Cancer of the Breast
====================

* David R. McCready

**CANCER OF THE BREAST.** 4th edition. Edited by William L. Donegan and John S. Spratt. 860 pp. Illust. W.B. Saunders Company, Philadelphia; Harcourt Brace & Company Canada, Ltd., Toronto. 1995. $216. ISBN 0-7216-4694-8

This comprehensive text centres on the clinical management of women with breast cancer. Although it provides the reader with details on breast anatomy, benign breast disorders and adjuvant systemic and radiation therapies, its strength lies in its emphasis on the surgical aspects of diagnosis and treatment. Breast cancer management has changed over the years, and the evolution of surgical decision making, multidisciplinary care and current state-of-the-art practice is summarized in this up-to-date text.

On the surface the book follows a standard format. The first chapters generically describe the anatomy, physiology and benign disorders of the breast but also concentrate on the spectrum of information pertinent to those studying breast cancer. The middle section tells the reader about the disease, from epidemiologic and etiologic viewpoints, detection and diagnosis, through the surgical treatment of the disorder to adjuvant radiation and systemic therapies. The last portion of the book deals with specific management problems and includes nursing care, breast reconstruction and malpractice liability.

However, the chapters could also be grouped into three different categories. The first category comprises the core chapters. They form the backbone of the text and most were written by the editors. The second category includes topics that essentially epitomize the multidisciplinary nature of breast cancer and are essential to current clinical management. These chapters include breast imaging, radiotherapy, chemotherapy and endocrine therapy of breast cancer. Nursing care, psychosocial factors and breast reconstruction also fall into this category. Interspersed through the book, forming a third category are “specialty chapters,” based on such topics as breast cancer cell kinetics and statistical methods. They make the book unique since they include some topics that have not been included in other texts. Yet the reader uninterested in their minutiae could easily skip these chapters without prejudice to the flow and understanding of the book.

The core chapters reflect the surgical expertise of the editors with clear text, embellished with appropriate charts and tables to illustrate the major truths and controversies. They have included their own substantial personal experience as well as the significant randomized trials that are pertinent in clinical decision making. In the section on surgical treatment of early (stages I and II) invasive carcinoma, the authors describe, in historical order, radical, extended radical, modified radical and simple mastectomies, and finally breast-conserving operations. I suggest, however, that by leaving breast-conserving operations to the end, the authors make a subtle, but incorrect, suggestion that extensive extirpative surgery may provide better surgical results than breast conservation. If the breast-conservation section were to be discussed first, the reader would get the impression that in most cases, breast conservation is preferable, not just to be undertaken if the patient declines modified radical mastectomy. Furthermore, descriptions of radical and extended radical mastectomies should be left to the end since they are now rarely performed.

Two specialty chapters deserve mention. The chapter on breast-cancer growth rates is an excellent reference for those who must research this topic. It includes much of the world’s literature on this topic. Some aspects are only for the mathematically inclined reader, but both the science and the practicalities are well documented and described.

The chapter by Leslie Hughes is extremely interesting and thought-provoking. It stimulates the reader to think about benign breast disorders as part of the natural progression of the breast through a woman’s life and suggests that many of the conditions that we tend to treat as diseases can be normal events in the breast life cycle.

This is an excellent textbook that focuses on the clinical management of patients with benign and, especially, malignant disorders of the breast. It has sufficient detail to be an important reference for those with special interest in breast diseases, but it is also readable, with substantial but general overviews of important topics. Many chapters provide a unique source of information and authoritative detail. General surgeons, oncologists with an interest in breast diseases, family physicians, and medical and radiation oncologists will all find this book valuable. It will be an asset to any general medical library and will serve as an excellent entry point for students wishing to research specific topics in breast cancer. The authors are to be congratulated for their work and for their dedication to the surgical advancement and treatment of women with breast cancer.