Book Review

The Breast: Comprehensive management of benign and malignant diseases

N Engl J Med 1999; 340:1126-1127April 8, 1999

Article

The Breast: Comprehensive management of benign and malignant diseases
Second edition. Edited by Kirby I. Bland and Edward M. Copeland III. 1631 pp. in two volumes, illustrated. Philadelphia, W.B. Saunders, 1998. $225. ISBN: 0-7216-6656-6

The editors of The Breast are oriented toward surgery, but the approach is broad. The result is an impressive work in two volumes, written by almost 150 authors. The first volume contains chapters on history, anatomy and physiology, pathology, genetics, molecular biology, diagnostic issues, screening, and biostatistical principles, whereas the second volume covers treatment.

It is relevant here to comment on the concept of the textbook, which presents the state of the art and is written by specific experts in each field, and to comment on the special problems that arise from new editions of earlier books. The larger the group of authors, the more complicated the contributions. This creates a substantial delay in publication, with a serious loss of information on important recent developments. The complicated work of editing and streamlining such a broad work requires considerable time, which further delays the publication. This delay shows in the lists of references, which cite no articles published after 1996, with only few from that year. Most references are the same as those published in the previous edition — a common problem in publishing new editions.

Bland and Copeland introduce many new chapters by discussing novel ideas and changed concepts: for example, the chapters on sentinel-node biopsy, ductal carcinoma in situ, and many other issues in the clinical and biologic aspects of breast cancer. In these new chapters, however, we miss the most recent information, which is especially a problem when new fields are reviewed.

When textbooks are written by numerous authors, they can create confusion for the reader. Clinicians and researchers who read The Breast will be confronted with opposing views in many chapters that overlap other chapters in subject matter. Restricting myself to surgical topics, I can mention examples: the approach to the axilla, the effect of local control on survival, and the pros and cons of one-step and two-step procedures. Even these worthy editors have not always succeeded in limiting their authors to producing apodictic writings on favorite personal themes or established ideas. By reading the different approaches, however, one learns that several apparently different ways of thinking may be correct; this helps to reinforce the importance of relativism in medical science.

Of course, because this book covers such a broad field, it is easy to find minor shortcomings. To mention some: a young surgeon who during an axillary clearance is disconcerted by abnormal anatomy (the confusing Langer's axillary arch is seen in a substantial number of patients) will look in vain in this book to find a description of such anomalies; a thorough paragraph on the risk of tumor inoculation by sloppy surgery is missing; the new palliative approaches for skin metastases (such as photodynamic therapy) are not mentioned, whereas the treatment of pericardial metastases is described in a special chapter. Also, some cosmetic criticism: there is no uniform system of citing references.

The majority of these points are minor indeed. I want to state explicitly that the editors have created an excellent book. The layout is perfect, the illustrations are generally of good quality, the tables are easy to read, and the text is highly instructive. Most of the pitfalls are inherent in the concept of a textbook. Nevertheless, the supply of information in this “breast encyclopedia” is useful for many, both students and specialists. I highly recommend The Breast.

Joop A. van Dongen, M.D.
Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands