There are many textbooks dealing with breast disease that strive to be comprehensive. This addition, as implied in the title, focuses primarily on the diagnosis and treatment of breast cancer. The contributions of the various expert authors deliver a text that is concise and readable on many levels. Because of its multidisciplinary focus this text is of interest to readers in many medical specialties, including surgery, radiology, and medical and radiation oncology.
The book is divided into 3 major sections. The first section covers a broad range of topics, including diagnosis and treatment; the second section examines specific clinical situations; and the third looks at some current controversies.
In the first section, titled “clinical management,” there are 13 chapters. The first 4 of these relate to breast cancer diagnosis with those on breast imaging and breast biopsy techniques being particularly up to date and complete. The fourth chapter “clinical classifications of breast cancer” appears unnecessary and confusing. The information in this chapter is redundant and at times contradicts that of similar material covered in more detail in other chapters. For instance, M.H. Torosian, the author of this chapter, states that mastectomy is indicated for the management of Paget’s disease, whereas in the following chapter on breast conservation, lumpectomy is quite legitimately stated to be an option for managing Paget’s disease. In discussing the management of inflammatory breast cancer, Torosian states, inaccurately, that axillary dissection is not typically performed in patients with inflammatory carcinoma. Torosian’s statement is not consistent with current standards of care in the treatment of inflammatory breast cancer. These standards are supported later in the book by other authors who advise axillary dissection in this group of patients.
The next 6 chapters examine the treatment of primary breast cancer, including surgery, ablative and reconstructive, radiation and systemic treatment. These are all excellent chapters, particularly the one (chapter 6) that looks at the use of mastectomy. Chapter 11 is a useful dissertation on the role of surgery for metastatic breast chancer. It is followed by a detailed and interesting review of molecular genetics relating to breast cancer development, which ties in nicely with the final chapter in the book, examining immunotherapy and gene therapy.
The second section covers particular clinical scenarios, including relatively common situations such as use of neoadjuvant chemotherapy, treatment of local-regional tumour recurrence and nipple discharge as well as the more uncommon management problems of breast cancer in pregnancy, axillary metastases with an unidentified breast primary, and uncommon primary breast tumours such as sarcoma and lymphoma. These topics are all well covered in an organized and comprehensive manner. I found this section to be the most valuable and very easy to read.
The final section comprises 5 chapters that look at current controversies and research. The first of these is a well-balanced discussion of the use of breast conservation without radiotherapy. The next 2 chapters are particularly relevant to the emergence of sentinel lymph-node biopsy: one reviews the use of axillary dissection in breast cancer; the second covers the diagnosis and management of internal mammary nodal metastases. The final 2 chapters relate to the use of high-dose chemotherapy and novel gene therapies. These are well written and complement earlier chapters.
Generally, this book is a positive contribution to the ever-burgeoning library on breast cancer. I would like to have seen a chapter reviewing hereditary breast cancer, including risk-reduction strategies. The book is well referenced, concise and easy to read, and I believe will be of value to many different practitioners, including physicians in training.