Atlas of Breast Cancer, Second Edition

For many people, a picture is much more instructive andmemorable than text. The second edition of the Atlas of Breast Cancer isdesigned for such people. With 154 pages and 213 figures, it is a graphicoverview of the pathophysiology, diagnosis, and treatment of breast cancer.

The atlas is divided into 13 chapters, focusing on the major areas of breastcancer care, including anatomy, prevention, diagnosis, and treatment. Consistentwith the philosophy of an atlas, it is light on text and heavy on graphics. Thepages are filled with tables, graphs, and photographs. Chapters 1 through 4serve as an introduction to the topic, covering epidemiology, normal anatomy,breast cancer development, and prevention. Chapters 5 through 9 focus on thediagnosis of breast cancer, covering breast imaging, biopsy techniques, andpathology. In the imaging chapter, screening recommendations and themammographic features of breast cancer are discussed. The pathology chapterscover 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 cancertherapy including surgical treatment of early breast cancer, radiation concepts,and systemic treatment of both early-stage and advanced disease. In general, theindividual chapters are well written and provide a good overview of theirsubjects. The graphics enhance the text and include detailed captions. Themammographic and pathologic images are well chosen and clear.

The strengths of the book are its accessibility to the nonexpert as well asits comprehensive scope. In the preface, Dr. Hayes states that his primary goalwas to create a single source of information that could serve as a rapid updateon breast cancer for the nonexpert. I believe that he has achieved his goal. Thebook provides a relatively quick overview of the important areas of breastcancer care.

One shortcoming, however, lies in the breast conservation sections of thesurgical and radiation chapters. I found the discussion of the management ofinvasive tumors without an extensive in situ component to be somewhat confusingand, in some places, contradictory. Also, in the section on biopsies, theauthors state that radiation therapy is the recommended primary treatment evenwhen infiltrating tumor is present at the margin. Although the definition ofwhat constitutes a "clean" margin is somewhat controversial, mostphysicians would agree that the optimal situation is to not have tumor presentat the inked margin, even if this requires re-excision. In fact, the breastcancer guidelines of the National Comprehensive Cancer Network considerinvolved-margin status after re-excision to be a relative contraindication tobreast-conservation therapy. I am concerned that these points will not be clearto the nonexpert for whom this book is designed.

In conclusion, this atlas will be most valuable to physicians in training aswell as general physicians and nononcology specialists, especially those with aninterest in women’s health care. For these groups, it offers a concise updateon breast cancer care in an appealing format.