B.A. Stoll - Böcker

This book is a logical companion volume to Women at High Risk to Breast Cancer (Kluwer, 1989) edited by me previously. It distinguishes two aspects of current ap­ proaches to clinical breast cancer prevention. The first is the need to advise individ­ ual women on how they might reduce their personal risk, while the second is the design of measures aimed at reducing the total incidence of breast cancer in the community. While the former is a problem faced daily by clinicians, the latter is a goal which will involve large scale, carefully planned interventional studies. Because knowledge of the risk factors for breast cancer is incomplete and clinical trial reports are scarce, there is as yet, no scientifically-based model for personal breast cancer prevention. Nevertheless, widespread publicity associated with breast screening programmes has created a large group of highly anxious women who have been informed that they are at higher than average risk to the disease. They are con­ cerned by the personal threat posed by a family history of the disease and by the al­ leged dangers of obesity, diet, alcohol, or the use of hormonal agents such as oral contraceptives or hormone replacement therapy.

Breast cancer is not only a burning public issue, but very soon we shall see genetic testing for a woman's predisposition to breast cancer. Many women will be demanding to know their degree of risk and will need counselling to cope with that information. This book is particularly aimed at primary health care professionals, including physicians, medical assistants, nurses and counsellors, who daily deal with questions from women concerned about their risk of developing breast cancer. To answer such questions, this book has combined a guide to identifying women at higher risk to breast cancer, with a balanced review of approaches which aim to reduce that risk. The book provides practical general measures which may reduce risk for women at average risk. For women at clearly increased risk various protective options with different levels of efficacy and acceptability are discussed. Central to the book is the patient-centered view. We need to face reality that it still will take many years before the current clinical trials of preventive measures provide meaningful results.

The emotional pressures on cancer patients and their families are increasing and traditional supports are decreasing. This book attempts to provide a readable, authoritative and balanced review of the emotional pressures and coping methods of cancer patients, and the help currently available to them. The special problems of children and terminal patients with cancer, and the role of the family in coping, are also examined. A balanced and critical assessment is made of defects in health organisation, training of personnel and attitudes to cancer patients in Western society. A similar assessment is made of the growing tendency to self help, mutual help and group activities for such patients. While each individual needs to select coping aids best suited to his or her own temperament, medical advisors need to make more time available for discussion of technical, emotional, social and sexual problems. The availability of a cancer-treating "team" makes this feasible. Chapters were invited from physicians, psychiatrists, psychologists and sociologists expert in this field, and they have responsed to the challenge of writing in non-technical language. This is so that readership can cross disciplinary boundaries and thus stimulate physicians, nurses, psychologists, sociologists, clergy and others, to satisfy some of the currently unmet needs of cancer patients. The reader may note a small amount of overlap between some chapters, permitted in order to maintain continuity and make each chapter complete in itself.

The emotional pressures on cancer patients and their families are increasing and traditional supports are decreasing. This book attempts to provide a readable, authoritative and balanced review of the emotional pressures and coping methods of cancer patients, and the help currently available to them. The special problems of children and terminal patients with cancer, and the role of the family in coping, are also examined. A balanced and critical assessment is made of defects in health organisation, training of personnel and attitudes to cancer patients in Western society. A similar assessment is made of the growing tendency to self help, mutual help and group activities for such patients. While each individual needs to select coping aids best suited to his or her own temperament, medical advisors need to make more time available for discussion of technical, emotional, social and sexual problems. The availability of a cancer-treating "team" makes this feasible. Chapters were invited from physicians, psychiatrists, psychologists and sociologists expert in this field, and they have responsed to the challenge of writing in non-technical language. This is so that readership can cross disciplinary boundaries and thus stimulate physicians, nurses, psychologists, sociologists, clergy and others, to satisfy some of the currently unmet needs of cancer patients. The reader may note a small amount of overlap between some chapters, permitted in order to maintain continuity and make each chapter complete in itself.

The last 30 years have seen little improvement in the age-adjusted mortality rates for most common types of cancer, and until we develop more effective and less damaging treatment modalities for these tumours, selection of each patient's treatment must depend on prognostic pointers. These lead to a calculated trade­ off between our estimate of likely benefit to the patient, as against cost in terms of quality of life. But changes have occurred recently in our understanding of the traditional prognostic pointers used for selecting such individualised treatment. First, it is increasingly recognised that the stage at which a tumour presents is more related to the chromo logical age of the tumour (how far it has progressed before diagnosis) than to its biological characteristics. While advanced chronological age of the tumour may predict a greater likelihood of early death, only biological criteria can predict the tumour growth rate, the likelihood of prolonged survival, the likely course of the disease after the first recurrence or the likehood of response to systemic therapy. Second, there is increasing use of failure analysis in relating the clinical and biological characteristics of tumours to their response to standard treatments. In the past, the relationship was interpreted mainly in terms of survival rate, but the site and timing of first recurrence and the pattern and timing of subsequent spread provide a better assessment of the control possible from local or systemic therapy.

Breast cancer is not only a burning public issue, but very soon we shall see genetic testing for a woman's predisposition to breast cancer. To answer such questions, this book has combined a guide to identifying women at higher risk to breast cancer, with a balanced review of approaches which aim to reduce that risk.

This book is a logical companion volume to Women at High Risk to Breast Cancer (Kluwer, 1989) edited by me previously. It distinguishes two aspects of current ap­ proaches to clinical breast cancer prevention. The first is the need to advise individ­ ual women on how they might reduce their personal risk, while the second is the design of measures aimed at reducing the total incidence of breast cancer in the community. While the former is a problem faced daily by clinicians, the latter is a goal which will involve large scale, carefully planned interventional studies. Because knowledge of the risk factors for breast cancer is incomplete and clinical trial reports are scarce, there is as yet, no scientifically-based model for personal breast cancer prevention. Nevertheless, widespread publicity associated with breast screening programmes has created a large group of highly anxious women who have been informed that they are at higher than average risk to the disease. They are con­ cerned by the personal threat posed by a family history of the disease and by the al­ leged dangers of obesity, diet, alcohol, or the use of hormonal agents such as oral contraceptives or hormone replacement therapy.