Day 017 - 25 Jul 94 - Page 43


     
     1        twenty or thirty years, the incidence of breast cancer has
              increased by some forty per cent over the same period?
     2        A.  Yes, that is quite correct.
 
     3   Q.   Can we pass then, please, to cancers of the colon and the
              rectum?  Can we start, please, with a relatively old piece
     4        of work, which is at tab 25 of your orange bundle, which
              is a piece of population study I believe it to be,
     5        conducted by Reddy and others, including Wynder, and on
              this occasion we see that Reddy comes before Wynder.  It
     6        was published in 1978.  I will read the abstract at the
              beginning:
     7
              "Dietary pattern feed and constituents of two populations
     8        with distinct risk in the development of colon cancer.  A
              high risk population in New York Metropolitan area and a
     9        low risk population in rural Kuopio were studied.  The
              average daily intake of dietary fat and protein was the
    10        same in the two groups, but the sources of fat were
              different, a greater proportion coming from dairy products
    11        in rural Kuopio and meat from the New York Metropolitan
              area".
    12
              Pausing there, has at this time (July 1994) any
    13        distinction been made between fats derived from dairy
              products such as butter, milk and cream, and fats derived
    14        from meat, so far as your field is concerned?
              A.  People have looked at various components of fat
    15        intake, but I would say again that the evidence for one
              fat or another being particularly important is
    16        controversial.  I think that they looked at these two
              groups of people because they felt they could consider the
    17        fat essentially to be the same.
 
    18   Q.   The abstract goes on:  "Not only the frequency of bowel
              movements was higher but also the daily total stool output
    19         ... (reading to the words)... fibre excretion was greater
              in Kuopio compared with New York due to high dietary
    20        intake in rural Kuopio ... (reading to the words) ....
              was lower in rural Kuopio but the total daily excretion of
    21        these constituents was the same in two populations. The
              daily fecal excretion of bacterial nuclear dehydrogenised
    22        activity and of neutrol sterols was higher in rural Kuopio
              and the concentration of these constituents was the same
    23        in the two groups.
 
    24        The high daily excretion of cholesterol metabolites in
              Kuopio might be due to high dietary intake of dairy
    25        products.  The data suggests that one of the factors
              contributing to the low risk of large bowel cancer in 
    26        Finland, in spite of high dietary intake, appears to be 
              the fact that a high dietary fibre leads to an increase in 
    27        stool bulk, thus diluting bile acids which have promoting
              activity".
    28
              A preliminary question, Dr. Arnott, then another
    29        question.  Looked at at the present day, how do you react
              to the proposition that bile acids have a cancer promoting
    30        activity?
              A.  There is experimental evidence from animals ----

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