Book Review

Multiple Primary Cancers

N Engl J Med 2000; 342:596-597February 24, 2000

Article

Multiple Primary Cancers
Edited by Alfred I. Neugut, Anna T. Meadows, and Eliezer Robinson. 484 pp., illustrated. Baltimore, Lippincott Williams & Wilkins, 1999. $110. ISBN: 0-683-30124-1

In this era of modern cancer medicine, there are now 8 million to 10 million survivors of cancer in the United States, a number that increases each year. Although many survivors are “cured” of their cancer, they remain at risk for second neoplasms. The best described of the second cancers, acute leukemia, can be a consequence of the DNA-damaging therapies that are the mainstay of most chemotherapy regimens. In other cases, the risk of second neoplasms is associated not with the effects of treatment but, instead, with a hereditary predisposition to cancer. In both circumstances, the study of patients with multiple cancers offers a unique opportunity to gain insight into the interactions between inborn genetic susceptibilities and acquired environmental factors.

Multiple Primary Cancers explores the biology and epidemiology of this important aspect of cancer medicine. The editors are well qualified in this field. Meadows was the first director of the Office of Cancer Survivorship of the National Cancer Institute, and Neugut and Robinson have collaborated on numerous clinical and epidemiologic studies defining the prevalence and scope of secondary neoplasms. The organization of the chapters is highly consistent, indicating special effort and attention by the editors that will be appreciated by readers. Overlap of material, inevitable in an undertaking such as this, serves to reinforce key associations. The editors have assembled an informative set of well-written reviews of the epidemiology of second cancers and of the molecular mechanisms underlying their pathogenesis. The chapters also include descriptions of most of the syndromes associated with hereditary predisposition to cancer, although more emphasis is placed on statistical studies than on the details of clinical management.

The book begins with two sections made up of chapters that review quantitative methods and cancer biology, but its real strength is the third section, which focuses on selected cancers. Here, readers with specialized interests in the field can learn about associations — many not yet understood — among a number of human neoplasms. For example, various chapters catalogue interesting associations between breast cancer and colon cancer, lymphoma and renal cancer, and melanoma and neuroectodermal tumors. Also described are syndromes of rare tumors that may be unfamiliar even to seasoned readers. For example, in their comprehensive chapter on sarcomas, Keohan and Antman discuss the Carney triad of gastric leiomyosarcoma, extraadrenal paraganglioma, and pulmonary chondroma, a cluster that has no clear explanation. These and other associations among human neoplasms that are documented in this important monograph suggest novel pathogenetic mechanisms that will inspire a future generation of clinician scientists and molecular epidemiologists.

Kenneth Offit, M.D., M.P.H.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021