Since the initial publication of Dr. Susan Love's Breast Book 5 years ago, every oncologist has seen this guide in the arms of many patients. When I read the cover to the second edition, stating that the book was "fully revised," I could not imagine how the universally excellent first edition could have been improved. The original text, in fact, remains essentially unchanged in the second edition. What has changed is the addition of some 138 pages addressing recent developments or expanding on various issues.
The New York Times calls this book "a down to earth guide... the bible of women with breast cancer." And yet, it is much more than that. Of the 515 pages (followed by 100 pages of appendices), only half are devoted to the diagnosis, treatment, and aftermath of breast cancer. The book begins with matters concerning the healthy breast, including a useful chapter on breast- feeding. The chapter, including a diagram and brand-name reference, describes a device used to simulate breast-feeding in women who have not been pregnant, which could be useful for an adoptive mother. This is but one example of information with which even the seasoned practitioner may be unfamiliar.
In her chapter on cosmetic breast surgery, Love describes the techniques used and indications for the typical aesthetic operations, and concludes with a philosophical approach to decision-making about plastic surgery. It is the next section, "Common Problems of 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 to women with a breast cancer history. Using the concepts and terminology in this section, the oncologist could lend greater accuracy and reassurance to the discussion of breast pain with patients. Since research and factual data on breast pain are so sparse, the chapter addresses the totality of scientific knowledge in this area.
The chapter on lumps and lumpiness is reliable, comforting, and highly informational. As Love states in the introduction, "The most frightening thing about breast problems really is not the possibility of cancer. The most frightening thing is not knowing, not understanding what is happening to one's own body...knowledge is power. With this book, I hope to give readers some of that power." Love succeeds in her mission to impart knowledge with a scientific, amusing, and readable style.
The book also contains a thorough review of all the imaging tests used 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 chemotherapeutic drugs, extra resources for additional reading, regional support organizations for cancer in general and breast cancer in particular, the comprehensive cancer centers in the United States, the charter divisions of the American Cancer Society, the list of references footnoted in the text for each chapter, and a glossary of common terms used by physicians. It is to Love's credit that she generally avoids such words or otherwise briefly explains them each time they are mentioned. Finally, a thorough index makes the lengthy work serviceable to the average reader with specific problems.
Love also is to be congratulated for the large, well-written section on randomized trials, which discusses the value of previous completed trials to modern breast cancer treatment and the benefits of entering randomized clinical trials for recently diagnosed patients. Love makes such a convincing case that readers previously unfamiliar with "randomized clinical trials" will be encouraged to bring up the issue with their clinicians. The future of breast cancer research will, thus, benefit.
Although it might be of limited interest to the breast cancer patient, I was personally taken by the new, last chapter, "The Politics of Breast Cancer," wherein Love discusses the "new money" sources for breast cancer research during the past 5 years and the behind-the-headlines workings of the committed women and their groups who deserve much of the credit for obtaining this funding.
Not a day passes when, in explaining various issues to my own patients, I am not mindful of the turn of phrases found in Dr. Susan Love's Breast Book.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
