For many people, a picture is much more instructive and
memorable than text. The second edition of the Atlas of Breast Cancer is
designed for such people. With 154 pages and 213 figures, it is a graphic
overview of the pathophysiology, diagnosis, and treatment of breast cancer.
The atlas is divided into 13 chapters, focusing on the major areas of breast
cancer care, including anatomy, prevention, diagnosis, and treatment. Consistent
with the philosophy of an atlas, it is light on text and heavy on graphics. The
pages are filled with tables, graphs, and photographs. Chapters 1 through 4
serve as an introduction to the topic, covering epidemiology, normal anatomy,
breast cancer development, and prevention. Chapters 5 through 9 focus on the
diagnosis of breast cancer, covering breast imaging, biopsy techniques, and
pathology. In the imaging chapter, screening recommendations and the
mammographic features of breast cancer are discussed. The pathology chapters
cover the processing of breast biopsies as well as breast cancer pathology.
Benign breast disorders are discussed in a separate chapter.
Chapters 10 through 13 cover the local and systemic aspects of breast cancer
therapy including surgical treatment of early breast cancer, radiation concepts,
and systemic treatment of both early-stage and advanced disease. In general, the
individual chapters are well written and provide a good overview of their
subjects. The graphics enhance the text and include detailed captions. The
mammographic and pathologic images are well chosen and clear.
The strengths of the book are its accessibility to the nonexpert as well as
its comprehensive scope. In the preface, Dr. Hayes states that his primary goal
was to create a single source of information that could serve as a rapid update
on breast cancer for the nonexpert. I believe that he has achieved his goal. The
book provides a relatively quick overview of the important areas of breast
One shortcoming, however, lies in the breast conservation sections of the
surgical and radiation chapters. I found the discussion of the management of
invasive tumors without an extensive in situ component to be somewhat confusing
and, in some places, contradictory. Also, in the section on biopsies, the
authors state that radiation therapy is the recommended primary treatment even
when infiltrating tumor is present at the margin. Although the definition of
what constitutes a "clean" margin is somewhat controversial, most
physicians would agree that the optimal situation is to not have tumor present
at the inked margin, even if this requires re-excision. In fact, the breast
cancer guidelines of the National Comprehensive Cancer Network consider
involved-margin status after re-excision to be a relative contraindication to
breast-conservation therapy. I am concerned that these points will not be clear
to the nonexpert for whom this book is designed.
In conclusion, this atlas will be most valuable to physicians in training as
well as general physicians and nononcology specialists, especially those with an
interest in women’s health care. For these groups, it offers a concise update
on breast cancer care in an appealing format.