Breast Cancer

This is a comprehensive 701-page volume filled with excellent illustrations, photographs, tables, and schematics. The overall structure of the book takes the reader from molecular oncology issues through pathology, diagnosis, staging, treatment, and a discussion of special issues related to breast cancer and the care of breast cancer patients.

Dr. Roses has presented his text in a relatively unique question-and-answer format. Although some might be put off by this style at first, it helps to focus the reader on the aspects of controversy that underlie each question. Inherent in the questions is an uncertainty as to the answers, reflecting an intellectual honesty throughout the text.

Each chapter presents detailed information, clearly written by one or more well-recognized health-care providers in the breast cancer field. For example, the chapters on surgical resection and the various approaches to breast masses offer practical explanations by experts who tell “how they do it.” Adequate supporting data and clarifying illustrations are provided, and Dr. Roses describes with specificity the various procedures used to remove part or all of the breast tissue.

Even the experienced surgeon will enjoy reading the fine descriptions of breast anatomy and surgical technique. The vast expertise of the contributing authors, such as Drs. David Page and Michael Lagios, is reflected in the depth of information regarding atypical hyperplasia and in situ breast cancer. Such extensive narratives are extremely valuable in an era where the first of these pathologic entities has become so important prognostically and the second has become so controversial in its treatment.

In the chapter on molecular and cellular biology, written by Dr. Ann Hornby, the clear technical descriptions are again enhanced by excellent illustrations. This chapter provides outstanding background on such key biologic issues as cell cycle, protooncogenes, c-erb B2, and the emerging molecular biology of intra- and intercellular activities (particularly those associated with the invasive process and extracellular matrix degradation).

The chapter on radiologic assessment gives the reader an opportunity to see the comprehensive work-up of the breast from screening through diagnosis, and classic abnormal clinical findings accompany the useful descriptions and photographs in the chapter on clinical assessment. Clinical assessment is prepared in a comprehensive, detailed, and copiously illustrated and diagrammed chapter. This chapter is somewhat undermined, however, by a perfunctory algorithm of the management of solid breast masses. The sacrifice of completeness for simplicity diminishes the value of this section to the reader.

Another problem lies in the attempt to take a position on relatively difficult issues—such as appropriate surveillance following treatment of primary breast cancer—where there is inherent controversy and a lack of data. These unsupported discourses are of limited utility to the reader. There are also segments in which individual data are presented to the exclusion or minimization of larger more powerful clinical experiences.

The breast cancer nursing chapter falls short of the overall detail and technical level evident throughout most of the volume. A collection of patient-based descriptions and definitions related to operative procedure, pathology, postoperative changes, and side effects, this chapter appears incongruous with the rest of the book.

That said, the chapters are easy to read and nicely laid out. Moreover, for a text that is this extensive and comprehensive in nature, there are few internal inconsistencies. The redundancy from chapter to chapter is minimal and serves more to reinforce the critical and controversial elements than to bore the reader with repetition.

Excellent chapters on the biopsychosocial aspects of breast cancer complement the basic science and clinical aspects of the text. In general, this is an outstanding, comprehensive first edition that gives the reader the opportunity to understand the continuum of breast cancer from biology through screening, diagnosis, treatment, and adjuvant care.