Book Review

Clinical Cancer Genetics: Risk counseling and management

N Engl J Med 1999; 340:157-158January 14, 1999

Article

Clinical Cancer Genetics: Risk counseling and management
By Kenneth Offit. 419 pp. New York, John Wiley, 1998. $64.95. ISBN: 0-471-14655-2

Dr. Offit's book on cancer genetics in clinical practice covers most of the essential material in this complex field in a highly effective and readable way. The role of genetics in cancer is put into context by a superb overview of the role of genetics in disease, and Offit reviews our current knowledge of specific forms of genetic predisposition in both common and rare cancers. Using this information, he is able to discuss the difficult aspects of applying this knowledge in the clinic, providing case histories to help illustrate problems. The chapter on quantitative risk assessment gives an excellent overview of how risk can be evaluated and expressed. In the final chapter, Dr. Offit tackles a “soft” but important component of cancer genetics in clinical practice: the psychology and ethics of counseling. This discussion inevitably contrasts with the scientific rigor of the rest of the book, but the importance of this component is made obvious and highlights the need for careful evaluation of counseling activities.

Two important aspects of this field receive little attention. Few doubt the impact that genes of relatively small effect will have on the field, particularly loci that have high-frequency, low-penetrance alleles and that interact with other genetic or environmental factors to contribute to the disease. In the future, it will be important to consider how to deal with such genetic effects that confer risks more relevant to populations than to individuals. The role of polymorphisms of genes involved in drug metabolism or responses is also not emphasized, although this is also a problem for the future.

This book summarizes the current state of cancer genetics in clinical practice and effectively captures the excitement in this fast-moving field. It clearly demonstrates how genetics can now be applied to clinical oncology and is a harbinger of things to come for all areas of medical practice.

John Bell, D.M.
Oxford University, Oxford OX3 9DU, United Kingdom