Dr. Susan Love’s Breast Book
Overview
Dr. Susan Love’s Breast Book is widely referred to as the breast cancer “bible.” It was first released in 1990, then revised every five years until 2015 (6th edition) with the most up-to-date information available at the time. We are reviewing it now because it is currently in the top 20 breast cancer books on Amazon and is one of the most comprehensive breast cancer books around. A cancer survivor herself, Dr. Love says “This year was more difficult than most as I struggled with “chemo brain” caused by the treatment I received for acute myeloid leukemia in 2012” (p. IX.) (Learn more about these memory problems in Zero Breast Cancer’s blog and factsheet.)
Dr. Love is a world-renowned breast surgeon whose mother, two aunts, grandmother, and several cousins have had breast cancer. As Founder and Chief Visionary Officer of the Dr. Susan Love Foundation for Breast Cancer Research, she is dedicated to finding a cure for breast cancer. Dr. Love is regarded as one of the "founding mothers" of the breast cancer advocacy movement and started the Love Research Army (formerly Army of Women), an online initiative partnering volunteers and scientists to accelerate breast cancer research.
Dr. Susan Love’s Breast Book covers just about every aspect of the breast and breast cancer. It is divided into seven parts: 1. The Healthy Breast and Common Problems, 2. What Causes Breast Cancer and How Do We Prevent It?, 3. Finding Breast Cancer (screening and diagnosis), 4. Decisions, 5. Treatment in the Age of Personalized Medicine, 6. After Treatment, and 7. Recurrence of Breast Cancer. Some of the topics that I found most interesting were:
- Advice for reducing risk – diet, exercise, avoid unnecessary X-rays, drink alcohol only in moderation, avoid taking noncontraceptive hormones – which are in line with Zero Breast Cancer’s 13 Ways to Reduce Your Risk of Breast Cancer campaign.
- The gamut of breast surgery techniques for both malignant and benign disease.
- Planning, alternatives, and potential complications of surgery.
- How the long-term effects of chemo, radiation, and other treatments can be prevented or lessened.
- How younger survivors can maintain their fertility post-treatment.
- Genomic tests available to pinpoint the exact type of breast cancer and tailor treatments to it.
- Evidence linking diet, exercise, and environmental exposures to breast cancer.
- Research on whether there is a viral or bacterial connection to breast cancer.
- The questions patients can ask or the results that they might expect from newer screening techniques like 3D mammography (tomosynthesis), whole breast ultrasound, and MRIs.
- How the politics of breast cancer has evolved beyond pink ribbon marches.
Because the book covers such a wide breadth of breast cancer, I will focus this review on some of the information that stood out to me.
In the not-too-distant past, the standard treatment for breast cancer was aggressive and extreme. Doctors rushed from positive biopsies to radical mastectomies – removal of not only the breast tissue but much of the surrounding muscle – often while the patient was still anesthetized and totally unaware of the extent of the surgery. Dr. Love describes in detail how her family experience enlightened her about the “collateral damage” of such treatments.
“In the long run I’m convinced you’re better off when you consciously choose your treatment than when it’s imposed on you as a matter of course. In the short run it may be more difficult, but more anxiety ahead of time while you are trying to make decisions about your treatment may make for fewer regrets afterward.” (p. 193)
In terms of survival and recurrence, a lumpectomy and radiation usually has the same outcome as a mastectomy, and may even be better. By the time a person is diagnosed with breast cancer, some malignant cells could have already escaped into the bloodstream. The amount of tissue examined makes no difference. It is the chemotherapy and hormone therapy that makes the real difference in survival, not what you do to the breast.
The book explains advances in targeted therapies, hormonal therapies, safer chemotherapies with new dosing regimens, as well as new approaches to surgery and radiation. This is an area that is continuing to evolve, with a great deal of progress in immunotherapy since this edition. For the most part, breast cancer is now a challenge, not a death sentence. There is extensive guidance for the many women now living for years with metastatic breast cancer to ask the right questions and recognize when to seek a second opinion. Treatment in this area has also changed since the book was published.
Dr. Love also addresses understudied areas where she has devoted much of her own research, like the anatomy of the breast ducts. It was surprising to learn that, while recent research has determined that breast cancer starts in the ducts, the intricacies of duct anatomy remains a puzzle that has still not been completely solved.
Despite funding challenges, Dr. Love and her colleagues started studying lactating women to map the ducts in the hope that this will lead to less invasive therapies, like cleaning out the duct, rather than removing the entire breast. Her foundation continues to carry out this research. A webinar presenting the initial findings of women's breast ducts was made in May 2022.
Dr. Love’s assertion that the course of breast cancer is highly individualized and unpredictable resonated with me personally. She goes on to describe the harmful psychological impact on patients of the all too frequently asked question “How long do I have?” She says no doctor, however, distinguished for their expertise, can make such a prediction. Some patients who are categorized as having “Stage 4” or metastatic disease go on to live years beyond conventional expectations.
Critique
This book is very long – 704 pages – yet I am unable to cite a single sentence that could be removed. It continues to be an excellent reference for those diagnosed with breast cancer and those of us who care for them, especially with its detailed index, making it easy to look up specific topics. She offers a short list of good resources, a pathology checklist, and an extensive glossary.
The chapter on prevention and risk reduction is fairly short. This book focuses on breast disease, so it is not a good fit for someone who primarily wants information about prevention.
Also, I did not find the illustrations to be visually pleasing, which made them less engaging to me. However, this is a subjective opinion based on personal taste that in no way detracts from the content of this very well-crafted book.
While some things have changed since this book was published in 2015, others remain the same. Our anatomy is constant, yet the work of Dr. Love and others continue to increase our knowledge. More genetic mutations and variants associated with risk have been identified, and although none has the large impact of BRCA1 and 2, new and lower cost testing will continue to help us. Current work should improve our ability in the next 5-10 years to predict who is at higher risk of breast cancer. Screening remains an area of controversy and our tools are still lacking.
Advances in diagnosis and treatment are happening rapidly. While this book still has good, basic information on these topics, it should not be the last or only place to look when making decisions about what to do for a primary, secondary or recurrence of breast cancer, especially metastatic cancer. Multiple genomic tests are now more available and offer ways to better target chemotherapy. Lymph nodes are no longer routinely removed, reducing the serious pain and suffering often caused by lymphedema. The PARP-inhibitors Dr. Love mentioned are now commonly used. New drug combinations and next generation monoclonal antibodies to treat people with HER2+ breast cancer have also greatly changed treatment.
Recommendation
Dr. Love’s early academic path was in the field of religion, which may be why her book’s offerings are gently infused with a comforting tone. She urges us to stay emotionally and spiritually fulfilled, and to make every single day of our lives precious.
Dr. Love has declared that this 6th edition will be her last. Be that as it may, this book continues to empower women to plan their own unique path of breast health, particularly after a breast cancer diagnosis. At some point, as we move further away from the 2015 status of science, it will lose its relevance. For now, it remains a very useful source of background and a uniquely comprehensive reference. We can hope that as newer, even more ground-breaking therapies emerge, Dr. Love or someone else will be inspired to produce a new edition.
Book reviewed by Laura Custodio, ZBC's Bilingual Program Coordinator
