Dr Joseph Kamugisha Breast cancer is one of the commonest malignancies or aggressive diseases that occur worldwide. It is among the most studied or researched cancer diseases on a wider scale. A few years ago, I had a chance to have internship at home. During this period, I encountered more than 50 cases of breast cancer while a good number of them had suffered recurrences with reported disease progression. I remember in my early days I had two critically ill breast cancer patients one aged 36 years and another aged 52. They had both returned from Nairobi where they had gone to have surgery and radiotherapy. Both of them reported with severe lymphatic obstruction of the arm and forearm with the side of the breast that underwent surgical operation or modified radical mastectomy. On evaluation with blood workup and imaging tests, both showed presence of bulk disease with recurrences in the affected limb. They had terribly fungitive wounds resulting from necrosis due to continued tissue destruction by the the disease. Fungus germ likes to attack dead tissues everywhere in the body and lymphatic obstruction is a precipitating factor for their aggressive character. Lymphedema in breast cancer patients may also occur as a secondary complication to surgery or mastectomy especially following the removal of lymph nodes that might be affected by the disease or for evaluation purpose. There were controversies as both patients arrived with physical compression of their affected limbs. I had to disband them and change the course of their symptomatic management. Physical compression is applicable to those whose obstruction is a complication from surgery but its efficiency is currently being evaluated as it has shown help to a lesser extent in a sizeable number of patients. Targeted fungal treatment is highly considered for wounds linked with lymphatic obstruction and the prophylactic part is currently under consideration. Despite of all these challenges, breast cancer is amongst the most controlled and easily monitored malignancies. There are predictive markers to measure the level of disease aggression but all this kind of work calls for regular monitoring with highly skilled approach. The diagnostic history of the highlighted patients missed the measurement of Ki-67 prognostic index though they had other part of the immunohistochemistry done. The Ki-67 is a very sensitive and predictive marker in breast cancer management and currently used on a broad sense to predict the possibility of recurrences or relapses in a specified period of time. This marker helps to assess the proliferation activity of the cancer cell. Many European clinical trials have showed that a higher Ki-67 index is associated with a poor prognosis and early recurrence of the disease with in a period of two years. A lower Ki-67 index is associated with a good prognosis and possibility of late recurrence in the period of 10 years. The proliferative measure from Ki-67 reflects the proliferative activity or aggressive behavior of the breast cancer to facilitate prediction of the time of recurrence. This helps physicians to plan for the appropriate therapy required in the patient course of treatment. It is there¬fore mandatory and very important to take the Ki-67 index into consideration in the management and follow-up of breast cancer patients. The Ki-67 together with Estrogen, progesterone and Herceptin-2 receptors helps to class breast cancer diseases. This enables to identify patients who may be at a high risk for disease relapse. It offers good consideration and can act as a guide to the choice of treatment especially in early breast cancer. The decision for endocrine therapy or chemotherapy treatments is based on the measure of the levels of hormonal receptors; estrogen, progesterone, the Ki-67 and the HER-2 receptor. Most updated breast cancer clinical trials also indicate that high Ki-67 index is linked or has correlation with the involvement of lymph nodes in the axillar or under the armpit.
