Book Review

Prevention and Early Detection of Colorectal Cancer

N Engl J Med 1997; 336:448February 6, 1997

Article

Prevention and Early Detection of Colorectal Cancer
Edited by Graeme P. Young, Paul Rozen, and Bernard Levin. 384 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $79. ISBN: 0-7020-2018-4

This is an excellent and timely book. Colorectal cancer is one of the most common cancers in the world and is discussed most frequently in terms of classical surgery, chemotherapy, and palliation. In this refreshing approach, editors from three continents have assembled a global view of prevention and early detection. In fact, the word “globalization” is used three times in the preface to emphasize the way in which — with the convergence of Western-style diets and the aging of populations — colorectal cancer has become a worldwide problem.

Each chapter includes a full-page outline of its objectives and an editor's summary. The illustrations are good and the bibliography exhaustive. The biology, molecular biology, and histopathology of the disease are comprehensively described, as are germ-line mutations in adenomatous polyposis coli and p53 genes. Also discussed are flat adenomas, microadenomas, de novo cancers, and all sorts of dysplasias. Lifestyle, environmental risks, and carcinogens are weighed in the balance. Many patients ask about diet, so the dietary summary is useful. There is also a fascinating update on chemoprevention.

The sections on high-risk groups contain good reviews on familial colorectal cancer and the ongoing surveillance of patients with adenomas, cancer, or inflammatory bowel disease. How often colonoscopies should be done, what size polyps to worry over, and when to surgically resect a malignant polyp are all debated. And did you know about attenuated adenomatous polyposis coli — a mutation at the extreme proximal end of the APC gene that gives rise to smaller numbers of polyps later in life with a right-sided predilection?

The results of the screening of populations in Australia, Japan, Europe, and the United States are presented, developments in screening technique are described, and the economics of health care is of course analyzed. For example, the authors say that colonoscopy is rarely cost effective because of its high cost and medical risk and because it detects many polyps that are not destined to become cancerous. This will not go down too well with endoscopists, but they — together with public health, epidemiology, and colorectal specialists — should still enjoy reading this book. My next lecture on colorectal cancer will be very different: prevention is better than cure.

Neil Mortensen, M.D.
University of Oxford Clinical Medical School, Headington, Oxford OX3 9DU, United Kingdom