Morrow M, Jordan VC: Managing Breast Cancer Risk. 1st Edition. Hamilton, Ontario: BC Decker Inc

'Prevention is better than healing because it saves the labour of being sick'

Thomas Adams, seventeenth-century physician

Twenty years ago there was little interest in defining personal breast cancer risk or insight into what to offer women at high risk of breast cancer. This situation has changed markedly, partly because of the discovery of the importance of mutations in predisposing genes for breast cancer and partly because of the growing realisation that there were management options that might reduce the risk of tumour development and that breast cancer was potentially preventable. Prevention is important because although breast cancer death rates are declining in the Western world, the incidence of the disease continues to increase. In the United Kingdom there are a total of 40,000 new cases of breast cancer per year, a 25% increase in 10 years.

Although most women who present with breast cancer today will be cured by the judicious use of local and systemic therapies, the trauma of the diagnosis and treatment causes the 'labour of being sick', in the words of Thomas Adams. The drive for early detection and prevention also comes from increased awareness of the importance of family history and other breast cancer risk factors among women and in the medical profession. From few interested in risk and prevention 20 years ago, most centres now have risk clinics and most breast cancer professionals are aware of the problem. Managing Breast Cancer Risk is a timely book since many specialities are involved in the management of women at risk and it brings several management trends together.

Managing Breast Cancer Risk is divided into logical sections covering the evaluation of breast cancer risk and the management of that risk. The main risk assessment tools are discussed in the first chapter and the risk factors taken into account when using these different tools are introduced. The factors are helpfully stratified into those conferring a high increase, a moderate increase and a slight increase in risk. This lays the foundation well for the remainder of the first section, which deals with these risk factors in turn. The chapters each conclude with a practical section summarising how the consideration of the risk factors presented in the chapter impacts on the management of the patient. One chapter of the first section compares breast cancer risk with the risks of other major health-threatening conditions such as cardiovascular disease, and serves as a reminder to the health care professional that other health issues should not be neglected.

The chapters on risk management assume minimal or no prior knowledge of the subject, and the principles are well explained. The evidence (or lack thereof) to support different imaging modalities for screening is well discussed with excellent illustrations. The section on pharmacological risk reduction outlines the molecular biology of cancer, and this enables the reader to understand the rationale and effects of chemoprevention. The chapter on surgical risk reduction is excellent, as is the section on reconstruction, which will provide the non-surgical reader a good overview of available techniques and their pros and cons.

The book is on the whole very readable and clear. The CD-ROM is likely to be helpful for readers who wish to search for particular topics rapidly but does not offer more information than the book.