(+++) THE BEST BREAST CARE

Dr. Susan Love’s Breast Book, 4th edition. By Susan M. Love, M.D., with Karen Lindsey. Da Capo. $22.

     So fact-packed that it is likely to intimidate the average reader, the new edition of Dr. Susan Love’s Breast Book contains more than 600 pages – in small type – of facts on breast health, common problems, screening and prevention, breast-cancer diagnosis and treatment, and the future of research in the field.  Amply illustrated, filled with tables and diagrams, packed with statistics, it is a highly comprehensive book and an invaluable tool, especially for women concerned about or suffering from breast cancer.  It is not without flaws: its sheer size makes it daunting, especially for women already traumatized by a recent cancer diagnosis; some of the language will be too technical for many readers; and the intentionally clinical writing lacks any sense of connectedness to patients as people rather than collections of parts.  If you accept these flaws before picking the book up, and are not challenged by its length and heft (more than two pounds as a paperback), you will find here the best collection of medical data on breast health you can buy.

     The statistics on breast cancer are enough to make any woman cringe: 600 new cases diagnosed in the U.S. every day, and more than 100 deaths of breast-cancer patients.  But cancer is by no means the only breast affliction.  Dr. Susan Love, a surgeon and clinical professor at UCLA, writes about breast development, plastic surgery (both enlargement and reduction), breast infections, nipple problems and more before even starting to discuss cancer.  Like everything in the book, these discussions are quite detailed: for example, Dr. Love not only explains what happens in mammography but also gives a table listing all six categories of breast-imaging reporting and explaining what each one means; and when discussing one precancerous condition, ductal carcinoma in situ (DCIS), she presents diagrams of three types (papillary, cribriform and comedo), compares DCIS with lobular cancer in situ (LCIS), and explains why surgery may be indicated but chemotherapy is not.

     This is not a book simply to pick up and read.  The early pages, on breast development, will be of interest to every woman; so will the discussions of diagnostic imaging (with examples) and self-examination.  But most women who buy this book will likely do so because of a particular problem or concern.  The book is best used by looking up that concern in the index, which is quite thorough, and reading only the relevant pages.  Even then, some material may be of little interest: not all women with Paget’s disease of the breast will be interested to learn that the condition was first observed in 1307 by John of Arderne – in a male priest.  Dr. Love’s understanding of the breast and its diseases is encyclopedic, and her book is an enormously useful tool to help women participate in their own treatment.  It is neither easy nor pleasant to read, but its importance can scarcely be overestimated.