This second edition of the text edited by Bland and Copeland
represents a comprehensive reference that reviews the history, pathobiology, and
current clinical management of diseases of the breast. Much more than a book
about breast cancer, it covers such diverse topics as the history of the therapy
of 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. As
such, it contains 24 sections and 94 chapters, and in terms of important
information in breast disease, there is virtually no topic left uncovered.
The intended audience consists of "young clinicians and
scientists who wish to acquire a fundamental knowledge of basic and clinical
laboratory 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 academic
surgeons and pathologists, who include much detail on historical surgical
operations and current surgical and reconstructive techniques. Experts in
certain topics, including the growth regulation of breast epithelium,
angiogenesis, radiation therapy, chemotherapy, and hormonal therapy, have
contributed to the multidisciplinary approach, but it is the attention to
surgical technique and methodology that distinguishes this text from others of
One particularly good section describes the natural history,
epidemiology, genetics, and syndromes of breast cancer. This section approaches
its topics from a clinically oriented viewpoint, relaying practical information
regarding genetic counseling and patterns of recurrence. The section on the
screening and diagnosis of breast cancer includes such basic information as how
to do a breast examination on a level that can be understood and learned by a
medical student or other novice practitioner. The same section includes a
comprehensive chapter on breast imaging, which will be helpful to individuals
with an interest in the diagnosis and treatment of breast diseases who are not
experts in radiology.
A special section is dedicated to the management of unusual and
advanced presentations of breast cancer. The topics covered in this section
involve clinical situations that are commonly referred to academic medical
centers. Included here is a chapter on recurrence in the augmented or
reconstructed breasta subject not commonly addressed in texts of breast
disease. In addition, there is a well-written chapter on the patient who
presents with axillary nodal metastases of an unknown primary, which emphasizes
the probability of the existence of breast cancer with an occult primary. This
chapter 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 to
presentations with conflicting opinions, with no discussion to allow the reader
to weigh the relative merits of each argument. For example, a section dedicated
to the therapeutic value of axillary node dissection suggests that chemotherapy
is generally not indicated for node-negative breast cancer and should only be
used in the setting of a clinical trial. This outdated view contradicts the
current standard of practice, and its inclusion is of concern because a novice
reader may see this statement and then fail to appropriately refer a patient for
a discussion on the pros and cons of adjuvant chemotherapy. A more balanced
approach is outlined in a later chapter on adjuvant systemic chemotherapy.
Another example of contradiction concerns the treatment of
ipsilateral breast recurrence after conservative treatment. An early chapter
discussing lumpectomy and axillary dissection states that after local
recurrence, "if satisfactory cosmesis and local disease control can be
achieved by repeat lumpectomy, there is no reason for mastectomy." No
discussion explains that this is not the current standard of care. Furthermore,
this statement is directly contradicted in a later chapter that states, "if
the patient has previously undergone lumpectomy and axillary dissection followed
by radiotherapy, the appropriate local therapy is simple mastectomy."
These are but two examples; there are additional areas of
controversy that are handled not by a simultaneous presentation of the two
arguments, but by the inclusion of two completely opposite opinions in different
sections of the text.
In summary, The Breast: Comprehensive Management of Benign and
Malignant Diseases represents an enormous undertaking with "the specific
goal of assimilating and collating contemporary basic and clinical scientific
data essential to the multidisciplinary principles and practice for the
treatment of disease of the breast." It is readable, well organized,
excellently illustrated, and likely represents the most complete reference on
diseases of the breast in existence today. The reader should recognize that
there are contradictions and some outdated opinions presented within, but this
does not make the reference less valuable to the clinician with a strong
interest in breast diseases.