Day 034 - 11 Oct 94 - Page 32
1
2 Again, not to labour the obvious, but there are no
3 qualifiers in that declarative sentence. "Age at menarche
4 is a well established risk factor for breast cancer and
5 later menarche (and consequently lower risk like height)
6 can reflect caloric restriction during the years of
7 growth". He is much briefer in this than in his earlier
8 paper, but the comments are resonant with it entirely.
9
10 Flipping to page 466, so far we have talked about menarche
11 in relation to the Kinlen study. Here he talks about the
12 other causal link with fat which he feels is important,
13 and that is the fact that fat encourages obesity, that
14 obesity is a risk factor for cancer.
15
16 MR. MORRIS: Which part of that sentence?
17
18 MR. JUSTICE BELL: Which page are you on?
19 A. I am now moving to page 466.
20
21 MR. MORRIS: It is the next page in the document.
22 A. This is the next page, the very beginning of that
23 page, the first complete sentence starting with the words
24 "In contrast to". Simply to put this in context ----.
25
26 Q. Do you want to read it out?
27 A. Yes. "In contrast to the findings at pre-menopausal
28 ages, post-menopausal breast cancer has shown a positive
29 relationship with body weight in nearly all the (more than
30 20) studies of the subject. This is probably an oestrogen
31 effect since androstenedione is converted in adipose
32 tissue to oestrone". Dr. Kinlen is simply pointing out
33 that studies have consistently shown that for
34 postmenopausal breast cancer obesity is a risk factor. He
35 also offers a mechanism that links those in a causal way,
36 that adipose tissue (meaning fat tissue) converts
37 androstenedione, which is a hormone produced in the body,
38 to oestrone and oestrogen; so that the high fat diet
39 which, without doubt, encourages the growth of adipose
40 tissue, encourages fat tissue and also then encourages the
41 production of the oestrogen oestrone.
42
43 Dr. Kinlen is using these in his two papers to try to
44 explain the fact that fat is, indeed, linked to breast
45 cancer and that those links are causal in nature, but they
46 are simply not direct where fat has some effect
47 immediately elevating breast cancer risk.
48
49 In my reading of both studies, I am impressed by the fact
50 that Dr. Kinlen seems to accept the links and to accept
51 them as being causal, that the preponderance of evidence
52 strongly suggests that dietary fat exerts its effect on
53 breast cancer risk in two ways, perhaps by lowering the
54 age of menarche and by aggravating obesity.
55
56 I have no further comments on that except to note its
57 date, 1991.
58
59 Q. You have next on your list that you gave us one of the
60 miscellaneous supplementary lists. Then you have No. 42
