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This book is an excellent resource for lay people trying to understand and deal with inherited breast and ovarian cancer. This genetic predisposition is caused by inherited changes in a number of genes, including the BReast CAncer1 (BRCA1) and BRCA2 genes. By dividing the subject matter into four main parts the reader is taken slowly and step by step through all the different aspects.
‘Understanding Cancer, Genetics, and Risk’ introduces these important basic principles in a way that is easy to understand for anyone without any previous scientific or medical knowledge. In ‘Assessing Your Risk’ and ‘Managing Your Risk’ the authors explain the value of genetic counselling, the different types of genetic tests available, and how the high cancer risk conveyed by BRCA1 and BRCA2 mutations can be managed or reduced by screening and surgical options. Mastectomies, possible breast reconstructive surgeries and gynaecologic risk-reducing surgeries are covered in great detail. I particularly liked how the authors Dr Sue Friedman, Dr Rebecca Sutphen and Kathy Steligo, breast cancer survivors themselves, are not trying to give any definitive solutions to these issues but are weighing up the pros and cons of each option, whilst emphasising that different solutions work for different people. The last section, ‘Living with BRCA’, looks at the impact these mutations have on various aspects of individuals’ lives, for example how to approach difficult conversations about increased cancer risks with family members. In addition, every chapter contains personal stories told by individuals who have dealt with the same issues or decisions, and expert views where certain aspects are explained in more depth. For example, Professor Andrew Tutt, who was involved in discovering the role of BRCA2 in DNA repair and how these repair defects can be targeted as a therapeutic strategy, explains how the resulting poly (ADP-ribose) polymerase (PARP) inhibitors have been shown to be very promising in clinical trials.
My main criticism of this book is that it is aimed at a North American audience. Sections about insurance cover don't apply to patients in the UK, where health care policies are different. The National Health Service, for example, only offers genetic testing to people with a strong family history of breast cancer. UK readers might therefore be left confused about the care they should expect to receive and find it frustrating to be told about a number of options without knowing which ones they have access to.
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