Book Review

Diagnosis and Management of Breast Disease

N Engl J Med 1997; 336:1193-1194April 17, 1997

Article

Diagnosis and Management of Breast Disease
By Richard E. Blackwell and James C. Grotting. 325 pp., illustrated. Cambridge, Mass., Blackwell Science, 1996. $49.95. ISBN: 0-86542-405-5

There are public discussions about breast health and breast disease almost everywhere, from national television specials to local fund-raising events. I have been involved in radio talk shows, discussion groups, and even foot races, all focusing attention on this important issue. These events are signs of growing activism in the lay community with respect to breast disease and the desire to take responsibility for one's own health. The increased public awareness and the large amount of information generated by research programs make it important to provide ways for the primary care practitioner to stay up to date on the topic of breast disease.

The opening chapters of this book cover the anatomy of the breast, normal physiology, benign disease, and organ dysfunction. As I read, I was bothered by the inconsistent chapter design, typographic errors, and an intermittent lack of focus. The discussion in the first chapter rambles from the embryology of the mammary gland to the production and function of prolactin and the control of lactation and ends with breast screening and self-examination, all in less than 15 pages. Subsequent chapters on galactorrhea and mastalgia and on congenital anomalies of the breast (which constitute almost one quarter of the book) are exhaustive and contain useful insights into the diagnosis and treatment of breast pain and nipple discharge.

Most of the remaining chapters address various aspects of neoplastic disease of the breast. There are chapters on standard topics of epidemiology, pathology, mammography, and management, including surgical, medical, and radiotherapeutic treatment of breast cancer. Other chapters take up magnetic resonance imaging (MRI) of the breast and breast reconstruction. As a group, these chapters present a standard approach to the care of mammary neoplasms.

In their preface, the authors state that the purpose of the book is “to furnish the primary care physician with a working guide to the diagnosis and management of breast disease.” In my estimation, they have fallen short of the mark. Many facts are presented but without clarification or enlightenment. Straightforward approaches to common clinical problems encountered by the primary care physician are not clearly outlined. The role of the physician's examination of the breast and regional lymphatics is completely ignored. There is no discussion of how to counsel patients about their risk of breast cancer, genetic testing, or participation in cancer-prevention trials. Yet the book gives excessive emphasis to procedures of unclear utility (MRI of the breast) or special interest (aesthetic breast surgery).

What readers might find this book useful? It is not of sufficient scope or depth for the cancer specialist. It may be informative to the house officer or primary care physician who wants to know what will happen after a patient with breast disease has been referred to a specialist. Unfortunately, the book provides the generalist with only a few useful tidbits for assessing and managing common breast diseases.

Eric A. Strom, M.D.
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030