Book Review

Cancer Epidemiology and Prevention

N Engl J Med 1997; 337:717September 4, 1997

Article

Cancer Epidemiology and Prevention
Second edition. Edited by David Schottenfeld and Joseph F. Fraumeni, Jr. 1521 pp. New York, Oxford University Press, 1996. $195. ISBN: 0-19-505354-0

The first edition of this book, published in 1982, provided a comprehensive review of the work of a generation of cancer epidemiologists and the application of their findings to the prevention and early detection of cancer. Before the publication of the first edition, the only work of similar scope and stature was the monograph by Johannes Clemmesen (Acta Pathologica et Microbiologica Scandinavica Supplement 174 I, 1965). Cancer Epidemiology and Prevention became an essential reference for cancer epidemiologists and other cancer researchers. The second edition of the book extends the knowledge base by a further 14 years.

The first edition was the collective work of 100 authors, 38 of whom have contributed to the second edition, with 71 new authors added. The book has grown from 1173 to 1521 pages. The pages are a bit bigger, and the print is sharper. Tables are used more frequently to summarize the results of the studies. The book is heavier to hold but easier to read.

The overall structure of the book is unchanged. It has five parts, covering basic concepts, the magnitude of the problem of cancer, its causes, descriptions of cancers according to the tissue of origin, and prevention and control. Within each part, most of the chapter headings are the same as in the first edition. In part I, chapters on the stages of neoplastic development, molecular epidemiology in cancer prevention, quantitative risk assessment, and mathematical models in cancer epidemiology have been added. These changes reflect recent advances in the knowledge of carcinogenesis at the intracellular level. A recurrent theme throughout the book is the integration of epidemiologic and experimental findings to formulate a coherent theory, exemplified by the two-hit model of carcinogenesis.

The core of the book, parts III through V, updates the review of descriptive and analytic data in the epidemiology of cancer. There have been some changes in emphasis. For example, a separate chapter is devoted to exogenous hormones, and some of the cancer sites have been subdivided. A noticeable change is the increased attention to host factors in many of the chapters.

This book summarizes the achievements of the discipline of cancer epidemiology as the century draws to a close. It documents the many additions that the discipline has made to our understanding of the causes of cancer and the potential for its prevention. However, it is clear that in terms of discovering new potential targets for prevention, little progress has been made since the first edition was published, with the exception of research on some viral carcinogens. In fact, the chief causes of cancer listed in part III had already been identified in Clemmesen's monograph. It is also evident, from chapter 11-I, that prevention and early-detection programs have had no perceptible effect and that the goal of halving mortality from cancer by the year 2000 will not be attained. In chapter 63, Dr. Schottenfeld states:

A future challenging direction in cancer prevention and control will be the application of technology for identifying genotypic and phenotypic markers of cancer susceptibility and predicting levels or degrees of individual lifetime risks for specific types of cancer. Individuals may then be counseled about actions they should take to reduce their susceptibility or expression of risk.

A brave new world indeed. In his foreword to the first edition, the late Dr. Abraham Lilienfeld congratulated the editors and contributors “on the breadth and completeness of their work.” Readers of the second edition will concur wholeheartedly with this assessment.

Gerry Bernard Hill, M.B.
University of Ottawa, Ottawa, ON K1H 8M5, Canada