Book Review

Advanced Therapy of Breast Disease

N Engl J Med 2001; 344:614February 22, 2001

Article

Advanced Therapy of Breast Disease
Edited by S. Eva Singletary and Geoffrey L. Robb. 344 pp., illustrated. Hamilton, Ont., Canada, B.C. Decker, 2000. $79.95. ISBN: 1-55009-106-9

Every year in the United States, approximately 180,000 women receive a diagnosis of breast cancer. Almost no one is untouched by an association with the disease. Clinicians who provide care for women with breast cancer realize that their patients have a surprising degree of scientific sophistication regarding their illness and are often well versed in the current literature on the disease. There is a good deal of advocacy for education and research in breast cancer and for bringing current medical opinion and information directly to the people affected by breast disease.

In 1998, the Food and Drug Administration approved a change in the labeling of tamoxifen to include its use for reducing the risk of invasive breast cancer in women who are at high risk for the disease. This change placed women with strong family histories of breast cancer, those with premalignant lesions on breast biopsy, and all women over the age of 60 in line for preventive treatment of breast cancer. Suddenly, primary care clinicians were being asked even more questions about the risk, prevention, and treatment of breast cancer.

The opportunities and controversies surrounding breast-cancer screening and prevention, as well as the growing advocacy for awareness of these issues, have made breast cancer a matter of concern for clinicians in all fields of medicine. Physicians in the primary specialties of surgery, internal medicine, gynecology, and family practice, as well as subspecialists in medical and surgical oncology, cancer genetics, and radiation oncology, all need concise, up-to-date information on breast disease. Singletary and Robb have effectively addressed this need in Advanced Therapy of Breast Disease. The book is well organized and discusses many aspects of breast disease, from the benign forms to the malignant.

Singletary and Robb, surgical specialists in breast cancer from the University of Texas M.D. Anderson Cancer Center, have compiled a series of reviews and articles from an international group of experts in breast cancer from Cambridge, England, to Palo Alto, California, and points in between, although the majority of the authors are colleagues from the M.D. Anderson Cancer Center. One weakness of this book is also a strength: the variety of authors causes heterogeneity in style, scientific opinion, and scholarly approach.

The book covers screening, breast self-examination, and breast-cancer prevention. Nipple discharge, gynecomastia, and breast pain are given separate chapters. There is attention to minimally invasive techniques for breast biopsy, the dissection of sentinel lymph nodes, and breast cancer in the elderly and during pregnancy. Aspects of reconstructive surgery and systemic therapy for early-stage, locally advanced, and metastatic breast cancer are also discussed. Most authors use an evidence-based approach even when discussing the more controversial topics related to breast care. Many sections include data from landmark clinical trials that have shaped current approaches to the management of breast cancer. The investigators who actually conducted these important clinical experiments have written many of the relevant chapters. Most, but not all, chapters are carefully referenced, and most include references as recent as 1998. Well-planned illustrations, tables, and photographs enhance the readability of the text. A CD-ROM version is included with the book, providing another way to use the material.

This book succeeds in its mission of guiding clinicians through the vast amount of literature on breast cancer and breast disease. It will help doctors and patients as they struggle with a rapidly changing field. As the editors state in the preface, “it is not intended to be a comprehensive review, but rather a unique collection of expert opinions from nationally acclaimed authorities in the field.” Both primary care practitioners and other physicians whose practices are devoted more exclusively to the prevention and treatment of breast cancer will value the ideas, opinions, and information imparted in Advanced Therapy of Breast Disease.

Paula Silverman, M.D.
University Hospitals of Cleveland, Cleveland, OH 44106