Breast cancer in men

Breast cancer in males is a relatively rare entity. In the sub-region, several reports indicate a higher incidence rate compared to other regions in the world. For many years, management strategies were derived from evidence based protocols established for managing female breast cancer. There are however,differences in the epidemiology, presentation, molecular profiles and response to therapies including chemotherapy, hormonal and targeted therapies. Outcomes even though mirroring female breast cancer may actually exhibit differences dependent onstage, race, prognostic and economic variables. The lack of large randomized trials on this subject has resulted in ad hoc management practices across the globe. With new information from renewed interest in the subject, screening and diagnostic guidelines are being established for high-risk groups and we expect to see improvement in outcomes for patients with male breast cancer. This article attempts to bring to light a summary of the current interest, recommendations and controversies in the management of male breast cancer

Management of Febrile Neutropenia in Patients Receiving Chemotherapy for Solid Tumors: a Retrospective Study of Twenty Cases from the Radiotherapy Centre; Accra; Ghana

BACKGROUND: One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country. OBJECTIVE: To assess the management of cancer patients with febrile neutropenia in a low resource setting. METHODS: Records of 20 cancer patients with febrile neutropenia (FN) over a three-year period were retrospectively analysed. Data retrieved included age; sex; type of cancer and number of cycles of chemotherapy taken. Other parameters included initial temperature; site of infection; absolute neutrophil count (ANC) at presentation and antibiotic choice. Use of antifungal drugs; duration of fever and overall treatment outcome were also assessed. RESULTS: The male : female ratio was 3:2 with a median age of 24 years (range: 15 - 68 years); and a mean temperature of 38.8 oC (range 38.0-39.8 0C). Mean absolute neutrophil count was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65) received Cisplatin; five (25) received Adriamycin; two (10) received Paclitaxel or Cyclophosphomide-Methotrexate-5; Fluorouracil (CMF). Ten(50) developed FN with the first cycle of chemotherapy; and six(30) in the second cycle. Twelve (60) had oral infection; four(20) had gastroenteritis and single episodes of respiratory and urinary tract infections. Eleven (55); received Ceftriaxone and Gentamycin; five (25) cases received Levofloxacin or ciprofloxacin and Amoxicillin/clavunate + metronidazole; two cases(10); Ceftazidime and Gentamycin; two cases(10) received Meropenem. Twelve (60) patients had antifungal therapy for oral candidiassis. Eight (40) patients received growth factors. The mean fever duration was 4.5 days (range 1-10 days). Two (10) of the patients died. CONCLUSION: Febrile neutropenia in resource limited countries can be managed with good history and physical examination skills. Aminoglycosides are important components of empiric treatment in Ghana