Studies throughout the world have demonstrated the success of screening programs in significantly reducing breast cancer mortality rates. The revolution in imaging, through new advances in mammography, ultrasound, and magnetic resonance techniques, has increased the detection of minimal, often non-palpable, carcinomas in the early stages.
A comprehensive overview for radiologists, pathologists, surgeons, and oncologists, Early Breast Cancer presents a wide-ranging analysis of diagnosis, pathology, and multidisciplinary management of the early breast cancer patient.
Since the 1960s, screening for breast cancer by mammography has been the subject of a number of controlled trials. These studies showed that, among 45-to-64-year-old women, regular mammography was associated with a 30 percent decrease in mortality due to breast cancer. A large tumor with high-grade histologic features and lymph-node metastases are associated with a poor prognosis. Mammographic screening can detect small tumors with low-grade histologic patterns that have not spread to the lymph nodes -- all features of a good prognosis.
In 1987, the National Health Service Breast Screening Programme (NHSBSP) was founded in the United Kingdom with the goal of reducing mortality from breast cancer and improving the quality of the management of breast disease. The NHSBSP aims to reduce mortality from breast cancer by 25 percent by the year 2000, and early results indicate that the national target is being met.
The data and experience gained from this multidisciplinary approach, which involves radiologists, pathologists, and medical and surgical oncologists, are presented in Early Breast Cancer. The main focus of the book is the radiologic and pathological features of early breast cancer, which together take up about half of this work. The section on radiologic diagnostic techniques features a wide range of mammographic and ultrasonographic images, which show normal tissue, benign and malignant tumors and cysts, and calcifications. Each diagnosis is listed in conjunction with its possible clinical permutations. Numerous case reports and potentially ambiguous results are also presented and are accompanied by suggested management strategies.
Various techniques of preoperative tissue diagnosis are also covered -- if in a comparatively limited format -- with an emphasis on fine-needle aspiration cytology. In addition, in the section dealing with the pathology of breast cancer, histologic images of various types of tissue are presented for comparison with the corresponding radiologic images, providing a didactically valuable correlation between radiologic and histologic diagnostic techniques.
The primary aim of the NHSBSP is the recognition of breast cancer in its early stages. Consequently, the sections on surgical treatment and adjuvant therapy focus on minimal breast cancer, offering clearly structured strategies for the local treatment of the breast and the axilla. The numerous suggestions regarding standardization, quality control, and organization, which deal with the importance of resection margins, local recurrence after breast-conserving surgery, and the marking of tumor specimens, along with a wide range of case studies, exemplify the book's emphasis on practical applications.
Early breast cancer calls for a specially designed multidisciplinary approach to management, challenging radiologists, surgeons, pathologists, and oncologists to adopt new concepts and strategies. To this end, all the specialized fields involved will benefit from the most comprehensive knowledge currently available on the subject. Early Breast Cancer conveys the relevant data without losing sight of clinical relevance. The information in this book shows how a growing number of patients can profit from timely diagnosis and treatment and substantially increase their chances of surviving breast cancer.
Reviewed by Teresa Wagner, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
