Donegan WL, Spratt JS: Cancer of the Breast 5th Edition. London, UK: Elsevier Science Ltd.; 2002. 1050pp

This is a very impressive and comprehensive text on the breast and breast cancer, which is now in its fifth edition. This book has already become a classic reference text and should grace the bookshelf of every professional looking after women and men with breast cancer. Any book in its fifth edition will of necessity carry its history with it. The Introduction, and chapters on benign breast disease, surgical treatment, staging, diagnosis, and pathology, include excellent historical accounts of the subject areas, and are elegant and well crafted.

The review of epidemiology was excellent, and presumably the next edition will include the emerging evidence from the Million Woman Study on hormone replacement therapy (HRT) and breast cancer risk. As a working clinician, I particularly enjoyed the excellent coverage of nutrition and breast disease (chapter 9), prevention (chapter 12), and exercise and weight control in prevention and rehabilitation (chapter 13). These provided a comprehensive review of evidence in the subject areas I am so often challenged on by my patients and friends, but of which I am relatively ignorant. 'What is your opinion, Doctor, of a healthy life-style to reduce the risk of breast cancer or breast cancer recurrence?' There was also a very comprehensive and up to date review of both hormone therapy and chemotherapy by authors of international repute, which I could not fault.

The coverage of molecular and biological aspects of breast cancer was on the whole very good, thorough, up to date and readable, and again provides an excellent reference text. I enjoyed the chapter on the genetic basis for the emergence and progression of breast cancer (10), and the molecular biology of breast cancer (11), although the latter needs some good illustrations to improve its comprehensibility. The chapter on cellular kinetics (19) was interesting but probably too long and somewhat outdated. The chapter on growth rates (21) definitely had too few pictures, and as this is an important and interesting area of research, and pertinent to the general breast cancer researcher, it needs to be re-interpreted in a more readable style. Too many mathematical equations in a text usually lead to inattention in the reader, and this important information needs to be better presented.

Where did the book disappoint? The chapter that covered prognosis (22) really needs to be separated and expanded to include information on the promise of the emerging technologies of molecular profiling, proteomics, and bio-informatics. Pregnancy and breast cancer is an important subject and I read the chapter with a patient in mind. 'Should I have another baby?' My 40-year-old patient asked me, who was a survivor of one pregnancy-associated breast cancer two years before. This chapter did not help me answer that question and needs to be expanded. All practising clinicians will have a small number of patients in whom this is a very important issue.

Overall, this comprehensive text surprises and delights much more than it disappoints, and I can highly recommend it.