Book Review

Textbook of Breast Cancer: A clinical guide to therapy

N Engl J Med 1998; 338:693March 5, 1998

Article

Textbook of Breast Cancer: A clinical guide to therapy
Edited by Gianni Bonadonna, Gabriel N. Hortobagyi, and A. Massimo Gianni. 359 pp., illustrated. St. Louis, Mosby, 1997. $99. ISBN: 1-85317-348-7

In the past decade, there have been considerable advances in our understanding of the biology of breast cancer and in its treatment. The primary treatment of breast cancer is complex and multidisciplinary, involving surgeons, radiation and medical oncologists, nurses, and social workers. As long-term follow-up data from clinical trials have become available and prognostic factors have been better defined, the heterogeneity of breast cancer as a disease has become increasingly apparent. At the same time, patients with breast cancer have become better informed about treatments and require a more detailed explanation of their treatment options (e.g., mastectomy vs. breast-conserving treatment and the pros and cons of adjuvant therapeutic regimens). All these factors increase the need for disease-specific expertise on the part of physicians. It is primarily from this viewpoint that the Textbook of Breast Cancer has been written. As the subtitle suggests, it is a clinically oriented textbook, rather than a comprehensive reference work.

The Textbook of Breast Cancer is a multiauthored book edited by three medical oncologists who have devoted much of their careers to research on the treatment of breast cancer. During the past two decades, they have contributed to the vast expansion of treatments, which is largely the result of systematic evaluations of hormonal therapy and chemotherapy in clinical trials (chapter 21 provides an excellent discussion of this subject). The contributors, who are from multiple countries and continents, represent the worldwide community of clinical investigators conducting research on breast cancer. This book provides an authoritative view of the status of the clinical management of breast cancer as of 1997.

The book is nicely formatted with accessible tables and figures. Although not as comprehensive as some other reference works on breast disease, it will serve the general oncologist well in reviewing important issues in the treatment of breast cancer, especially adjuvant therapy and the treatment of metastatic disease. Less attention is paid to the surgical, pathological, diagnostic, and radiotherapeutic aspects of management, although these topics are adequately covered. As in any multiauthored textbook, there is some repetition and lack of coherence, as well as a problem of flow. For example, the chapter on adjuvant hormonal therapy reproduces valuable survival curves and tables of data from the meta-analysis of the Early Breast Cancer Trialists' Collaborative Group, yet similar data are omitted from the preceding chapter on adjuvant chemotherapy. A small section on the quality of life for patients with recurrent breast cancer surprisingly appears in the chapter on salvage therapy, whereas this discussion might have been more appropriately integrated into the chapter on psychosocial research. The chapter on the current and future roles of growth factors overlaps somewhat with the chapter on high-dose chemotherapy and also discusses experimental immunologic and gene or genetic therapies that seem unrelated to the subject of the chapter. Overall, the expertise of the authors and the thorough nature of most chapters compensate for these problems.

Breast cancer is one of the most common cancers treated by medical oncologists, and they are likely to find this a good addition to their libraries. A user-friendly textbook on this disease will also be valuable for some primary care physicians specializing in women's health. For these audiences, and especially oncology trainees, the Textbook of Breast Cancer provides up-to-date, clinically important information on the treatment of breast cancer. Especially valuable is the long-term perspective on the clinical management of breast cancer provided by the editors and contributors. Specialists in breast cancer, however, may prefer other, more comprehensive reference works on the disease.

Patricia A. Ganz, M.D.
UCLA Schools of Medicine and Public Health, Los Angeles, CA 90024