Day 017 - 25 Jul 94 - Page 37


     
     1        going to take part in studies.  It is often very difficult
              to, for example, in case control studies get people in the
     2        lower socioeconomic groups because of their reluctance to
              participate, so you do tend to get bias.
     3
              Of course, the reason that there is a higher risk in the
     4        higher socioeconomic groups is because they are women who
              are subjecting themselves the risk factors we discussed
     5        already, such as low numbers of members of family, in
              other words, not having very many children, often having
     6        the first child at a late age, so, you know, it is a
              measure of the fact that these are women who are subject
     7        to increased risk factors anyway.  That is why the
              incidence is higher.
     8
         Q.   I will finish it off:  "These data are not consistent with
     9        the hypothesis that high dietary fat intake increases
              breast cancer risk.  Indeed, they suggest a possible
    10        protective effect of high fat intake, but this result may
              be influenced by methodologic problems with the dietary
    11        assessment.  These results certainly indicate the need for
              further exploration".
    12        A.  Which is a very reasonable conclusion.
 
    13   Q.   Are we still on a voyage of exploration?
              A.  I think we are.  In all honesty, I think that we have
    14        not overcome a lot of the problems which have existed in a
              number of these studies and which continue to be
    15        problems.  And we do definitely need to conduct further
              studies.  Whether they will actually be able to overcome a
    16        number of these problems of dietary recall and measurement
              of fat, measurement of other components of calorie in the
    17        diet, is open to question.  But we certainly need to
              conduct further studies; we do not have the answers yet.
    18
         Q.   I want to look briefly at two more up-to-date studies; one
    19        again by Dr. Kinlen who came back to the sort of subjects
              he was discussing in 1987 in 1991, which is at tab 7 of
    20        your file.  This is published in the British Medical
              Bulletin Volume 47, No. 2.  It is published by the British
    21        Council.  The article is headed Diet and Breast Cancer.
              It is again by the same Dr. Kinlen, in the box:  "The
    22        issue of diet", do you have it?
              A.  Yes.
    23
         Q.   "The issue of diet as a cause of breast cancer has been
    24        dominated by fat.  Some have judged this convincing enough
              to warrant dietary recommendations aimed at prevention.
    25        Others find the evidence so far rather weak.
  
    26        this hypothesis arose because fat appeared to cause 
              mammary tumours in rodents and because in women, mortality 
    27        from the disease in different countries strongly
              correlates with the corresponding per caput fat
    28        consumption as crudely measured in food balance tables.
              These correlations concern animal, and not vegetable, fat
    29        and are stronger for postmenopausal than premenopausal
              breast cancer.  Other early observations that seemed
    30        relevant are the increase in breast cancer among the
              Japanese in the USA, a group whose intake of fat has also

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