Management of breast cancer in Madagascar]

PURPOSE: Retrospective analysis of management and outcome of breast cancer in Madagascar. PATIENTS AND METHODS: From January 1996 to December 1998, 259 women with breast cancer were seen in the only department of oncology of the island, located in Antananarivo. It is equipped with a cobalt unit (unavailable in 1996). There was no uniform policy on surgery. Chemotherapy and hormonotherapy were not available for all patients. Reduced equipment enabled a minimal pre-therapeutic workshop. RESULTS: Mean age was 48.5 years. One hundred and fifty-six women were premenopausal. The majority (69%) lived less than 50 km from the department. Tumours were at an advanced stage in 67% of the cases; the mean delay for diagnosis was 9.4 months. Treatments were done with curative intent in 118 cases and with palliative intent in 64 cases. Partial surgery (89) was adequate in 40.5% of the cases; total mastectomy concerned 94 women. Axillary lymph node dissection was done in 94 cases and was positive in 76 cases. The number of involved nodes was noticed in 47 cases. Curative radiotherapy concerned 106 patients, 41 after total mastectomy and 44 after lumpectomy, and was exclusive in 21 cases. Palliative irradiation was done locally with hypofractionation for 35 patients. Chemotherapy was performed in 86 women. The 4-year survival of the 136 assessable patients was 73%. CONCLUSION: Improvement in breast cancer treatment outcome in Madagascar is the result of earlier diagnosis of the disease. Information and education of the population together with caregivers are necessary, because updating and improving technical equipment is not currently possible due to the economic problems that the country has to face.     

Fatigue in Cancer

J. Armes, M. Krishnasami and I. Higginson (eds). Oxford UniversityPress, Oxford, UK, 2004, 334     

Cancer in Rwanda

Data are presented on the frequency of malignant tumours registered at the population-based cancer registry in the southern prefecture of Butare, Rwanda, from May 1991 until 2 months before the outbreak of civil war in April 1994. Beginning in 1992, subjects were also interviewed about socio-demographic and life-style factors that have been associated with cancer risk in the West. The distribution of cancer in Rwanda is similar to that in other countries in sub-Saharan Africa. The most frequent cancers are those with possible infectious aetiologies: liver cancer (12%), cervical cancer (12%) and stomach cancer (9%). In addition, cancers known to be associated with HIV infection are relatively frequent (Kaposi's sarcoma [6%] and non-Hodgkin's lymphoma [3%]). Chronic infection, including infection with HIV, high parity and multiple sexual partners are important determinants of cancer incidence in this population. Tobacco consumption is low in Rwanda and there are few tobacco-related tumours, such as lung and laryngeal cancer. Other tumours believed to be associated with aspects of Western life-style, such as colorectal and breast cancer, are also relatively infrequent. © 1996 Wiley-Liss, Inc.     

Anemia in Cancer

In summary, anemia developing in a patient with cancer can be due to several different factors. A relative failure of erythropoiesis, in conjunction with a modestly shortened erythrocyte survival, is the most likely explanation for the anemia and can occur in patients with or without bone marrow invasion. Several theories have been proposed to explain the mechanism of limited red cell production in cancer. Internal iron starvation and cancer toxic factors have been widely implicated. Immunoglobulin inhibitors of erythropoiesis occur in the rare entity, pure red cell aplasia, which is sometimes associated with thymomas. Autoimmune hemolytic anemia and microangiopathic hemolytic anemia can also occur in patients with solid cancers, pointing out the need for a complete evaluation of anemia in any patient with recent-onset anemia. Successful treatment and prognostic implications of anemia in cancer is dependent on proper diagnosis.     

Cancer in Pregnancy

Cancer in pregnancy may be increasing in incidence with advancing maternal age and higher rates of obesity. The diagnosis of cancer in pregnancy provokes complex management issues balancing short‐ and long‐term risks for both mother and baby. Every case needs to be individualized, with a multidisciplinary team of midwives, obstetricians, oncologists, surgeons, radiation oncologists, and neonatologists assisting the family to make informed decisions regarding the best treatment course for the mother and baby. The present article reviews the evidence regarding the safety of diagnostic imaging, procedures and treatment modalities for cancer for the pregnant woman and fetus. The efficacy of novel anticancer therapies highlight the need for International Registries to accumulate safety data for these agents in pregnancy as expeditiously as possible.     

Cancer in waiters

The risk of cancer was studied in 2,413 males registered as waiters at the 1960 census in Norway. A personal identification number was used in linking this cohort of waiters with the Norwegian Cancer Registry. The follow-up period was 1961-1984. An excess risk of cancer was observed for the following primary sites: upper respiratory and digestive tracts combined 42 observed against 11.3 expected, liver (14 versus 2.87), rectum (28 versus 13.89), and lung (67 versus 43.66). The highest risk for all these types of cancer was seen among those who were waiters at both censuses in 1960 and 1970. In the case of cancer of the stomach the observed number of cases was significantly lower than expected (14 versus 25.68). It is known that smoking habits and alcohol consumption are substantial aetiological factors for the types of cancer in which an excess risk has been demonstrated here.