Day 036 - 13 Oct 94 - Page 23


     
     1        part of Dr. Kushi's study, the same page, the right-hand
     2        column halfway down there is a paragraph which begins:
     3        "The above considerations notwithstanding", do you have
     4        that?
     5        A.  Yes.
     6
     7   Q.   "The above considerations notwithstanding, the association
     8        of dietary fat with breast cancer did not approach
     9        statistical significance in our study, and in this respect
    10        our results are entirely consistent with the other four
    11        prospective cohort studies that have investigated this
    12        association.  If there is a causal relationship between
    13        fat intake and risk of breast cancer, it is likely to be
    14        of small magnitude across the range of fat intakes
    15        observed in studies such as this.  Since the magnitude of
    16        such an effect appears to be similar to the differences
    17        that arise from differing analytic approaches, appropriate
    18        consideration of the proper methods for analysis of
    19        dietary data and adjustment for energy intake in
    20        epidemiologic studies is warranted.
    21
    22        Several approaches that may provide additional insight
    23        into the issue of dietary fat and breast cancer have been
    24        proposed or are underway".  We remind ourselves that we
    25        are in July 1992 at the time this was published.
    26
    27        "First, efforts can be made in ecologic studies to
    28        minimise errors associated with collection of data on
    29        dietary habits and potential confounding variables in
    30        geographic areas with contrasting breast cancer
    31        incidences.  With these improvements, it may be possible
    32        to determine whether the strong ecologic associations are
    33        causal.  Second, as with the pooling project of
    34        case-control studies, an effort is underway to pool data
    35        from several prospective studies, including this one, to
    36        relate a quantitative estimate of fat intake to risk of
    37        breast cancer (Hunter, D: personal communication)" --
    38        presumably through Dr. Kushi.
    39
    40        "This project will provide increased power to detect an
    41        association within the ranges of fat intake under study,
    42        but may be unable to address limitations that result from
    43        relative homogeneity of fat intakes.  Prospective studies
    44        in populations with sufficiently wide variation in fat
    45        intake and including a sizeable proportion of the
    46        population with fat intakes well below 30% of energy may
    47        be required to overcome these limitations.  Finally,
    48        randomized trials such as the Women's Health Trial or the
    49        low-fat intervention component of the Women's Health
    50        Initiative may also provide evidence as to whether low fat 
    51        intakes decrease risk of breast cancer." 
    52 
    53        Two things about that passage which I have just read,
    54        Dr. Barnard.  The first is this.  Dr. Kushi, at any rate
    55        in July 1992, does not appear to know of any prospective
    56        studies which studied fat intakes much below 30 per cent
    57        of energy, is that right?  We see that from the last bit
    58        of the page.
    59        A.  What he is saying is that such studies would be
    60        helpful.

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