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Sten.ographic Transcript Of HEARINGS Before The s -s ~a~.--r't. ~. -~~-. v- .., .; ~•.- .re ~_1 ..:U'!.....1_ ~...~ti ~ E tJ~ ='t.:. ~rI .._~:ra :~ ~OTED STATES SENATE Volume No. SJ's Ei R; ~_.:_4JTED TO Z:ELLE : D IS I-'s`'.SES Ue&-lcsday, 28 July 1976 Washington, D. C. ACE-FEDERAL REPORTERS, INC. Official Reporters 415 Second Street, N.E. Washington, D. C. 20002 Telephoha: (Code 202) 547-6222 NATIONWIDE COVERAGE TIMN 210997

l;R-9?..'. U Q. GIBSON ngl 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 1 24 R.poden. Inc. ~ 25 C O N T T. N T S 1/L Statement of: Page Dr. Gio Gori, ) 175 National Institute of Cancer ) . ) Dr.-Frnst Wynder ) 206 American Health Foundation ) . ) Dr. Mark Fiegsted ) 218 Harvard University ) ) Dr. Dave-Y.ritchevsky ) .224 Wistar Institute, ) Philadelphia, Pennsylvania ) ) Dr. Jerry Woc7an ) 229 Massachusetts Institute of ) Technology ) TIMN 210998

173 DIET RELATED TO KILLER DISEIISES f ; , 2 3 5 6 7 8 9 10 11 ~ 12 t 13 ; f 14 15 16 17 18 19 20 21 22 23 24 ~~ P^' ~. Inc. ~ 25 Wednesday, July 28, 1976 U. S. Senate Select Committee on Nutrition and Human Needs Washington, D. C. The Select Committee met at 10:00 a.m., pursuant to call, in room 224 of the Russell Senate Office Building; the Honorable George McGovern, chairman of the committee, presiding. Present: Senators McGovern, Humphrey, Dole, Bellmon,• Percy and Taft. Senator McGovern. I'd like to welcome to the second day of these hearings on nutrition as it relates to disease and health Dr. Gori, of the National Institute of Cancer; Dr. Ernst Wynder, American Health Foundation; Dr. Mark fiegsted, Harvard University Dr. Jerry Wogan, Massachusetts Institute o•f Technology; and Dr. Dave Kritchevsky, Wistar Institute, Philadelphia, Pennsylvan Cigarette smoking is related we are told to 30 percent of the cases of cancer in the United States and there's now stron, preliminary evidence bad diets contribute to at least another , 30 percent of the cancer cases. This morning we will narrow our investigation into the relationship between diet and cancer.. Yesterday we ranged over the whole field of diet as it rela~ to a number of health problems. Today's hearing we hope will a. es TIMN 210999

174 1 2 3 4 5 6 7 I 8 9 10 11 12 13 14 15 16 17 18 ~ 19 20 21 22 ~ 23 L 24 I ~ nc. 25 elucidate the need for a more comprehensive examination of the links between diet and cancer and the role diet can play in pre- venting the occurrence of this lethal disease that now destroys the lives of so many Americans. The horrors of cancer are known to everyone. It is the second biggest killer in the United Stat and perhaps our most dreaded disease. Therapy still proves to be an ineffective solution in most cases of cancer. Even early detection and intensive chemotherapy or radiation treatment rarely improve the survival from many cancers. However, cancer is not totally unavoidable. It is not an inevitable consequence of life. Many striking correlations have been found between diet and cancer. Positive correlations have been found between high fat consumption and breast cancer and colon cancer; betwe'en a lack of fiber and cancer of the lower intestinal tract. These findin s alone illustrate the potential of a prudent diet for controlling the growth of cancer at its ethiologic root. Correlation, of course, is not causation, but causation nee not be proven before action is very strongly warranted. The United States is preeminent in its scientific and medical exper- tise. We must avail ourselves of this valuable resource in the total commitment of reducing the incidence of cancer in this country and it is to that goal that this morning's hearing is designated. In view of our experience yesterday, which took us up until TIMN 211000

1.75 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Inc. ; 25 about 20 minutes to 2:00, I think if we are going to stay on schedule in the time that the Senate is following a heavy schedu on the Senate floor that if there's no objection by the members of the committee or the witnesses;,what I'd like to do is to ask each of the five-witnesses ta open with a statement. We will use your entire prepared statement but if you could hold your opening testimony to about ten minutes and then if the members of the committee would do the same thing -- I'll ask the staff to time us so that after we have had ten minutes of questioning from a member of the committee we will be asked to defer further questions until the next time around. . On that basis, I'd like to call our first witness, Dr. Gori of the National Institute of Cancer. STATEMENT OF DR. GIO GORI, NATIONAL INSTITUTE OF CANCER Dr. Gori. Thank you, Mr. Chairman. I believe that if I have . to summarize, and I have a few slides to show, I may have to impose you with some lecturing this morning. Senator McGovern. You can if you wish, Dr. Gori, read your statement as far as time permits. I don't want us to feel this is a hard and fast rule. Dr. Gori. I think I will try to stick to your demands this morning and, of course, I will have to be sketchy by definition so if you have any questions I will be more than glad to answer them at any time during my presentation. e TIMN 211001

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ~ RK+o.ters, ~ 25 Senator McGovern. Members of the committee should feel free to break in from time to time. Dr. Gori. I'd like to frame the program of cancer a little bit within the other diseases that plague our society today and you don't see well the bottom of the slide here, but the bottom line goes from 1900 to 1970, so it's a 70-year span off time and you can see that during that time most of the infectious disease have been conquered. Today tuberculosis, influenza, pneumonia and smallpox and a number of other'diseases have been conquered greatly due to improved prevention -- vaccines, better sanitatio of water, food., etc. People live longer and by living longer they expose them- selves to develop those diseases of a chronic nature such as heart disease and cancer that we have seen raising dramatically in the last 30 years. Nutrition is coming of age and only a few years ago it would have raised some eyebrows to have said that nutrition it- self may be responsible for cancer or cardiovascular diseases. The evidence we have today makes,this statement not only a possi bility but a certainty. I'd like to get into the details of this a bit now. Most of the information we get is from epidemiologic studies, namely studying the experience of different cancers in different populations. If we take, for example, Japanese migrants to the United States to Hawaii in particular, you can see that they E; n TIMN 211002

177 1 2 3 4 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 i ~ s t ~..... change their original experience for colon and stomach cancer to the experience in the United States. For instance, stomach cancer is very high in Japan and low in the United States. Colon cancer is low in Japan and high in the United States. Within two generations the experience of these immigrants to the United States changes from the experience in Japan to the experience in the United States.. This is true for a number of other migrant populations. It' true by and large for other cancers. Breast cancers follow a similar pattern for the Japanese migrants and we have similar data for Polish migrants to the United States, for migrants in different countries like migrant groups in Colombia, all indi- cating that a change in dietary habits is followed with a change in experience in cancer incidence. Senator Bellmon. Are you sayi::g that the incidence of other forms of cancer goes up when immigrants come to this country? You mentioned stomach cancer going down•. Dr. Gori. Yes, some go up and some go down, meaning that they are doing something good in their dietary habits and some- thing bad. i•7e'll give you some details on that later on perhaps -There are differences between geographic locations in the world for certain types of cancer. For instance, breast cancer is very high in the United States as you can see and if you go down to Miyagi, which is a locality in Japan,•it's very low. • TIMN 211003 S

I 1/ft 1 The same thing is true for prostate cancer. 2 Senator McGovern. Later on, Dr. Gori, are you going to 3 tell us what the ingredients in the diet are which explain this 4 Dr. Gori. Yes. I•will touch on that briefly. The stomach 5 cancer you can see the dramatic differences'we observe between 6 Japan -- very high, and the experience in the United States. B1 7 and large, stomach cancer today is a disease of the poor 8 connected with probably a low intake of vitamin C and protein, 9 a high intake of carbohydrates, starch in particular, that is 10 typical of the diet of the poor in many countries. 11 Now somebody could say that there are other things that 12 change when*migrant populations go from one place to another; 13 for instance, the environment. -I'd like to show some data. Th 14 environment is not likely to be responsible for this measure of 15 chandes. Indeed, the pollution levels in Japan are very 16 similar to the pollution that we have in this country, if not 17 worse, and another strong element of evidence is what we have 18 observed in smokers. Smokers are known to inqest, to introduce 19 in their bodies, large quantities-of carcinogens: Carcinogenic 20 substances are very similar to what is present in the environme tr 21 and if this carcinogenic substance was responsible for producin 22 certain forms of cancers, like colon cancer and breast cancer, 23 we should observe an excess of these cancers in smokers because 24 again they take in so much of these carcinogens. Indeed, we 25 don't observe this, indicating therefore that these types of TIMN 211004

1,19 i 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 carcinogens are not likely to affect certain forms of cancer like colon cancer, stomach cancer, breast cancer., Here, for instance, you see the difference in benzoapyren ingestion of benzoapyrene between smokers and non-smokers in the LosxAngeles area. It's a 24 time'and again for certain forms of cancer that we believe are dietary dependent we don't see any excess in cancer in smokers in spite of the fact that all this enormous amount of carcinogens. We have alsc indication that people that are exposed to .DD.T 30 years ago -- crop dusters and factory workers -- do not have an experience of increased cancer incidence, indicating that probably'DDT at the levels used and experienced by these people was not a risk factor for cancer in the human populati Also, we have studies with users of sweeteners like saccharin and cyclamates and they also, as you can see from th data here, do not show an increased experience of cancer over the non-users. Now the stomach cancer experience in Japan is changing dramatically over the last 20 years. There's been a continuin decrease of stomach cancer and an increase of colon and breast cancer. This follows the change in dietary-patterns that 22 23 24 i 25 have been introduced in Japan after the war. As you can see, they have decreased their intake of s*tarches, have increased dramatically their intake of milk, milk products, eggs and. TIMN 211005

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 0 ?2k i 23' 40'. ", " i f meat. Now all this indicates that their diet is becoming more westernized and indicates therefore that they can be expected to change their old patterns of cancer incidence -- low colon cancer, high stomach cancer -- to the reverse, which is true in' the westernized societies-- low stomach cancer and high colon cancer and high breast cancer, and this apparently is happening in Japan right now. There is also a strong correlation between dietary fat intake and experience of breast cancer. A similar correlation can be made for colon cancer but in the interest of brevity I won't show that. And you can see here that as the dietary intak of fat, the bottom line, increases, you have an almost linear increase in the incidence of breast cancer. Now I want to emphasize that this is a very strong corre- lation, but that correlation does not mean causation. I don't think anybody can go out today,and say that food causes cancer. , We•all have to eat food and what we say is not that food causes cancer, but.that certain imbalances in the diet may be predis- posing or may form certain metabolic imbalances that eventually lead to the development of these forms of cancer that we are talking about. ?4'! ;1differentiate Senator Belimon. You use the term dietary fat. Do you j4have a strong correlation to saturated fats similar to the IS i{ between animal and vegetable fats? Dr. Gori. We could differentiate that, too. You would s ~ TIMN 211006 v..~,.....,.. . .