(++++) COPING WITH BREAST CANCER

Dr. Susan Love’s Breast Book, Fifth Edition. By Susan M. Love, M.D., with Karen Lindsey. Da Capo. $22.

The Pink Ribbon Diet: A Revolutionary New Weight Loss Plan to Lower Your Breast Cancer Risk. By Mary Flynn, R.D., and Nancy Verde Barr. Da Capo. $16.95.

     With all the attention that breast cancer receives in books and the media, you would think it is by far the greatest killer of women, but in fact it is not even in the top five. The exact order of reasons for death depends on how statistics are used: whether referring to all women, women of a certain age, women in the United States or worldwide, and many other factors. But no matter how you look at them, statistics show that cardiovascular disease is the number one killer of women as well as men, and that such causes as flu, pneumonia and HIV/AIDS are as deadly to women as breast cancer – or more so. Yet breast cancer has a very strong medical and political constituency drawing attention to it, and its longtime reputation as a disfiguring disease (or a disease treatable only through disfiguring), plus the sexual elements associated with breasts as opposed to, say, hearts or lungs, maintain this form of cancer in the spotlight. And for women who have breast cancer – or simply want to know more about it to help a friend or relative manage it – there has been no better source for the past 20 years than Dr. Susan Love’s Breast Book. Now in its fifth edition and packed with new information on diagnosis, treatment and scientific research, the book has grown into a 700-plus-page heavyweight tome (including more than 100 pages of appendices and notes). There is simply an enormous amount of material here, from the latest diagnostic techniques to a wide variety of treatment options to the possibility of recurrence – and how to live with it. From information on normal breast development to discussions of sexuality after a breast-cancer diagnosis, Love – clinical professor of surgery at UCLA and president of a research foundation that bears her name – gives information and advice in forthright, plainspoken language. Much of the material here uses medical and scientific terminology and may therefore be hard for some readers to follow, but the information is so valuable that the effort is worth making. Here women will find out how risk factors are used to evaluate the chance of breast cancer – and where those factors fall short; what forms of detection are now available, what their advantages and disadvantages are, and why early discovery of breast cancer does not always improve survival chances; what sorts of breast cancer exist (there are five different types now acknowledged), and what forms of treatment are best for each kind; and, perhaps most important to women faced with this diagnosis, how to live with breast cancer – including information on helpful vitamins and minerals, postmenopausal hormone therapy, exercise, diet and more. There is even a fascinating section on putting the placebo effect to work by trying treatments that have no scientific basis but have been found to make some women with breast cancer feel better. There is simply no more clear-headed and comprehensive guide to this often devastating disease than Dr. Susan Love’s Breast Book, and the new edition is the most information-packed one yet.

     The question of nutrition for breast-cancer patients takes up only a small part of Love’s book, with Love noting that the effects of diet on breast cancer “have been difficult to prove, but there is some evidence that it can help.” Most recommended diets for women with this disease “come as no surprise,” Love writes, being “low in fat, high in fruits and vegetables, [and] low in processed foods, sugar, alcohol, and hormone-treated beef and chicken.” Love does not find this particular subject worthy of in-depth treatment, and that leaves the field open to books such as The Pink Ribbon Diet. Research dietitian Mary Flynn and cookbook author Nancy Verde Barr essentially argue for the so-called Mediterranean diet, which Love also endorses. Flynn and Barr say this diet is better for breast-cancer patients than the low-fat one usually recommended for them, and they argue for it in the context of weight loss and maintenance of appropriate weight throughout life – both to reduce breast-cancer risk and to improve health after a diagnosis. They also say the diet is more enjoyable and affordable than a low-fat one and therefore likely to have higher compliance. These are all “maybe” propositions, and indeed the entire argument for a dietary approach to breast cancer is a rather thin one; hence, the book gets a (+++) rating. In fact, it gets most of that rating from the recipes, which take up more pages than the dietary discussions and contain some very fine suggestions for soups, sandwiches, salads, beans, pasta, poultry, seafood, vegetables and even breakfast and desserts. Each recipe comes with a calorie count and information on starch, vegetable, fat, fruit and dairy content. And some of the ideas really are delicious: dried cranberry and almond muffins, basil pesto with walnuts, crab-stuffed mushroom, shrimp and vegetable fried rice, chocolate biscotti, and many more. Ingredient and equipment lists are clear, directions are well structured (not all the recipes are easy, by any means), and the “good to know” boxes contain interesting and useful information. For example, it is a pleasure to have a cookbook that recommends trying sea salt for its flavor and coarseness while acknowledging that it is basically the same as table salt and that its trace minerals “are insignificant to health.” As an advocacy book for a particular nutritional approach, The Pink Ribbon Diet is not really revolutionary, but as a cooking guide for those who choose to follow this dietary regimen – whether or not they have breast cancer – it offers some delicious dishes.