Book Review

Cancer Epidemiology and Prevention, Second Edition

Edited by David Schottenfeld and Joseph F Fraumeni
New York: Oxford University Press, 1996; 1521 pp;
ISBN 0-19-505354-0; $278.95 (CAN)

This is the second edition and update to the 1982 volume originally published by WB Saunders Company. David Schottenfeld and Joseph Fraumeni are the editors of both editions, and their experience, as well as that of the many contributors, make this book a comprehensive resource for those with interests in cancer prevention and control. The new edition is quite voluminous, reflecting the explosive growth of knowledge and information about cancer in the past fifteen years.

The general outline of the book follows that of the previous edition, including basic concepts, magnitude of cancer, causes of cancer, cancer by tissue of origin, as well as cancer prevention and control. However, there have been important additions to these sections. For example, chapters on molecular and genetic events in neoplastic transformation, molecular epidemiology, principles and applications of cancer prevention and control, as well as more comprehensive treatments of cancer prevention strategies are welcome contributions.

The content of the book is largely current. However, the editors acknowledge that the task of completing the edition was a challenge and required that chapters be updated again during the preparation of the book to reflect the rapid changes occurring in the knowledge of cancer biology, prevention and control.

Indeed, some of the specific details presented in the volume are already overshadowed by new information or advancements, e.g. emerging data about the potential benefits of mammography in women aged 40-49; the potential role of percent free versus bound prostate specific antigen (PSA) in improving sensitivity and specificity in detecting prostate cancer; efficacy of fecal occult blood testing/sigmoidoscopy in reducing mortality from colorectal cancer; observations of recent decreases in breast and prostate cancer mortality; recent data noting a narrowing of the black/white gap in mammography utilization, etc.

The large amount of material in the book has led to some repetitiveness or inconsistency of information presented. Multiple tables of known and potential carcinogens appear in various chapters, differing somewhat in format but presenting similar information. Reported incidence and survival rates for naso-pharyngeal cancer from the chapter "Cancer Incidence, Mortality, and Patient Survival in the United States" differ significantly from the chapter on naso-pharyngeal cancer in the "Cancer by Tissue of Origin" section of the book. This may be due to different years of data reporting, differences in grouping of sites and/or histology, different populations used for age-adjustment, or a combination of these factors that are not readily apparent to the reader.

Another chapter uses breast self-examination as an example of the use of a health behaviour model, but a subsequent chapter clearly states that there is little evidence of the efficacy of breast self-examination to reduce breast cancer mortality. In addition, in an attempt to squeeze as much information into this volume as possible, there are areas (particularly in the section on cancer prevention and control strategies) that are limited in their scope and depth of review, e.g. specific behavioural or community-based interventions for lifestyle changes such as alcohol consumption, diet and physical activity.

This book is an impressive, scholarly compendium of essays by recognized experts on a broad range of cancer-related topics. However, with nearly 1500 pages, an evolution in the approach to presenting this kind of information may be needed. With the inclusion of large amounts of information about cancer biology, cancer epidemiology, and cancer prevention and control, there is a tendency for the primary focus or target audience of the book to be obscured.

Ultimately, the answer to these difficulties may not be another voluminous update in the next decade, but rather a revisitation of the purpose of the volume, reassessment of the target audiences, with a potential segmenting of the one volume into several volumes with their own editors and production schedules. In addition, given the recent advances in computer science and technology, new and innovative approaches to presenting this kind of information in an easily accessible, user-friendly manner may be warranted.

Despite these areas of concern, this book is a major contribution to cancer epidemiology, prevention and control.

Overall rating: Very good

Strengths: Comprehensive approach

Weaknesses: Difficult to keep up to date with new
advances in scientific knowledge
Some repetitiveness and internal
inconsistencies

Audience: Varied

Daniel S Miller
Cancer Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Georgia
USA  30341

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