Day 033 - 10 Oct 94 - Page 24


     
     1        A.  I see.  In that particular sentence I was referring to
     2        simply an association that one finds in the backgrounds of
     3        cancer patients compared to other individuals who are like
     4        them in many ways.  One finds they have been eating diets
     5        particularly high in fat, saturated fat, higher in
     6        calories; one of the contributors to that, one of the
     7        principal contributors would be meat.
     8
     9   MR. MORRIS:  But, overall, on the subject of colon cancer and
    10        the link between that and the kind of diet which is
    11        specified, would you say that was a causal link, an
    12        associative link or indirect link -- what kind of link?
    13        A.  The link is almost certainly causal.  That is not
    14        simply -- I say that not simply from the evidence we have
    15        presented so far, but there is also evidence that
    16        when -- let me back up for a moment, if I may -- when
    17        colon cancer begins it can often begin as a polyp, and if
    18        one can prevent the onset of polyps, one can reduce the
    19        incidence of cancer developing.
    20
    21        It has been shown that when fibre is added to the diets of
    22        individuals who have already been diagnosed with polyps,
    23        the likelihood of those recurring can be modified,
    24        indicating that, in fact, the link, if you will, must be
    25        causal; that a high fibre diet increases the likelihood of
    26        cancer developing in the colon.  A high fibre diet can
    27        reduce that risk, and that this is not simply an
    28        association but that, in fact, the diet is changing the
    29        body in such a way that cancer is more likely to grow or
    30        more likely to progress in individuals where the diet is
    31        high in fat and less likely when the diet is high in
    32        fibre.
    33
    34   MR. JUSTICE BELL:  So one might think the fact that if you add
    35        something to diet that gives you a better chance once
    36        cancer is diagnosed; it does not mean that it is a lack of
    37        it which has caused cancer, but, to your mind, it does
    38        mean that or it is an indication of that, is it?
    39        A.  The fibre intake of individuals in western countries
    40        is quite low compared to that of other countries.  If one
    41        increases the fibre intake of individuals who have had a
    42        history of colonic polyps to match that of -- this is
    43        typical of under developed countries -- one can reduce the
    44        likelihood of recurrence.
    45
    46        So, by that I guess I might say one is taking one step to
    47        normalise the diet or return it to a -- to return the diet
    48        to that which is more helpful for the body.
    49
    50   MR. MORRIS:  Could you explain what polyps are, their 
    51        relationship with cancer? 
    52        A.  Yes, P-O-L-Y-P-S.  Polyps are benign growths that are 
    53         -- that seem to be one of the initial changes that
    54        ultimately will lead to cancer of the colon.
    55
    56   Q.   So polyps are not in themselves cancerous?
    57        A.  That is correct, but they are an indication that that
    58        individual is at a substantially higher risk of cancer.
    59
    60   Q.   Obviously, we could probably talk all day about link and

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