The Breast: Comprehensive Management of Benign and Malignant Diseases, Second Edition

This second edition of the text edited by Bland and Copelandrepresents a comprehensive reference that reviews the history, pathobiology, andcurrent clinical management of diseases of the breast. Much more than a bookabout breast cancer, it covers such diverse topics as the history of the therapyof breast disease (from ancient times to the modern era of molecular biology),as well as medical and legal issues specific to the care of breast cancer. Assuch, it contains 24 sections and 94 chapters, and in terms of importantinformation in breast disease, there is virtually no topic left uncovered.

The intended audience consists of "young clinicians andscientists who wish to acquire a fundamental knowledge of basic and clinicallaboratory concepts and techniques that will complement their training."Illustrations are plentiful, and each chapter’s bibliography is extensive.

A substantial portion of the text is written by academicsurgeons and pathologists, who include much detail on historical surgicaloperations and current surgical and reconstructive techniques. Experts incertain topics, including the growth regulation of breast epithelium,angiogenesis, radiation therapy, chemotherapy, and hormonal therapy, havecontributed to the multidisciplinary approach, but it is the attention tosurgical technique and methodology that distinguishes this text from others ofits genre.

One particularly good section describes the natural history,epidemiology, genetics, and syndromes of breast cancer. This section approachesits topics from a clinically oriented viewpoint, relaying practical informationregarding genetic counseling and patterns of recurrence. The section on thescreening and diagnosis of breast cancer includes such basic information as howto do a breast examination on a level that can be understood and learned by amedical student or other novice practitioner. The same section includes acomprehensive chapter on breast imaging, which will be helpful to individualswith an interest in the diagnosis and treatment of breast diseases who are notexperts in radiology.

A special section is dedicated to the management of unusual andadvanced presentations of breast cancer. The topics covered in this sectioninvolve clinical situations that are commonly referred to academic medicalcenters. Included here is a chapter on recurrence in the augmented orreconstructed breast—a subject not commonly addressed in texts of breastdisease. In addition, there is a well-written chapter on the patient whopresents with axillary nodal metastases of an unknown primary, which emphasizesthe probability of the existence of breast cancer with an occult primary. Thischapter outlines a reasonable therapeutic approach to this rare entity.

The length and breadth of this work are among its assets;however, the sheer number of chapters and contributing authors do lead topresentations with conflicting opinions, with no discussion to allow the readerto weigh the relative merits of each argument. For example, a section dedicatedto the therapeutic value of axillary node dissection suggests that chemotherapyis generally not indicated for node-negative breast cancer and should only beused in the setting of a clinical trial. This outdated view contradicts thecurrent standard of practice, and its inclusion is of concern because a novicereader may see this statement and then fail to appropriately refer a patient fora discussion on the pros and cons of adjuvant chemotherapy. A more balancedapproach is outlined in a later chapter on adjuvant systemic chemotherapy.

Another example of contradiction concerns the treatment ofipsilateral breast recurrence after conservative treatment. An early chapterdiscussing lumpectomy and axillary dissection states that after localrecurrence, "if satisfactory cosmesis and local disease control can beachieved by repeat lumpectomy, there is no reason for mastectomy." Nodiscussion explains that this is not the current standard of care. Furthermore,this statement is directly contradicted in a later chapter that states, "ifthe patient has previously undergone lumpectomy and axillary dissection followedby radiotherapy, the appropriate local therapy is simple mastectomy."

These are but two examples; there are additional areas ofcontroversy that are handled not by a simultaneous presentation of the twoarguments, but by the inclusion of two completely opposite opinions in differentsections of the text.

In summary, The Breast: Comprehensive Management of Benign andMalignant Diseases represents an enormous undertaking with "the specificgoal of assimilating and collating contemporary basic and clinical scientificdata essential to the multidisciplinary principles and practice for thetreatment of disease of the breast." It is readable, well organized,excellently illustrated, and likely represents the most complete reference ondiseases of the breast in existence today. The reader should recognize thatthere are contradictions and some outdated opinions presented within, but thisdoes not make the reference less valuable to the clinician with a stronginterest in breast diseases.