About every five years, Dr. Susan Love MD, MBA fully revises and updates her comprehensive yet accessible book on breast cancer, Dr. Susan Love’s Breast Book. Now in its 6th edition, the book continually reflects ongoing changes in scientific and clinical understandings of breast cancer and relies on the most current information to help readers to make sense of the mountains of information, sometimes conflicting, about this disease and its treatment.
There is a lot to like about this book. It is extensive, readable, well-organized, and contains solid references. In fact, whenever a person asks me for information about breast cancer decision-making, I advise them to get this book before they do anything else. It is the best available first stop in one’s journey to learn about the healthy breast and common breast problems as well as varied aspects of breast cancer risk and diagnosis, the details of treatment options for different types of breast cancer, issues related to aftercare and follow-up, dealing with cancer recurrence, and living with what Dr. Love calls “the collateral damage” of treatment.
Another great contribution is the book’s regular revision: it demonstrates how knowledge can change and protocols shift in the ongoing quest for evidence-based information and practice.
There was a time when the current thinking was that all breast cancers were the same and should be treated the same way. Now we know this was wrong. Breast cancer cells do not act in isolation; their behavior is affected by conditions around them. There are different subtypes of breast cancer with differing outcomes, and not all of them progress in the same way. Some never progress at all. It takes more than a mutated cell to cause cancer. Thus, more treatment is not always better, and the immune system itself plays a vital role in the control of cancer.
It took years to obtain that knowledge. During that time, people suffered from extensive surgery, high-dose chemotherapy, too much radiation, and treatments that just didn’t hit the right targets. Protocols and practices change at a slower pace than the research that eventually informs them. This is why informed medical decision-making requires the best available evidence, viewed in context of all the other evidence, and why we need a new edition of this book every few years.
Crucial topics updated from the 2010 edition include:
- How the immune system works and certain treatments interact with it
- What genetic tests may contribute to the tailoring of certain treatments based on breast cancer subtype
- Ways to mitigate the long-term effects of chemotherapy, radiation, and other treatments
- Links between breast cancer and diet, exercise, and environmental exposures
- Whether there is a viral or bacterial connection to breast cancer
- Diagnostic techniques like 3D mammography, whole breast ultrasound, and MRI, and what they mean for diagnostic accuracy
- Post-treatment fertility
- Changes in the treatment of metastatic disease
In my opinion, the 6th edition of Dr. Susan Love’s Breast Book easily retains its New York Times status as “the bible for women with breast cancer.” But like all sacred texts, it won’t provide the definitive answers to all of our questions. At 690 pages including resources, notes, glossary, and index, there is simply too much research to distill for any given breast cancer topic.
A reader won’t necessarily understand why, for example, experts may (still) disagree on the limitations of mammograms, genetic tests, prophylactic procedures, or the next best route for a person with metastatic disease for whom their most recent drug option suddenly stopped working or became too toxic for their bodies to handle. Such nuances and technicalities are beyond the scope of the book and would require an in-depth treatment of all studies on each topic, including their methodological strengths and weaknesses.
Dr. Susan Love’s Breast Book is Breast Cancer 101, the necessary foundation and springboard for understanding the fundamentals of breast cancer and treatment. Armed with the knowledge, background, and questions raised in this book, anyone would be equipped to enter the zone of medical uncertainty surrounding breast cancer to ask more questions, get more answers, and learn what they need to know to make the decisions that are right for them.
Dr. Susan Love is a clinical professor of surgery at UCLA and president of the Susan Love MD Breast Cancer Foundation.
