average which may
    55        signify that Japanese women had a tendency to be larger in
    56        size and may also signify that a greater proportion of
    57        them were obese than had been in the past?
    58        A.  Yes, my Lord.  There is substantial literature that
    59        might shed some light on that question which I have not
    60        brought with me, but if I might summarise it in a couple

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