Early Breast Cancer: From Screening to Multidisciplinary Management
http://www.100md.com
《新英格兰医药杂志》
The detection of breast cancer early in its natural history is one of the major objectives of cancer control. However, mere detection is not sufficient. A successful outcome demands the application of skills at every level of the process — organizing screening programs, administering screening tests, diagnosing the abnormalities detected, and treating the cancer. Early Breast Cancer attempts to cover all these aspects, from mammography to adjuvant therapy. The result is a large book with 79 contributors. The book's editors describe it as an "intermediate-sized text which should be of value not only to established practitioners but also trainees working in the subspecialty of breast diseases." That the editors have directed their book to trainees explains a great deal, since one would expect that most established practitioners would know much of what is discussed in the chapters that are relevant to their practice, and they probably would not be very interested in the chapters that are relevant to other specialists. Nevertheless, trainees who will be seeing patients with early breast cancer should at least have a smattering of knowledge about the total range of issues considered.
The underlying premise in nearly all the chapters is that the detection of impalpable breast cancers is important. In practice, all breast-screening programs in technically advanced countries depend on mammography. So this volume is directed to readers in such countries and not to those in developing countries with limited resources that dictate other approaches to early detection, even as their countries are faced with an increasing breast-cancer problem.
(Figure)
Color-Enhanced Mammogram Showing a Scirrhous Tumor.
Custom Medical Stock Photo.
Given that most of the chapters deal with technical issues, there is limited space for in-depth critical reviews. Of the chapters that attempt such a review, I found that the one by Powles and Chang on endocrine prevention of breast cancer was the most illuminating. The authors recognize that using the incidence of breast cancer as the end point for chemoprevention trials is not sufficient, especially when, as in the NSABP P-1 trial of the National Surgical Adjuvant Breast and Bowel Project, the cancers prevented are largely estrogen-receptor–positive cancers with a good prognosis. It is not yet clear, however, that trials initiated since then will have the statistical power (or forbearance by their monitoring committees) to use a mortality end point. If they do not, the doubts raised by Powles and Chang about the effectiveness of such therapy will remain.
This book was produced in the United Kingdom, and most of its authors are from England. Seven authors are from the United States, 16 are from Italy, and 1 is from Australia. This means that nearly all the authors based their writing on their extensive experience in the U.K. National Health Service Breast Screening Programme, which is one of the best organized programs in the world. Some readers may presume that the authors' experience is not relevant to screening and managing breast cancer in the United States and Canada. In my view, that presumption would be wrong, because in the United Kingdom, expert committees were set up to establish standards for screening as well as pathology, and physicians there have some of the most extensive experience with the use of minimal surgery for breast cancer. Therefore, the standards espoused by the authors of the various chapters are important benchmarks against which North American specialists and programs can measure their own performance. For this reason alone, the book demands space on many bookshelves, because it is possibly the best reference book to date on the subjects it covers.
Anthony B. Miller, M.B., F.R.C.P.
University of Toronto
Toronto, ON M5S 1A8, Canada
ab.miller@sympatico.ca(Second edition. Edited by)
The underlying premise in nearly all the chapters is that the detection of impalpable breast cancers is important. In practice, all breast-screening programs in technically advanced countries depend on mammography. So this volume is directed to readers in such countries and not to those in developing countries with limited resources that dictate other approaches to early detection, even as their countries are faced with an increasing breast-cancer problem.
(Figure)
Color-Enhanced Mammogram Showing a Scirrhous Tumor.
Custom Medical Stock Photo.
Given that most of the chapters deal with technical issues, there is limited space for in-depth critical reviews. Of the chapters that attempt such a review, I found that the one by Powles and Chang on endocrine prevention of breast cancer was the most illuminating. The authors recognize that using the incidence of breast cancer as the end point for chemoprevention trials is not sufficient, especially when, as in the NSABP P-1 trial of the National Surgical Adjuvant Breast and Bowel Project, the cancers prevented are largely estrogen-receptor–positive cancers with a good prognosis. It is not yet clear, however, that trials initiated since then will have the statistical power (or forbearance by their monitoring committees) to use a mortality end point. If they do not, the doubts raised by Powles and Chang about the effectiveness of such therapy will remain.
This book was produced in the United Kingdom, and most of its authors are from England. Seven authors are from the United States, 16 are from Italy, and 1 is from Australia. This means that nearly all the authors based their writing on their extensive experience in the U.K. National Health Service Breast Screening Programme, which is one of the best organized programs in the world. Some readers may presume that the authors' experience is not relevant to screening and managing breast cancer in the United States and Canada. In my view, that presumption would be wrong, because in the United Kingdom, expert committees were set up to establish standards for screening as well as pathology, and physicians there have some of the most extensive experience with the use of minimal surgery for breast cancer. Therefore, the standards espoused by the authors of the various chapters are important benchmarks against which North American specialists and programs can measure their own performance. For this reason alone, the book demands space on many bookshelves, because it is possibly the best reference book to date on the subjects it covers.
Anthony B. Miller, M.B., F.R.C.P.
University of Toronto
Toronto, ON M5S 1A8, Canada
ab.miller@sympatico.ca(Second edition. Edited by)