Day 022 - 12 Sep 94 - Page 06

     
     1        the relevant family history is.  So you take a family
     2        history from that patient.  You are looking at all members
     3        on that side of the family, the blood side of the family,
     4        who may have had breast cancer at some time in the past,
     5        because you do that because of the possibility of
     6        counselling children of that patients, because if you have
     7        more than one blood relative with breast cancer, it
     8        increases your risk of developing cancer even greater.  So
     9        a very important aspect of assessing a patient is knowing
    10        what the family history is.
    11
    12   Q.   But you have said that you do not know exactly what it is
    13        with the genes that is causing the problem?
    14        A.  We do not.
    15
    16   Q.   You would say that you cannot demonstrate the cause?
    17        A.  Well, we cannot demonstrate a genetic abnormality, but
    18        this is an absolutely consistent finding that there is
    19        this increased risk if a blood relative has got the
    20        disease.
    21
    22   Q.   Right, but that could be attributed to some other factor,
    23        for example, environmental, dietary, whatever?
    24        A.  No.  It is far too consistent for that because it is
    25        found throughout the world in all communities.  It is not
    26        only in certain parts of the world that one sees this; one
    27        sees it everywhere.  So you see it in areas where the
    28        incidence of breast cancer is low; you see it in areas
    29        where the incidence of breast cancer is high.  It is an
    30        absolutely consistent finding.
    31
    32   Q.   When, for example, groups of people migrate to other
    33        countries, is it not true there has been a number of
    34        studies which have shown that their risk of cancer has
    35        increased or decreased, or whatever?
    36        A.  Yes, that is true.  But, you see, what you have is an
    37        underlying probable genetic factor on which is super-added
    38        some other factor which is modifying that expression.
    39        That is the whole problem, is knowing what these other
    40        factors are.
    41
    42   Q.   OK.  In your opinion, apart from genetics, what other
    43        factors do you consider to be relevant?
    44        A.  Well, in breast cancer there are a number of defined
    45        factors.  For example, the age at which you begin to
    46        menstruate, the age at which you give rise to your first
    47        child; to some extent, but to a lesser extent, the number
    48        of children that you have.  Another factor is the age at
    49        which you have the menopause.  These are all well-defined
    50        factors which appear to have a direct influence, again 
    51        throughout the world, irrespective of whether you are in 
    52        an area of high incidence or low incidence of breast 
    53        cancer.  These are factors which are found consistently
    54        for all patients.
    55
    56   Q.   Right.  Has cause and effect been shown for these?
    57        A.  No.
    58
    59   Q.   In your opinion, are there any dietary factors to be taken
    60        into account?