BREAST CANCER 

Breast cancer occurs when there is abnormal, uncontrollable growth of cells in the breast. These cells grow beyond the normal confines of the breast tissue and can spread into adjacent structures and distant organs. It is the most common malignancy affecting females in the western world (second commonest in developing countries – after cervical cancer). In England and Wales, over 40,000 new cases are diagnosed each year with over 20,000 deaths. Men can also be affected by breast cancer but it is more rare (cf. 260 cases, 68 deaths). Mortality from breast cancer remains high in developing countries due to inadequate screening programmes. 

RISK FACTORS 

There is no known single cause for breast cancer but there are numerous risk factors. The common denominator for these risk factors is prolonged exposure to excessive oestrogen (the female hormone that promotes the growth of breast cells). 

These risk factors include:

*Early menarche (less than 11 years at onset of menses) and late menopause (more than 52 years before cessation of menses) 

*Advanced age (mean age of breast cancer was found to be 49years in a Nigerian study) 

*Family history (breast, ovarian or colonic cancer in first degree relatives – mother or sister) 

*History of breast cancer in a male relative 

*History of breast cancer in contralateral breast, especially if there is genetic mutation in genes BRCA1 and BRCA2.

*Late pregnancy (>30years before the first pregnancy carried to term) or no pregnancy at all. 

*Use of oral contraceptive 

*Use of hormone replacement therapy 

*Unhealthy lifestyles such as increased weight gain, sedentary lifestyle, alcohol intake, tobacco smoking etc. 

SIGNS AND SYMPTOMS 

Most cases of breast cancer remain asymptomatic until they become advanced. A lump usually becomes palpable in the breast at a late stage. However, NOT ALL BREAST LUMPS ARE CANCEROUS. A breast lump can be suspected to be cancerous if it feels hard or irregular, contains solid nodular components or is fixed to the skin or underlying muscle. 

Most lumps are painless. Pain occurs in only 5% of cases. Other possible signs of breast cancer include:
*Unusual changes in breast size and shape 

*Dimples on the breast skin (orange peal appearance) 

*Retraction or inversion of the nipples 

*Abnormal nipple discharge – purulent or bloody

*Axillary lump (swelling in the armpit) 

*Dilated veins on the breast 

*Tethering or ulceration of the breast skin

*Symptoms of spread to other organs, such as lungs (cough, bloody sputum), brain (neurological deficits like stroke, seizures, etc.)  or bones (fractures) 

SCREENING TESTS 

Because of its insidious onset, the best way to curb the menace of this deadly disease is through effective screening programmes. This will help to detect it at the early stages, whereby successful treatment can be achieved. 
What are the screening modalities available? 

-Self breast examination (SBE) : all women in the reproductive age group should learn how to check their breasts at least once every month (just after the menses)
-Clinical breast examination : once in a while (depending on age, presence of risk factors and result of previous examinations) women should have their breasts examined by a physician. Any sign or symptom detected during the SBE should be reported promptly for double-check. 
-Radiological tests : includes Ultrasound, Mammography, Magnetic Resonance Imagine, or a combination of these as indicated, depending on the density of the breast tissue and individual risk factor assessment. 

DIAGNOSIS 

A definitive diagnosis is made through biopsy. This could be done through a needle with radiological guidance, to obtain a sample from the lump and send to the laboratory for confirmation. Excisional biopsy can also be done – a surgical procedure whereby the entire lump is removed and sent for laboratory (histological) examination. Other investigations needed to rule out, or confirm metastases, as well as prepare patients for treatment include:

Chest xray

Brain imaging

Abdominal scan

Bone scan

Full blood work up 

Renal and liver function tests, etc. 

MANAGEMENT

The first level of management is to “stage” the disease. This “staging” provides an idea of how advanced the malignancy is. It also gives us the prognostic indices such as likelihood of cure, remission and recurrence. The popular TNM classification is used to categorise the diseases into stages 0 to IV, where 0 is the earliest stage and IV is the most advanced stage. TNM stands for: 

T-clinical staging of breast lump

N-lymph node involvement 

M-presence and type of metastasis (local or distant spread) 

Treatment depends on the stage. This can either be curative or palliative. There are 3 broad modalities of treatment : Surgery, 

Chemotherapy and Radiotherapy. Other classes of treatment are:

*Hormonal therapy 

*Genetic modulators

*Immunotherapy 

A combination of these modalities are often employed. Palliative measures used in advanced cancer include:

-Pain relief 

-Treatment of metastatic disease 

-Psychological support

-Hospice care

-Home care and end of life support 

CONCLUSION 

Breast cancer is a disease of public health importance. Thanks to the aggressive campaign for active screening and early detection, mortality rate has been decreasing steadily in the developed world but this can not be said of the developing countries. We need to do more of public enlightenment and advocacy programmes to augment the effort of the government in preventing and curing this disease. 

References:

-NICE guidance, UK, 2016 update

-Medscape reference, Breast Cancer, 2017 update. 

​FASTING AND PREGNANCY

 


Pregnancy is not a disease in itself but there are significant physiological and anatomical changes that may pose some discomfort to the pregnant woman. According to the scholars, pregnant women can be categorised into 2 as far as fasting is concerned:

1. The one who is healthy and fit, who is able to fast without any jeopardy on herself and her baby. 
2. The one who is sick and weak, who is unable to fast because of perceived harm on her and her baby. 

For pregnant women in category 1, fasting is waajib. The same ruling applies to breastfeeding mothers (after 40 days of postnatal bleeding). 

As for those in category 2, they are expected to stop fasting and repay the missed days after childbirth and before the next Ramadan. They fall in the same ruling as the sick or traveller. The evidence for this concession is in a hadith reported by Imaam Ahmad from Anas bin Maalik Al Ka’abi: “Allaah has relieved the traveller of fasting and half of the prayer as He relieved the pregnant and breastfeeding women of fasting” (hasan) 

Pregnant women can fall into category 2 due to conditions such as:

*Severe hyperemesis gravidarum (nausea and vomiting with metabolic derangement and marked weight loss) 

*Infections like Malaria, respiratory or urinary tract infections etc. 

*Pre existing medical conditions with worsening during pregnancy, eg. Sickle cell anaemia, diabetes, hypertension, epilepsy, etc. 

*Longstanding infertility or recurrent miscarriages in the past or bleeding in the present pregnancy (fear that fasting may lead to pregnancy loss) 

*Any other condition necessitating hospital admission and aggressive treatment. 

Dear mothers, study yourself but do not assume. Discuss with a qualified doctor who also knows some basic fiqh of fasting and let him advise you on which category you fall into. 

“… and whoever is ill or on a journey, the same number [of days which one did not observe Saum (fasts) must be made up] from other days. Allah intends for you ease, and He does not want to make things difficult for you… ” (Qur’an chapter 2 verse 185)

SKIN BLEACHING – MEDICO-ISLAMIC PERSPECTIVES

 
Among people of colour, there is a widespread desire for a toned, lighter skin – especially ladies. Higher levels of melanin (a dark pigment produced by the skin cells) makes it easy for us to develop uneven tone and exaggerated darkening, especially after inflammation. 
Skin whitening/toning is not wrong in itself. The question is: what is your goal? An evenly toned or a permanently bleached skin? It’s not uncommon for dermatologists to prescribe skin whitening/toning creams to patients who are battling with skin diseases which have resulted in unsightly darkening. 
The commonest active agent in these creams is Hydroquinone. There’s usually no more than 2% concentration and it’s used for a short duration. There are concerns about increased risk of skin cancer with prolonged use. However, people have abused this substance in the name of maintaining the whiteness and even tone. 
Most bleaching creams contain steroids, such as hydrocortisone and clobetasol. These are powerful substances that, (when abused) not only affect the skin, but can be absorbed into the bloodstream, disrupting the normal homeostasis of the body. 
Overly bleached skin can look unnaturally white with a grayish tint, resembling the skin of a cadaver! When Hydroquinone is used in concentrations higher than 2%, it begins to give paradoxical results. There have been reports of the development of exogenous ochronosis, the darkening of the skin which is permanent and very resistant to any treatment. Though there is a possibility that this skin reaction can develop with lower doses, the risks are increased when the dose is higher.
Overuse of skin whiteners causes pigmentation to build up in your extremities (fingers, toes, ears etc), causing them to look darker and mismatched. This can culminate in what is called “the bleach panda effect”, where the skin on the face becomes thinned around the eyes and have increased pigmentation. Cute on a panda, not so nice on humans! Thinning of the skin results in increased susceptibility to injuries, infections and delayed wound healing. 
Can you whiten (or tone) your skin without the need for toxic chemicals? Yes. Opt for mild exfoliation with natural things like honey, lemon, yogurt, potato peel, etc. Packaged herbal remedies and nontoxic exfoliating creams are also widely available. These are much milder and gentler on your skin. Eat fruits and vegetables. Drink plenty of water. Reduce your exposure to sunlight and maintain an excellent personal hygiene. More importantly, love yourself. Embrace your dark skin and be grateful to your Lord. 

As Muslims, we must understand that we are accountable to Allah for all our actions, be they right or wrong. Hence, we must strive to always please Allah with our deeds by adhering strictly to His commands and refraining from all forbidden acts. In Q. 95:4, Allah declared that He has created man in the best form.
This declaration, however, does not mean that man cannot seek improvement in his shape or look. For instance, a deformed person can seek medical care to correct his deformity. Likewise, a person with tumor in his brain or cataract in his eyes can approach the appropriate professional to remove it. None of these conflicts with the verse above.
What the Shari’ah frowns at is any action that leads to altering or changing (completely) the creation of Allah for no just cause (such as medical reasons). For example, the Prophet (saw) forbade tattooing of the body and plucking of the eyebrows, but permitted plaiting/shaving of the hair as well as other forms of beautification.
On the issue of skin bleaching, the Ulamaa have declared it to be totally haraam if the purpose is for beautification and it is permanent. This, according to them is based on the express provision of Q. 4:119 wherein Shaytaan said: “And most certainly, I will lead them astray and excite them in vain desires, and bid them so that they can slit the ears of the cattle, and most certainly, I will bid them so that they shall ALTER ALLAH’S CREATION…”
The implication of the verse above is that such frivolous alteration in Allah’s creation as seen in bleaching of the skin for no reason other than to appear brighter than one’s natural look and deception of others is clearly in following of the footsteps of Shaytaan, which Allah has warned us against (Qur’an 2:168, 208, 6:142 & 24:21)
Shaykh Saalih Al-Uthaymeen was asked about the ruling of using whitening creams and he replied: “Yes, it is haraam if it changed the colour of the skin permanently. In that case, it is like tattooing, and the Prophet (upon him be peace) cursed the woman who does tattoo and the one on whom it is done. But if it is done to remove a defect, such as if there is a dark, disfiguring mole on the skin and the individual uses something to remove it, then, there is nothing wrong with that.
WAllaahu Ta’aala A’alam.

*Special thanks to Sirnucy Lafiagi for his contributions*

BRING BACK OUR SIX-PACK! 


Dear husbands, 
Fast backwards to 10 years ago (or more) and imagine your fresh and shinny beards before the greyness began to set in. Imagine your full hair before baldness took over. Imagine your board-like, six-pack tummy and toned arms before the stretching and fat deposits… 
Now, wake up from that imagination and take a look at your body now. You’re quick to complain about your wife’s postpartum body transformation, but she doesn’t complain about any of the “recessions” that she has noticed in your physique as you age. 
I’m not trying to make you feel bad o. I just want you to know that we miss your youthful body as much as you miss ours. The good news is, you can get that body back. At least, part of it. You can cut down on the sugars and fats. You can spare 5 minutes daily for workouts and abs-tightening exercises…
We don’t have to feel bad because of the changes that have happened in our bodies. Instead, we can focus on our inner beauties and develop ourselves productively. 
Goodbye to sweet sixteen. 

Welcome to steamy sixty! 

​ETIQUETTES OF COUGHING, SNEEZING AND YAWNING

Coughing and sneezing are survival mechanisms which Allaah (swt) has put in place to help us ward off undesirable elements from our respiratory systems. They are signs of irritation by germs, allergens or foreign bodies in the respiratory tract while sneezing especially is an allergic reaction to dust, fumes, etc. 

A “productive” cough expels sputum which may carry millions of pathogenic droplets (such as microbes causing the flu, pertussis, Tuberculosis, etc). Sneezing helps to protect/free the airway, resulting in relief from mucus congestion. Persistent cough and sneezing (+/- other symptoms) require medical attention. 

So, you see, coughs and sneezes are meant to bring you comfort. Therefore, you shouldn’t use your comfort to inconvenience other people. You shouldn’t release germs to infect others. Cover your mouth and nose with your upper sleeve (the inner part of your flexed elbow), a handkerchief or a piece of tissue paper. Dispose of the handkerchief or tissue properly and immediately, wash your hands with soap and water. 

Even a seemingly harmless cough could be harmful to your neighbours because your respiratory tract contains millions of commensal bacteria which are “customised” for you alone! Don’t share that cocktail with us please! 

On the other hand, yawning is a sign or stress, hunger, sleepiness or laziness. You release a deep breath with a huge amount of air which could also contain droplets of germs. So you need to cover your mouth as well. Some people are fond of talking or making an exaggerated sound while yawning. This is plain uncouth and satanic! 

Abu Hurairah (RA) reported: The Prophet (SAW) said, “Allaah likes sneezing and dislikes yawning. When any one of you sneezes and says ‘AlhamduliLlaah (praise be to Allaah)’, it becomes obligatory upon every Muslim who hears him to respond with ‘Yarhamuk-Allah (may Allah have mercy on you)’. Yawning is from the devil. When one of you feels like yawning, he should restrain it as much as possible, for the devil laughs when one of you yawns.” [Al-Bukhari]. 

PS: If someone coughs, sneezes or yawns beside you and he’s not courteous enough to close his mouth, please don’t hesitate to cover your own mouth, look away or take a few steps away from him! 

​40 DAYS IN PRISON-PARADISE

I had just birthed my first child, and my mum decided to punish me for all the meat I stole in her pot when I was small. So, she barred me from drinking anything cold because, according to folklore, cold drinks during the puerperal period reduces breast milk production and the baby would get a cold because the milk is cold. I tried to convince her that these things are not true, she no gree. 

Can you imagine being denied a cone of ice-cream on a hot summer afternoon? Yeah, that was how she expected me to suffer for a whooping 40 days! Thank God she didn’t stay with me 24/7. Anytime she went back to her husband’s house, I would drink as much cold water as I could and pretend as if nothing happened.

On the 40th day, she organised a small party for me. To me, it was a bitter-sweet party. It marked the day I was finally free to treat the baby as I was thought in Paediatrics. I was able to go back to the fridge and consume anything cold – even the ice-cubes. But it also meant that I could no longer enjoy the midday nap while she takes care of the baby. Only then did I realise what it takes to become a mother… 

Thank you Grandma for all the love and support (and punishments!) 

CONTROL YOUR FLATUS

I know someone who will love this post- Abu banaat. I can’t remember any of his posts where he didn’t “frown” at people who fart excessively and indiscriminately. Lol! I totally understand you bro. Yoruba people would say: Olúhun ò dá ilé isó (God didn’t create a separate room for farting). But hey! Must you pollute the air that we all breathe in?

Now, let’s break it down. Why do some people fart so much and what’s the remedy?

*OVEREATING. The more you eat, the more you fart. It’s that simple. There are commensal bacteria in your gut that feast on undigested food. The major byproduct from these bacteria is gas. Solution: eat less/just enough.

*”GASEOUS FOODS”. Some foods are prone to producing more gas: eggs, beans, cabbage, potatoes etc. Solution: Modify your diet and substitute these foods for less gaseous ones. Or prepare such foods in different ways, eg, peel the beans.

*EATING TOO FAST. This is also related to overeating. When you swallow food too fast, without chewing until soft, digestion becomes more difficult and slower. Therefore, the bacteria would have extra work to do and then, extra gas is produced (usually more pungent, yuck!) Solution: eat slowly, chew before swallowing, drink in sips, avoid drinking with straw.

*OPENING THE MOUTH WHILE EATING. By default, we all swallow air. When you keep your mouth open, or talk too much while eating, you will swallow more air and then, fart more. Solution: close your mouth and minimize talking while you eat.

*UNHEALTHY DRINKS. This includes alcohol and carbonated drinks. What do you see when you open a bottle/can of Coke/malt/beer? Gas. Your body cannot assimilate gas. You either bring it back (by belching) or pass it down (by farting). Solution: minimize or stop drinking fizzy drinks. Quit alcohol.

*HYPERACIDITY. Flatulence can be a symptom of peptic ulcer disease. Solution: If you have been diagnosed of ulcer, get yourself treated once and for all. If you have an important interview or your future mother-in-law has finally agreed to meet you, respect yourself and get an over-the-counter antacid (like Gestid or Gascol).

*UNKNOWN CAUSE. If you don’t quite know what your problem is and all remedies don’t seem to work, then I can’t help you. Meanwhile, you can try some tricks and cheats; like using perfumes or wearing a fart-proof underwear!