Book Review

Treatment of Pre-Cancerous Lesions and Early Breast Cancer

N Engl J Med 1993; 329:1285-1286October 21, 1993

Article

Treatment of Pre-Cancerous Lesions and Early Breast Cancer
Edited by Irving M. Ariel and Anthony C. Cahan. 346 pp., illustrated. Baltimore, Williams and Wilkins, 1993. $85. ISBN: 0-683-00255-4

Breast-cancer management has of necessity become a multidisciplinary specialty. Not only is broad expertise from a number of disciplines required; most often, lifelong commitment to patients is essential to deal with dynamic therapeutic problems.

This 346-page treatise attempts to deal with the problems of the precancerous lesion and early breast cancer, a difficult task since both are hard-to-define and still-evolving concepts. The challenge facing the editors is therefore great. This book covers a spectrum of topics from cystic diseases of the breast to adjuvant therapy for stage I and II breast cancer. It perhaps attempts too much and ends up covering its subject unevenly. There are some useful chapters; those on the management of cell atypia, the role of surgery in early breast cancer, and the role of adjuvant chemotherapy are notable examples. The chapter on breast cancer in pregnancy, a problem requiring skill and guidance, succinctly discusses a rare but important medical dilemma usually slighted in other textbooks. The illustrations are of excellent quality throughout.

However, there is great unevenness in both the writing and the editing throughout the book, beginning with the preface. Typographic errors in reference citations and statistics can be overlooked, but there are a number of controversial points, too briefly discussed, for which references should have been provided. Such points include the recommendation that frozen-section analysis be performed for nonpalpable, mammographically visible lesions in lieu of processing the whole specimen, even though information may be lost or altered when the frozen section is used. Prominently featured but incorrectly cited is an important paper discussing survival among patients with small tumors with or without nodal involvement. The study cited does not conclude that patients with tumors of less than 1 cm and axillary-node involvement have an excellent prognosis and can be spared adjuvant therapy; it concludes the opposite. There is a general sense in the discussions of tamoxifen therapy that the drug should be taken on a lifelong basis, a point that in terms of economic and medical cost is still under prospective investigation. One gets the impression that discussions of these topics might have been handled more comprehensively in a book with a narrower focus than this one.

Although the text is quite readable, the inclusion of data that require further discussion and interpretation makes it difficult to extract principles for practice from this book. The cost ($85) is not that much less than that of other, larger books devoted to the management of breast disease. This work could not stand alone as a guide for those in training or for those in practice who need a complete reference on the management of nonmetastatic breast cancer. It is perhaps best suited for those with experience who are seeking another point of view.

John K. Erban, M.D.
New England Medical Center, Boston, MA 02111