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Familial breast and ovarian cancer: genetics, screening, and management
  1. C M Drovdlic

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    Edited by Patrick J Morrison, Shirley V Hodgson, Neva E Haites. Cambridge: Cambridge University Press, 2002, £65.00 (US$95.00), pp 418. ISBN 0 521 80373 X (hardback)

    This book is an overview of the major issues surrounding clinical practice for individuals and families with familial breast or ovarian cancer. The book includes background information about the high penetrance hereditary cancer syndromes that are currently known, current thoughts on lower penetrance genes that confer a risk of developing these cancers, genetic counselling and testing issues, management and treatment recommendations, epidemiological data, and guidelines for the development of cancer genetics services. Contributors include experts from around the world in oncology, genetics, and epidemiology.

    The strength of this book lies in its review of the literature and objective presentation of controversies in clinical cancer genetics. This book provides a plethora of tables replete with summaries of relevant literature. In the text, controversies such as breast cancer risk associated with hereditary non-polyposis colorectal cancer (HNPCC), and optimum management of BRCA carriers, are handled fairly and give the reader an appreciation for the state of literature on these topics.

    Some chapters are particularly informative and entertaining. For example, the chapter on gene therapy for breast and ovarian cancer (Kennedy and Johnston) gave me a new appreciation of the difficulties posed by gene therapy, but also surprised me with what has already been accomplished. I also particularly enjoyed the fictional vision of the ideal clinical genetics future provided by Jonathon Gray in the chapter presenting data from the current, evolving, Welsh cancer genetics service.

    There are, however, some shortcomings in the information presented. For example, in the chapter discussing the clinical genetics of breast cancer (Haites and Gregory), the subsection on penetrance of BRCA1 and BRCA2 mutations quotes an 80–85% lifetime risk of breast cancer, but does not include other estimations from population-based studies, or distinct populations like the Ashkenazim. It was surprising to see this omission given the extensive reviews of the literature elsewhere in the book.

    As a straight read, the organisation of this book feels disjointed and repetitive; it is clearly more useful as a reference book. Chapter topics tend to overlap, and so the reader is given multiple summaries of the clinical implications of mutations in the BRCA genes, and repeated discussions of topics like prophylactic oophorectomy in BRCA mutation carriers.

    For general practitioners, and those new to providing care for families with familial breast or ovarian cancer, this book is a good resource for background information and a discussion of the current issues. In addition, those looking to begin a regional (or larger) cancer genetics service will find specific guidelines for organisation and referral criteria that are already being evaluated. However, while freshly minted cancer geneticists may find this book helpful in getting them up to speed, seasoned clinical cancer geneticists may not learn anything new for their clinical practice.