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 its genre.
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 breast—a 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.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
