Yashar Hirshaut - Breast Cancer: The Complete Guide:

Jane Brody

Personal Health columnist for The New York Times

I n early February 1999, a sonogram done as part of my annual mammogram and breast exam revealed a suspicious area in my left breast, which led to an ultrasound-guided needle biopsy and the diagnosis of an early and, I am happy to say, highly curable cancer. This was followed a week later by ambulatory surgery: a lumpectomy and sentinel node biopsy. I was in and out of the hospital and back home in just four hours. I consider myself very lucky to have developed breast cancer when I did and to have a surgeonDr. Peter I. Pressman, co-author of the book you now hold in your handswho was one of the pioneers in surgical techniques that were no more aggressive than were needed for the disease being treated. I clearly remember writing in my first book, You Can Fight Cancer and Win, published in 1977, that if I ever developed breast cancer and had to lose my breast to live, then so be it. Those were the days of total or radical mastectomy for every woman treated for breast cancer. As I saw it, losing a breast was not nearly as bad as losing one's life.

How far we've come since then! No longer is mastectomy the most common approach to treating breast cancer, thanks to the devoted efforts of scores of researchers and clinicians such as Dr. Pressman and his coauthor Dr. Yashar Hirshaut who have greatly refined not only surgical techniques to minimize physical trauma, but diagnostic methods and postsurgical treatments. Together these have led to a steady increase in a woman's chances of surviving breast cancer while limiting the damage done to her physical and mental well-being. Even cancers that have already spread beyond the breast are now being managed as chronic illnesses rather than a quick and certain death sentence.

The authors were also pioneers in writing, for the benefit of all women and those who love them, a readily accessible and comprehensive guide to breast cancer diagnosis, treatment, and post-treatment: Breast Cancer: The Complete Guide, first published in 1992 and now appearing in a fully revised fifth edition. Through these five revisions, their book has stood the test of time and brought women and their loved ones the most up-to-date information available about managing this disease, the disease that for decades women have feared most.

But now it is time to replace fear with facts: More than 96 percent of women do not die of breast cancer and more than 70 percent of those who develop breast cancer do not die from it. Indeed, through an unending stream of improvements in diagnosis and treatment, each year the chances of surviving breast cancer have been rising by about 2 percent.

This book tells the story of this progress in full, yet easily understood, detail. In this new edition, you will find the most reliable information currently available on the role that diet and exercise can play in preventing breast cancer. You will find discussions of such important new developments as the use of breast MRIs as a diagnostic tool, especially for monitoring women who have already had cancer in one breast and for those with a defect in the genes BRCA1 and BRCA2 that renders them highly susceptible to developing breast cancer. For women at such high risk, there is now the option of skin-sparing and nipple-preserving mastectomy and breast reconstruction, which greatly reduces their risk of ever developing this disease.

You will also note that for most women with suspicious breast lesions on a mammogram or sonogram, much less invasive core needle biopsies are replacing surgical biopsies to determine whether a cancer is present. And you will find that, for seemingly early cancers, sentinel node biopsies are replacing removal of most or all of a woman's underarm lymph nodes, greatly reducing her risk of developing lymphedema, a chronic swelling of the arm.

Then there is the extraordinary progress being made in post-surgical treatments, both with radiation and chemotherapy. For some, partial radiation therapy and accelerated therapy that significantly shortens treatment time are being more widely used. Hormonal therapies, especially postsurgical treatment with Arimidex, have significantly increased cancer-free survival in women with estrogen-receptor (ER)-positive breast cancers. And for women whose cancers are especially aggressive because they are positive for the gene HER-2/neu, treatment with the drug Herceptin has revolutionized their care, and now newer drugs like Avastin and Tykerb promise even better results.

Perhaps even more exciting, because it had long seemed so unlikely, is the progress being made in treating recurrent and metastatic breast cancer with a growing number of drugs and drug combinations that have added years of life worth living for many women I know.

But what excites me most is the promise held by modern genetics: the growing ability to determine on the basis of genetic tests not only who is at greater risk of developing breast cancer but also how an individual woman's breast cancer is best treated. No more one size fits all. More and more treatments are being tailored to the genetic characteristics of a particular cancer, thus increasing the chances for long-lasting, disease-free survival and cure.

Of course, the many new diagnostic and therapeutic options also make matters more confusing for women, which is why a book like this one is so valuable. While I hope you have not had and will never get breast cancer, having available the information contained in this book and acting on it may one day help to save your life and preserve your physical and mental health.

So read on. Here's to your good health.