To her credit, [Dr. Love] sets the record straight whenever there’s a medical misstep that needs correction—another reason why this book should be the preferred guide on breast health for women of all ages.
Title: Dr. Susan Love’s Breast Book
Author: Susan M. Love, MD
Publisher: Da Capo Lifelong Books
Publication date: September 8, 2015
Price: $24.00; paperback, 704 pages
For more than 25 years, Dr. Susan Love’s Breast Book has been the best source of information for women with breast cancer. Susan M. Love, MD—with contributions from writers Karen Lindsey and Elizabeth Love—recently published the sixth edition of the book. In the introduction, Dr. Love revisits her first edition with a sober reminder of some of the clinical travails that have paved the road to today’s successes:
“[O]ur belief that all breast cancers were the same and should be treated the same was wrong, as was the idea that more aggressive tumors required more aggressive treatments. At the time this had led to high-dose chemotherapy and stem cell rescue in an effort to kill every cancer cell … ultimately this approach proved no better than regular dose chemotherapy.”
Although this is a valuable read for oncology fellows or medical students toying with the idea of pursuing a career in oncology, Dr. Love’s book is targeted at women with breast cancer. Wisely, she opens with a chapter called, “The Breast,” in which she gives a well-written A-to-Z discussion about “the only organ in your body that you are not born with. You come into the world with a nipple and lots of potential; some cells behind the nipple that, given the right hormonal stimulation, will grow and become a breast.” Clear and accurate writing such as this terrific opening is seen throughout this fine book. It looks easy, but it’s far from that.
Another strong point in Dr. Love’s approach is her references to previous editions, giving readers a sense of the organic and painstaking process they are participating in. “In the first edition of this book, I wrote about the common use of the term ‘fibrocystic disease,’ which doctors once used to describe a number of symptoms.… The term had no real meaning, even though the symptoms were very real.… Unfortunately some doctors still tell women they have fibrocystic disease, as I have discovered from the comments women have sent to me on Facebook,” writes Dr. Love. She then continues with nicely drawn subchapters detailing common breast problems.
To her credit, she sets the record straight whenever there’s a medical misstep that needs correction—another reason why this book should be the preferred guide on breast health for women of all ages. “Doctors have a tendency to describe all nonmalignant lumps as cysts. They’re not. A cyst is a distinct kind of lump. Typically it occurs in women in their thirties, forties, and early fifties and is most common in women approaching menopause,” writes Dr. Love.
Every woman of a certain age has known someone who has had and possibly died of breast cancer. Naturally, women want to know what their chances are of developing the disease and ways to prevent or at least reduce their risk of breast cancer. Although this information is constantly being updated, Dr. Love drills down to the most current data, from the types of risk factors to prevention strategies that have been validated by epidemiologists and public health experts.
The chapters on risk and prevention are information-dense, and the reader will come away fully informed. However, laypersons without some science reading background will find discussions on lobular involution and ductal lavage quite challenging.
The relevance of screening remains a point of confusion and contention among women and their breast advocacy groups. Dr. Love tackles the issue with frankness and authority, explaining that when screening was first introduced, the understanding was that cancers grow at a certain rate and “at some point get out into the rest of the body.… Thus, we concluded that if we could find the cancers before this happened, we could prevent people from dying from breast cancer.” Of course, that wasn’t the case, and Dr. Love explains why.
She then wades into the thorny issue of the clinical worth of breast self-exam, breast physical exam, and mammography, debunking the myth that early detection saves all lives and the problems of false-positives and overdiagnosis that lead to overtreatment. The various iterations of the U.S. Preventive Services Task Force on mammography recommendations don’t add comfort. But in the end, after learning about the fallibility of breast cancer screening, women want a clear way forward from the author. She provides just that: “What mammography can do is important.… For now it’s what we have, and it makes sense to use it.”
The chapters on diagnosis and treatment are written with firm delicacy, giving an exact description of scanning and biopsy techniques. Dr. Love never lets her detailed clinical discussions stray from the patient as a whole person who has been pushed to the furthest edge of vulnerability by a diagnosis of breast cancer.
Chapter 10, “What Kind of Cancer Do I Have?” is some of the book’s most valuable reading, and also its most difficult. It is in this chapter that women will truly understand the challenges faced by their oncology team. Sorting out the various types of breast cancers, pathology reports, hormonal relationships, molecular classifications, and the commercial tests that help determine the best treatment strategies can be overwhelming, but this is what a newly diagnosed patient faces. That said, many lay readers will need help decoding this highly scientific section, and it is best used as a partnering tool with a woman’s oncology team.
Part Five (“Treatment in the Age of Personalized Medicine”) is the strongest section of the book, and it is here, in treatment, where women need the most guidance and support. Since almost every form of breast cancer involves surgery, Dr. Love uses a steady and even-handed approach in her narrative, from lumpectomy to mastectomy to reconstructive surgery.
Women reading this material will come away better informed and less fearful. Yes, the descriptions of postmastectomy reconstructive surgery will be digested in long pauses, but each section is a gem of information, explaining the difficult decision-making process many women undergo. Moreover, Dr. Love empowers her readers to be strong advocates for their breast health and appearance.
Moving into the dizzying array of targeted therapies will again prove difficult reading for many women, but the knowledge that these exciting therapeutic options exist adds another layer of measured optimism for breast cancer patients and their caregivers. In chapter 16, Dr. Love deals with lifestyle changes and complementary treatments; her own growth as a clinician and advocate since the first edition of this remarkable series becomes obvious when she talks about the salutary effects of prayer and laughter. Survivorship issues are handled with sensitivity, as are the difficult but necessary sections on end-of-life planning and living with recurrence.
Fittingly, Dr. Love’s epilogue is called Eradicating Breast Cancer: Politics and Research,” in which she points out that her first edition made no mention of the politics of the disease, because there were none. The second edition of Dr. Susan Love’s Breast Book chronicled the birth of the breast cancer political movement. And she has been there every step of the way. Dr. Susan Love’s Breast Book is highly recommended for readers of The ASCO Post and their patients. ■