This presentation will provide a background of Tumour Infiltrating lymphocytes (TILs) in cancer and specifically in breast cancer and examine the link between the tumour microenvironment and molecular breast cancer subtypes, prognosis and clinical outcomes. The presentation will include preliminary results from a study examining TILs and molecular breast cancer subtypes in Kenyan women with breast cancer.

INTRODUCTION Breast cancer is the commonest cancer among women globally. Whereas SSA has generally lower incidence, it has a comparatively poor survival, higher mortality and in relatively premenopausal women. We now know that breast cancer is a heterogeneous disease with several and potentially many molecular subtypes. Subtyping helps to determine more effective therapy. The question is does profile based therapies offer better outcomes and is that sustainable for resource limited countries.
METHODS a review of the current evidence
RESULTS Immunohistochemistry (IHC) techniques have been used since the 1970s. IHC biomarkers for androgen, oestrogen and progesterone receptors have prognostic and survival value. IHC tests for several reasons are not readily available in most SSA resource limited centers. Secondly protocols for tissue handling may not be fully adhered to in situations where the IHC is available compromising the results. This is rectifiable though. Beyond IHC is genomic sequencing, a fast evolving field, mostly out of reach for routine application in many facilities that offer cancer care. Yet a powerful tool in unravelling the complexities of breast cancer tumor biology across the races and time. Unpacking these complexities is the premise for personalized cancer care.
CONCLUSIONS Profile based therapies may offer better treatment outcomes compared to those that don’t. This quest to individualized cancer care may not be attainable for SSA in its current form, therein lies the challenge and opportunity for finding more affordable and scalable technologies

Male breast cancer (MBC) is a rare entity that is becoming more common; it accounts for 1% of all breast cancers. Different incidences have been reported depending on the study population, but it has been said to occur more commonly among men of African descent and Ashkenazi Jews having a risk that is 80% greater than other men because of Breast Cancer (BRCA) 1 or 2 genetic mutations. In Nigeria, the incidence varies between 1.9% and 9%. In an unpublished work done at the Lagos University Teaching Hospital, female breast cancers were found to increase over a 15yr period, whilst male breast cancers were found to decrease over the same time period. One of the major prognostic factors in breast cancer is the histological subtype. Histological types with excellent prognosis include tubular carcinoma, cribriform carcinoma, and mucinous carcinoma. Due to its low incidence, limited information is available concerning its epidemiology, predisposing factors, hormone receptor status, treatment and prognosis
A study assessing the histologic and immunohistologic patterns of MBC seen at the Lagos University Teaching Hospital in a 10yr period revealed that Invasive ductal carcinoma accounted for 88.9% of the cases. Seventeen (94.4%) cases were positive for ER only, 16(88.9%) cases were positive for ER and PR, while all the tested cases were HER2 negative. We inferrred that the absence of HER2 positivity may give clues to the high survival rates of patients with MBC in our environment. Late presentation is a common occurrence among cancer patients in Nigeria and has been observed more in men. However, with increase in medical knowledge and availability of medical facilities, men apparently have begun to present earlier. A recent study from Zaria in Nigeria had only 29% of the patients presenting after 12 months, though the median duration of the presentation was 11 months.