Breast Cancer

A definitive and practical reference work for breast surgeons, 'Breast Cancer' provides a clear presentation of the issues involved in the diagnosis and management of breast cancer. Information ranges from basic mechanisms of oncogenesis and pathophysiology to psychological support. Edited by a breast surgeon with input from a multi-modality breast team, this book reflects current practice in diagnosing and treating breast cancer.

Questions take the form of chapter subheadings, with the text directed at answering these critical questions.

Contributing authors developed their questions with the needs of colleagues, patients, and family members in mind to help enhance communication among the entire clinical team.

Coverage includes oncogenesis diagnosis (including molecular diagnostic techniques), pathology, surgery, chemotherapy, radiation, and more.

An abundance of tables and illustrations provides statistical support and clarify important content.

Breast cancer is the most common cancer among women in the Western world. Its incidence has gradually been rising and, since the introduction of screening mammography in the 1980s, its growth has even accelerated. Moreover, in some regions of Asia, a surge in incidence has also occurred and has been attributed, at least in part, to a "Westernization" of lifestyle. Recently, it has been observed in several countries that the mortality associated with breast cancer is dropping. This may be due to changes in the biology of tumors (e.g., a greater proportion of estrogen-receptor-positive tumors), earlier presentation as a result of screening and education of the public, and improvements in treatment. About one third to one half of patients with breast cancer benefit from these improvements, so -- with such a common disease -- modern management that incorporates these improvements can affect the lives of many women.

The goal of Roses's Breast Cancer is to present current issues in the diagnosis and management of breast cancer from the viewpoint of the practicing physician. It offers considerably more information than is usual in general surgical and medical textbooks, but by covering virtually all aspects of the disease in 688 pages it is less encyclopedic in certain areas (e.g., molecular biology) than are specialized textbooks on these subjects. Interestingly, the book is organized in a question-and-answer format. "What is the frequency of breast cancer in the United States?" is the first question in the book; "What other social and psychological issues should be addressed with the patient?" (in the chapter on genetic counseling) is the last. Although artificial, this approach helps to keep the text focused on the needs of all who are involved in the care of patients with breast cancer.

The book is also a source of information on subjects related to breast cancer that elsewhere are often dealt with superficially. Twelve pages are devoted to breast cancer in men, 20 to breast cancer in women who are pregnant, and 22 to the pathology of special forms of breast cancer. Inevitably, a book such as this also has its imbalances. The chapter on the treatment of metastatic breast cancer is considerably shorter than the chapter on pathology. Almost 40 pages deal with reconstructive surgery, whereas only 11 pages concern the principles of chemotherapy. Moreover, of that 11-page discussion, 5 pages deal with high-dose chemotherapy with stem-cell transplantation, an approach of unproven value in the treatment of metastatic disease.

Breast Cancer is a beautiful book that contains a wealth of information and illustrations related to this fascinating disease. Despite its imbalances, it will be of great use to all those who care for patients with breast cancer and who have questions requiring a quick, precise, and up-to-date answer.

Reviewed by Geert H. Blijham, M.D., Ph.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.