Book Review

Prevention of Breast Cancer

N Engl J Med 1994; 330:1165April 21, 1994

Article

Prevention of Breast Cancer
(Medical Intelligence Unit.) By Ian S. Fentiman. 118 pp. Austin, Tex., R.G. Landes, 1993. $89.95. ISBN: 1-879702-74-6

This is a short, concise book on the prevention of breast cancer. Dr. Fentiman tackles difficult questions thoroughly and provides some very sensible observations. For instance, his handling of the increasingly controversial and public question of the usefulness of yearly mammograms is well referenced and enlightening. His review of the pertinent material concludes that mammography is a useful screening method, even for women younger than 50, and that it would decrease mortality. The evidence is presented in a cogent and organized manner.

Fentiman devotes a whole chapter to the discussion of risk factors such as diet, ionizing radiation, genetic factors, and in situ cancers. The chapter also includes a good explanation of the Wolfe system of categorizing breast parenchymal factors on mammograms, which was always a muddle to me until I read this book. Although I am still not convinced of the usefulness of this classification, I agree with Dr. Fentiman that computerized analysis may add an exciting new dimension to mammography.

Readers will appreciate the extensive review of different hormones, including oral contraceptives, and their effect on the risk of breast cancer. The longest chapter is devoted to a comprehensive discussion of tamoxifen. Dr. Fentiman is highly qualified to discuss the numerous British studies on the treatment of breast cancer in the elderly with tamoxifen. The British have done the only credible research in this area, and it is good to see it summarized and discussed in one place by one of its participants.

The last chapter of the book, entitled “The Future,” is especially good. Dr. Fentiman has formulated a number of possible approaches to increase our ability to identify and perhaps prevent breast cancer in the future. Many of the ideas are intriguing, and readers are left with much to contemplate. Anyone involved in the treatment of women with breast disease will value this book. It covers all the important points, yet it is concise and easily understood.

M. Margaret Kemeny, M.D.
North Shore University Hospital, Manhasset, NY 11030