Day 034 - 11 Oct 94 - Page 31


     
     1        Dr. Gregorio, that hormonal factors not "may cause" breast
     2        cancer but do, that an earlier age at menarche is
     3        associated or does -- is, in his words, an established
     4        risk factor for the disease.  He then states that the --
     5        he also has stated that the nutritional status influences,
     6        in a declarative sentence, the age at menarche; that
     7        caloric intake on the incidence of breast cancer -- "the
     8        effects of caloric intake on the incidence of breast
     9        cancer are mediated not only by obesity but also by age at
    10        menarche".
    11
    12        Forgive my laboured interpretation of this, but what I am
    13        trying to point out is that if a central question in the
    14        case is the nature of the association, is this in some way
    15        causal, are these links -- can they be properly
    16        characterised by the fact that dietary fat is at least
    17        suspected as contributing for a cancer, I would suggest
    18        that in the evidence that the Plaintiffs have brought (and
    19        which was in existence in 1987) these links, which were
    20        causal in nature, were already accepted and already well
    21        known.
    22
    23        Let me, perhaps, digress for one moment to make a couple
    24        of comments about elementary physiology.
    25
    26   MR. JUSTICE BELL:  Yes.
    27        A.  A gramme of fat, simply to review something very
    28        basic, a gramme of fat has nine calories.  A gramme of
    29        carbohydrate or of protein has only four calories, which
    30        is the reason why it has been well known and long
    31        established that high fat diets encourage obesity, and is
    32        what Dr. Kinlen is referring to when he states that the
    33        effects -- or it is very important, when one looks at the
    34        discussion regarding caloric intake, high fat foods are,
    35        by their very nature, much more calorie dense, higher in
    36        calories on a per weight basis, than high carbohydrate
    37        foods or high protein foods.  There is simply no way
    38        around that.
    39
    40        I have no further comments on that study, simply to
    41        emphasise that these causal associations were already
    42        known and already accepted at that time and, in fact,
    43        offered into evidence by the Plaintiffs.  Can I turn then
    44        to Kinlen's other study?
    45
    46   MR. JUSTICE BELL:  Certainly, if that is what you want to say
    47        in relation to 87, so go back to 7 then.  That is the 91
    48        one.
    49        A.  Thank you, my Lord.  In 1991, to look at Kinlen's
    50        study to see whether he back tracks or contradicts himself 
    51        on whether or not menarche is an established risk factor 
    52        or whether caloric intake can affect it, if we look on 
    53        page 465 ----
    54
    55   MR. MORRIS:  Which is page 406 in the bundle.
    56        A.  This is Kinlen's 1991 Study on Diet and Breast
    57        Cancer.  About two thirds of the way down the page is the
    58        subtitle "Menarche", where Dr. Kinlen makes the statement:
    59        "Age at menarche is a well established risk factor for
    60        breast cancer".

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