Book Review: Dr. Susan Love's Breast Book, 2nd Edition

Since the initial publication of Dr. Susan Love's Breast Book5 years ago, every oncologist has seen this guide in the armsof many patients. When I read the cover to the second edition,stating that the book was "fully revised," I could notimagine how the universally excellent first edition could havebeen improved. The original text, in fact, remains essentiallyunchanged in the second edition. What has changed is the additionof some 138 pages addressing recent developments or expandingon various issues.

The New York Times calls this book "a down to earthguide... the bible of women with breast cancer." And yet,it is much more than that. Of the 515 pages (followed by 100 pagesof appendices), only half are devoted to the diagnosis, treatment,and aftermath of breast cancer. The book begins with matters concerningthe healthy breast, including a useful chapter on breast- feeding.The chapter, including a diagram and brand-name reference, describesa device used to simulate breast-feeding in women who have notbeen pregnant, which could be useful for an adoptive mother. Thisis but one example of information with which even the seasonedpractitioner may be unfamiliar.

In her chapter on cosmetic breast surgery, Love describes thetechniques used and indications for the typical aesthetic operations,and concludes with a philosophical approach to decision-makingabout plastic surgery. It is the next section, "Common Problemsof the Breast," however, that is the gem of medical explanation.Breast pain/sensitivity/discomfort is the bane of many oncologists'professional existence, as it is common and so distressing towomen with a breast cancer history. Using the concepts and terminologyin this section, the oncologist could lend greater accuracy andreassurance to the discussion of breast pain with patients. Sinceresearch and factual data on breast pain are so sparse, the chapteraddresses the totality of scientific knowledge in this area.

The chapter on lumps and lumpiness is reliable, comforting, andhighly informational. As Love states in the introduction, "Themost frightening thing about breast problems really is not thepossibility of cancer. The most frightening thing is not knowing,not understanding what is happening to one's own body...knowledgeis power. With this book, I hope to give readers some of thatpower." Love succeeds in her mission to impart knowledgewith a scientific, amusing, and readable style.

The book also contains a thorough review of all the imaging testsused to diagnose breast cancer, both clinically and experimentally.As usual, Love is able to simplify complicated ideas, terminology,and multistep procedures.

The 100 pages of appendices include information on chemotherapeuticdrugs, extra resources for additional reading, regional supportorganizations for cancer in general and breast cancer in particular,the comprehensive cancer centers in the United States, the charterdivisions of the American Cancer Society, the list of referencesfootnoted in the text for each chapter, and a glossary of commonterms used by physicians. It is to Love's credit that she generallyavoids such words or otherwise briefly explains them each timethey are mentioned. Finally, a thorough index makes the lengthywork serviceable to the average reader with specific problems.

Love also is to be congratulated for the large, well-written sectionon randomized trials, which discusses the value of previous completedtrials to modern breast cancer treatment and the benefits of enteringrandomized clinical trials for recently diagnosed patients. Lovemakes such a convincing case that readers previously unfamiliarwith "randomized clinical trials" will be encouragedto bring up the issue with their clinicians. The future of breastcancer research will, thus, benefit.

Although it might be of limited interest to the breast cancerpatient, I was personally taken by the new, last chapter, "ThePolitics of Breast Cancer," wherein Love discusses the "newmoney" sources for breast cancer research during the past5 years and the behind-the-headlines workings of the committedwomen and their groups who deserve much of the credit for obtainingthis funding.

Not a day passes when, in explaining various issues to my ownpatients, I am not mindful of the turn of phrases found in Dr.Susan Love's Breast Book.