Annals of Oncology 15:845, 2004
© 2004 European Society for Medical Oncology
Breast Cancer Management
J. M. Nabholtz, K. Tonkin, D. M. Reese, M. S. Aapro, A.U. Budzar (eds). Lippincott Williams and Wilkins Publishers, City, 2nd edition, Year, 624 pp, US$159.00.Breast cancer clinical management is literally a world where news and complexity are the key words. This book is a valid attempt to introduce some order into the breadth of the subject by presenting itself as a guide for the clinical oncologist.
Contents cover the treatment of breast cancer, from early stage to metastatic disease and supportive care, to scanning the breast cancer literature. Two sections are dedicated to the emerging clinical and preclinical approaches, such as antiangiogenic therapy, gene therapy and DNA microarray analysis. Overall this work is a very complete and comprehensive reference guide. I would add that it is a little bit dispersive: the style adopted is often to present a topic as a list of studies described in detail.
All of the data are well interpreted using the ‘evidence-based medicine’ approach. The authors have introduced paragraphs entitled ‘summary of evidence’ at the end of important chapters, like for example those on adjuvant treatment of node-negative and node-positive breast cancer, where the clinician can quickly access an overview of key treatment points.
This book has resulted from the work of the Breast Cancer International Research Group (BCIRG), a translational cooperative group, oriented to help the clinician to use new therapies through scientific and academic control and globalization of research. The BCIRG evaluates the characteristics of clinical studies by adopting a five-level system to categorize evidence. Such a system is a very useful tool for the physician who has to make clinical decisions by weighing up literature data.
Globally all the topics are developed extensively. The chapter on clinical data analysis with an overview of future perspectives is interesting. A detailed explanation is given of the Response Evaluation Criteria In Solid Tumors (RECIST), which are adopted today for all studies with an evaluation of response as the primary or secondary end point. The former World Health Organization criteria are accurately considered alongside the RECIST ones, making this topic easily accessible to everybody. The chapter dedicated to screening and prevention is weaker, as the discussion is limited to chemoprevention with tamoxifen, and in the screening chapter there is no mention of the recent debate on the role of breast magnetic resonance imaging. Another partially covered topic is sentinel node biopsy and how to manage findings of micrometastasis or isolated tumor cells.
Overall this book represents a milestone in breast cancer literature due to the mass of updated bibliography and the modern idea of rationalizing the clinical data to create an evidence-based ‘method of work’ for the clinical oncologist.
Bergamo, Italy
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