© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 17, 1505,
September 1, 1999
© 1999 Oxford University Press
BOOK REVIEWS |
Tamoxifen for the Treatment and Prevention of Breast Cancer
V. Craig Jordan, ed. Melville (MN): PRR, Inc., 1999. 309 pp., illus. $45.95 ISBN 1-891483-00-5
Correspondence to: Allen M. Mondzac, M.D., 2141 K Street, N.W., Suite 707, Washington, DC 20037.
Tamoxifen for the Treatment and Prevention of Breast Cancer, edited by Craig Jordan, is a reworking of his previous book—Tamoxifen: a Guide for Clinicians and Patients. That book was published 1 year ago and reviewed in these pages in March l998. It covers the same material that comprises the first two thirds of this "new book." The clinical trials data, the early trialist material, and the meta-analyses are again reviewed, along with the story of the development of tamoxifen and Dr. Jordan's career and work. A handful of chapters on the Breast Cancer Prevention Trial, the Study of Tamoxifen and Raloxifene (STAR) trials, and the new genetic work on BRCA1 and BRCA2 have been appended to these sections from the earlier book.
The section on drug development is not present in the previous volume. The discussion of drug development cost is an apology for drug company profits and is weak and over simplified. Surely, this important and timely issue deserves a more detailed examination and explanation. This section, which is entitled "How overly simplified level and never mentions drug costs and company profits, which are the real issue. Costs and profits deserve more attention and a more probing discussion, considering that the U.S. Congress is grappling with drug costs as this review is being written.
The reworking of the old sections of the book (also reviewed by this reviewer 1 year ago) is tedious. For example, uterine cancer is discussed in multiple sections. The discussion of uterine cancer on p. 114 states that if "hyperplasia or endometrial cancer occur, the patient should undergo a hysterectomy and tamoxifen can be reinstituted immediately." No reference is given. The reader wonders whether this recommendation is standard practice in all cases of tamoxifen-induced endometrial cancer. This recommendation is certainly worthy of some discussion and there are other approaches to adjuvant or preventative treatment under those circumstances, which should be discussed in this text.
Other aspects of tamoxifen toxicity are barely discussed. Menopausal symptoms and sexual problems associated with tamoxifen use are given short shrift, as is the whole section on thromboembolism and deep vein thromboses and their effect on continuing treatment. One of the question and answer sections on menopausal symptoms contains a rather surprising statement. Ms. Amy Langer, M.B.A., Executive Director of the National Alliance of Breast Cancer Organizations, states that the "thoughtful oncologist will often give brief estrogen interventions to alleviate severe acute symptoms. It may not be commonly known in the medical community that this practice is acceptable, especially among primary care physicians." As we know, hormone replacement therapy for menopausal symptoms in women with a history of breast cancer who are on tamoxifen is a difficult issue and one that is far from clear. The editor should not have included this statement (without references) in a book that will be read by the general public, who might think that this practice is standard in most communities. It is not.
There are two question and answer sections on tamoxifen. The questions are repetitive and cover practically the same materials as were covered in the previous edition.
This book, like the previous volume, could be useful to very motivated patients, nurses, social workers, and family members of patients with breast cancer who are taking tamoxifen. The practicing oncologist will find this book to be too simplistic where he or she may need more precise scientific data. It is too repetitive to be read in its entirety by the busy practitioner. The book may find a place in the library of the family practitioner or gynecologist who wants a basic reference text on this important drug. It can provide material for patient counseling. If the publishers want this book to have a wide appeal and acceptance, they should eliminate the 20 pages of photographs of tamoxifen researchers, which are of little general interest, as well as the photographs at the end of the book and the personal photographs interspersed throughout the text. These photographs tend to be annoying.
For all of its weaknesses, this book, like its predecessor, does compile and make available an enormous amount of information on tamoxifen. It will make a good, simple, not overly scientific reference book for oncologists, medical students, and oncology nurses who deal with patient education on a regular basis. However, the book is not for the general public and not for most patients. It is too detailed and somewhat misleading in certain areas. Certainly, it might be a reference book in any good library. With all of the personal and professional information on Dr. Jordan, his wife, and their careers contained in this book, it is a volume that his fans, friends, and family members will want for their very own.
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