Introduction
Breast Cancer is the most common cancer in the UK.  More than 100 new cases of breast cancer are diagnosed each day.  Diagnosis and treatment have improved significantly over the last thirty years with a corresponding fall in death rate.  Breast Cancer is now the third most common cause of cancer death in the UK after cancers of the lung and large bowel, with around 13,000 deaths each year.

Geographic Variation
Worldwide, more than a million women are diagnosed with breast cancer every year, accounting for a tenth of all new cancers and 22% of all female cancer cases.  Incidence rates vary considerably, with the highest rates in developed world and the lowest rates in Africa  and Asia.  Around 346,000 cases occur each year in Europe and 183,500 in the USA.

Migrants from low to high risk countries acquire the risk of the host country within two generations.  For example, Japanese migrants to the USA acquire increased incidence rates compared with the population in Japan and there is evidence that the earlier in life a woman takes up residence in a ‘high risk’ country, the higher her risk of breast cancer compared to her country of origin.

Incidence
In 1999 there were 41,000 new cases of breast cancer diagnosed in the UK.  The lifetime risk of being diagnosed with breast cancer in women is 1 in 9.

Age
Breast cancer risk is strongly related to age, with more than 80% of cases occurring in women over 50 years old.  The highest number of cases is diagnosed in women aged 50-64, the age group targeted in national screening programme. 

Although very few cases occur in women in their teens or early 20s, breast cancer is the most commonly diagnosed cancer in women under 35.  The rates continue to increase with age, with the greatest rate of increase prior to the menopause; this supports a link with hormonal status.

The strongest risk factor for breast cancer is age: the older the women, the higher her risk.

Trends
The incidence of breast cancer has been increasing for many years in economically developed countries.  The historically low rates in Eastern Europe and the Far East have begun to rise rapidly.

Introduction of the national screening programme in the UK in 1988 led to a transient additional increase in incidence in women aged 50 – 64 as early undiagnosed cancers were detected.  This lasted for the first 4 – 7 years of the programme. The underling increase in incidence predates screening, continues today, and is evident in all ages between 45 years and 99 years.

Prevalence
As the incidence of breast cancer is high, and five year survival rates are over 75%, many women are alive who have been diagnosed with breast cancer. 

Causes
There is not a single cause.  There are many factors which influence the incidence of breast cancer.

The following factors increases risk of breast cancer:

1) Living in developed country.
2) Earlier age of starting menstruation.
3) Having children at older age.
4) Having fewer full term pregnancies.
5) None or short time of breast feeding.
6) Menopause after the age of 50.
7) Use of oral contraceptives.  Slightly increases the risk.
8) Use of HRT.
9) Positive family history.

Prevention
Regular breast checks and 3 yearly mammography can detect early cancers and help improve long term prognosis of breast cancer sufferers. 
 
Symptoms & Treatment
Many breast cancers are detected by mammography before any symptoms are noticed.  Other signs include breast lumps (although most are benign), change in size or shape of the breast, dimpling of breast skin, nipple inversion, change in the nipple, swelling or lump in the armpit and very rarely a blood-stained discharge form the nipple or rash around the nipple.

Treatment includes surgery and radiotherapy to control local disease, and systemic treatments (chemotherapy and/or hormonal therapy) to combat spread.  Systemic treatments may also be administered up front as a primary treatment to reduce the size of the tumour prior to surgery.

Nearly all patients, whatever the stage of their disease, have some form of surgery.  Other tests are carried out to assess the extent of the disease.

A patient’s treatment will depend upon a number of factors including the stage and grade of their tumour, hormone receptor (oestrogen and progesterone) status, menopausal status and general health.

Early Breast Cancer
Early breast cancer is potentially curable.  Surgery is carried out to remove the tumour with an increasing trend towards more conservative surgery and reconstruction of the breast.  A short course of radiotherapy is given to patients who have had conservative surgery or are considered at high risk of local recurrence.

Women who have oestrogen sensitive (ER positive) tumours receive some form of hormonal therapy like Tamoxifen to block the cancer promoting effect of oestrogen.

Survival
Survival rates for breast cancer have been improving for more that 20 years.  The relative five year survival rate for women diagnosed in England in 1993-1995 was 76% compared with only 54% for women diagnosed in 1971-1975.

Mortality
In 2001 there were 13,000 deaths in the UK from breast cancer.  Breast cancer accounts for around 17%  of female deaths from cancer in the UK and was the most common cause of cancer death in women until 1999, since then there have been more deaths from lung cancer.

Mortality from breast cancer in the UK had fallen dramatically since 1989 when over 15,000 women died from the disease compared with 13,000 in 2001.  Over the same period the death rates have fallen by 26% from 42 to 31 per 100,000 women.

The reduction in mortality rates is likely to have several different causes including screening, increasing specialisation of care and the widespread adoption of Tamoxifen treatment since 1992.  

Future
With rising incidence rates and the aging of the population, the number of women with breast cancer is going to increase with important implications for the health service and provision of the specialist care that breast cancer patients need.   The good news is that many more women are surviving breast cancer, so that it is becoming a disease women live with rather than die from.
Associated with the development of breast cancer is increasing.  Some of these alterations hold promise for use as molecular markers in diagnoses and early detection, or for monitoring disease progression or response to therapy.  They are also providing leads for the design of new treatments.   Alongside, scientists are using the latest techniques to reveal genetic variations between breast tumours, and between patients, that influence the outcome of radiotherapy, drug and hormone treatment.  Increasingly, this will be translated into the clinic in the tailoring of treatment to the individual patient and her tumour.

Nasim Panjwani has suffered from breast cancer.  She has had surgery, radiotherapy and chemotherapy.  Alhamdulillah she is well now.  Here, she describes her experiences and is willing to share her experiences with other fellow sufferers or advise women who wish to ask her for advice, guidance, support or general moral support.

Often when you hear somebody has fallen ill, is suffering, or has died the reaction from most of us is sympathy. Yet this good trait does not always translate into empathy, of actually understanding what the person or persons are enduring. Some may term this as human nature and others may say it is not possible to truly understand the sufferer. However, this misconception should be eradicated. There is an urgent need to raise awareness about illnesses, specifically breast cancer in this article, for its religious, medical, psychological and social effects are diverse and dramatic. Isolation, anger, lack of information and health support, fear of death and a test of faith are only some of these effects.
 
My experience of breast cancer was undoubtedly a shock to me but a shock I would later understand. When I first knew I had breast cancer, it was a typical day and I had just dropped off my kids to school. In fact, since the day I had my mammogram, which was 6 weeks prior to being informed of the illness, I thought ‘everything was okay.’ Little did I know what would await me. When I was called in at my local breast clinic and I saw three doctors staring at me, I knew this would be an extraordinary day. Their staring had a reason. I had breast cancer.

My initial reactions were filled with pessimism, lack of preparation and anger. I detested the way I was told I had breast cancer. The doctor’s tone was distinctly cold. Almost as a quip, he said ‘Yup, just as we expected its breast cancer.’ It is easy to say one should immediately accept the results. In reality, however, it is important to understand the severity of the event. Understanding comes with time.

I also had to confront the illness with minimum information and there was little time to have a proper discussion with the doctor. But what I really felt bitter about was the time I had to wait for my mammogram. I had asked for it at the age of 37 years, some time after my mother died from breast cancer but they turned me down. Then my aunty was diagnosed with breast cancer and after persevering, they finally gave in. By that time I was 42 years old and the cancer had made its nest in me for 5 years. Because of unjustifiable refusal and delay, I could have died. Thankfully to Allah (s.w.t), I am alive.

My deeper feelings to the illness, however, were something, which I had to contemplate over. As the tears rolled down my cheeks, I thought about my kids but it remained a thought. I could not face them, nor inform them of the seriousness of the illness. Still, my thoughts festered. I contemplated about ‘tidying up my life’, asking for forgiveness from Allah (s.w.t). But I also thought, ‘Why me?.’ There were many emotions but emotions, as time passed by, made me realise Allah (s.w.t) was testing me.

At this point, I must emphasise that this test of faith needs support from family and friends as breast cancer is a most lonely illness. But the ultimately, this is an individual test. You have to prepare to face the illness because it is your body that will mentally and physically suffer. Here, extra prayers and du’as are invaluable.

Some of these feelings remained, whilst others escaped me as I embarked on the next stages of my journey, the operation and treatment. Alhamdullilah, the removal of the lump from my breast was successful and at that point, I felt a sense of relief. But what hit me with unflinching force, putting me in a daze, was the doctor’s recommendation that I undergo chemotherapy and radiotherapy. Radiotherapy involved short weekly appointments of absorbing rays to destroy cancer cells. But chemotherapy was an uphill struggle, one that I cannot easily forget. It involved periodical injections of drugs with unpleasant side effects. From nausea, muscle pains, tiredness to mouth soreness and loss of hair, I was screamed. When I went for a shower and my hair fell off in lumps, it was as if I was losing my femininity. My reaction was somewhat confirmed by my relatives’ reaction. They too could not face to see me.

I will never forget one experience during my chemotherapy treatment. I had an adverse reaction to some of the drugs.  I could not breathe and my face began to swell up. I was struggling to breathe and could not speak. I felt I was going to die.  Thankfully, my husband called the nurse in time and I recovered from that frightful episode. It filled me with sickness when I thought of having chemotherapy again. I felt I was a little child on my first day of school. Nervous, frightened and had nobody to turn to.
 
The final stages of treatment involved taking extra drugs and steroids to put my body in balance, as I was losing vital cells. Again, the side effects of muscular and shooting pains, discolouring of nails, dryness of skin, restlessness and mouth ulcers took their toll on me. I share this with you because breast cancer is not a temporary illness. Its effects continue long after the operation and initial treatment.

During my treatment, it was pleasant to know that all the phone calls were for me instead of my husband! But it is also important to realise that family and friends support may waver and this is something you have to accept. Everyone’s life is busy and you cannot burden them with your illness. People’s reactions also differ. Some may be more easy-going than others whilst others may not know how to react around you. This is also a reminder that you should try and get back to leading your life in a regular and inshallah, more Islamic manner.

Breast cancer is a common illness today and more women are suffering from it now than ever but it is treated as a taboo subject, both at a community and society level. It is imperative that information and medical advice (in all languages) be given to all women but at the same time, women must make effort to learn more about it. It is vital to go for regular check ups and have a mammography done to detect breast cancer. Early detection can save lives but in particular, those who are under the age of 50, should be advised to have a scan. Support on a medical, family, religious, counselling and communal level needs to be increased to provide a backbone to the sufferer. In terms of physically easing the process, reflexology and aromatherapy definitely help to reduce stress and anxiety, which I would recommend.

Today, I have overcome the operation and treatment of breast cancer because of Allah (SWT)’s mercy. He is Al-Wali, the Protector and He gives guidance and strength at this distressing time. But it is also our duty to help those who are suffering. We must raise awareness about breast cancer.  It is the only way the sufferer’s journey will be prevented from being completely lonely and difficult. I believe my experience of breast cancer has increased my faith so that I may better myself in my imaan.  I am happy to offer my service of support to sufferers as a patient.

All correspondence will be treated in confidentiality