"I can't have breast cancer," I say with conviction. "I'm only 36. I have two children under three, I'm vegan, I don't smoke, I eat organic food and I'm breast-feeding. You must have made a mistake." Mr Hussain looks me straight in the eyes, smiles and pats my hand.
I stagger out of the clinic. Matt is holding me. My children, Abigail, aged two, and Joaquin, aged 12 months, have been waiting at home with my parents. They are devastated by the news. My mum keeps saying sorry. She believes this is a legacy she has left me. She has had two separate episodes of breast cancer. My dad, who never cries, breaks down.
I had found the lump just before Christmas. Joaquin had woken for a feed. As I laid him back down between Matt and myself, I felt something on my left breast. At first I thought it was a tissue on the mattress, but as I investigated I found a hard and painful lump about the size of a chickpea.
At the breast clinic they tell me to stop breast-feeding immediately. Joaquin is highly distressed at this turn of events. So am I. I finally get him to sleep at 3am, his cheeks still wet with tears. I nod off but wake an hour later in a cold sweat. I wake Matt up. "If I die will you tell the children how much I love them?" I ask him. "No," he says. He holds me in his arms. "You are not going to die so you can tell them yourself." This is a pattern that repeats itself. His faith in me never falters.
I sit in the bath the next day. "I have breast cancer." I repeat this statement over and over. I feel strangely defeated and lost. I try to rally myself. I am an activist with a long history of fighting injustice. And yet here I am, losing all my confidence, feeling helpless and unsure what to do next.
The next week at the clinic the results of the core biopsy are back. Miranda, the unit's nurse, hugs me. This simple act of affection touches me deeply. However, it's not good news. The cancer is a grade three - the most aggressive one you can get. I am sent for a battery of tests: mammograms, chest X-rays, blood tests, liver scans. I am furious. I march up and down the corridors of the Bristol Royal Infirmary refusing to sit in the waiting areas. The shock of being told I have breast cancer has subsided and in its place is blind anger.
I wake up again in the middle of the night. It's bin collection day and I have a strong desire to run up and down the street kicking the bins into the road. Instead, I go and sit in the children's room and watch them sleeping. The anger dissipates and in its place is despair.
The day before I am due to go in to have the tumour and lymph nodes removed is Abigail's third birthday party. The event is strangely moving and poignant. I see my mum and dad choked and tearful when the cake is brought in. Everyone starts to sing "Happy Birthday" and I start to cry.
I wake up from the operation and smile as I see the surgeon has not made a mistake. My left breast is still there. I meet Joe, another breast cancer patient, on the way out. We swap phone numbers. She is to become a friend and constant source of support.
Returning to the clinic nine weeks after the operation causes a rising sense of panic in me. Mr Hussain says very clearly that the cancer has gone, but he also has bad news. My lymph nodes are clear but they have found lots of pre-cancerous cells around the lump. The breast that I love so much, that has fed my two babies so well, is diseased. I hear the word mastectomy. I sit on the bed and go into a trance-like state. The breast nurse is saying something about a reconstruction but I hardly hear her. I am completely hysterical. I remember returning home from school when I was 11 years old, repeatedly finding my mum slumped on the floor in tears. She had gone into hospital to have a lump removed and woke up to find herself without her right breast. It was 25 years ago and yet her distress still haunts me.
My mum and I decide together to go for genetic testing. There are serious implications for Abigail if we both carry the gene. She will be offered a double mastectomy in her twenties. I have shelved my distress about this for another time. There is only so much I can deal with at the moment. I have already decided that my right breast must go regardless of the results.
Somehow I find my way to the Bristol Cancer Centre. I book an appointment with Sue Alston who specialises in healing and visualisation techniques. As I am talking about the pain of stopping breast-feeding she leans forward and says, "You weren't ready to stop, were you?" I feel like I have arrived. Finally, someone who not only listens to what I am saying but hears me too. I cry and cry, releasing all my inner fears. I talk of dying, leaving the children. A can of worms opens and I can't get the lid back on. Later in the same week I go to see the famous holistic doctor, Rosie Daniel. She is upbeat, sincere and positive. I feel stronger. I suddenly start to gain ground.
I am round at a friend's house. She suggests having a goodbye-boob party. I dismiss the idea but, walking home through the snow, I decide to go for it. Twelve female friends from all walks of my life gather together. It's three nights before the mastectomy. They each bring some food and a poem. They light candles and make wishes for me. I cry and laugh in equal proportion.
I awake from the reconstruction with a boob that looks like Madonna's conical bra. When the bandages come off, Abigail comments that the doctor has left a roundy circle on my boob. My mum squeals in delight, "It's fantastic!" My old breast is gone, in its place is something hard and strange but I'm delighted with the results.
I am to hear of several cases at the Bristol Cancer Centre where pregnant and breast-feeding mothers, who find a lump, are told to return to their GPs at a later date only to find the cancer has spread. My tumour was painful, smooth and appeared to be free-moving, the opposite of your average malignant lump. I am eternally grateful to my GP for referring me.
I am now five months on from the operation. I have four more doses of chemotherapy to go before my cancer year, as I have called 2004, is over. I have remained upbeat and positive for the most part. The loss of my thick Irish hair bothers me not at all. The steroids have bloated me out and I am bald but my eyes still sparkle and I am still smiling.
I have resisted the new identity society has placed on me. In many health professionals' eyes I have become a cancer patient. I am not always a very good one. I am neither dignified nor silent. I question the doctors; refuse growth hormones that are suppose to increase my white blood cell count. I find alternative treatments for nausea and vomiting that include homeopathic remedies, acupuncture and massage. I seek out friends who make me laugh. The breast cancer diagnosis is only a small part of me.
Joaquin is now 20 months, a little blond firework dashing from thing to thing, starting in wonder at the spider's web he finds in the garden or the hot-air balloon he sees in the sky. I share his delight with the world. Abigail is a quieter soul but equally delightful. A few days ago she found me tearful at the news of a neighbour's death. She ran and got some tissues, wiped away the tears and told me I'd feel better now the sad had come out.
My notes state that because of my age, grade of cancer and the immunhistology of the tumour I am at significant risk of a re-occurrence. Abigail sits on my knee and says, "You're not going to leave me, are you? I'm too little to leave." "No," I reply, "I'm going to be here when you are four and five and six...", I count all the way up to 40. "And 43," states Abigail. I laugh with her. "And I'll be here when you're 43."
So that is where I am heading. I have rather a lot to do over the next 40 years. As well as bringing up two children, the world remains an unjust place. I have no intention of allowing the cancer to return, but if it does I will control it and live with it.
BREAST CANCER: THE MYTHS
MORE WOMEN ARE DYING
Quite wrong, happily. Death rates are falling - thanks largely to tamoxifen, the hormonal drug taken by postmenopausal women after treatment for breast cancer, which dramatically reduces the chances of its return. Newer drugs, called aromatase inhibitors, which may be taken when tamoxifen stops, are cutting the death rate even further.
However, more women are getting breast cancer, up 70 per cent since 1971 and 15 per cent between 1990 and 2000. This is partly driven by the ageing of the population and partly by lifestyle changes, such as growing obesity. About 41,000 women are diagnosed each year and 12,800 died from breast cancer in the UK in 2002. The lifetime risk of developing breast cancer is now one in nine.
SCREENING IS EFFECTIVE FOR EVERYONE
For some women, but not all. There is disagreement about this. In the UK, women are invited for routine mammography by the NHS every three years between the ages of 50 and 64, shortly to be extended to 70. In the US, screening is recommended from the age of 40. British specialists argue that mass screening for women under 50 is not justified (except for those at high risk) because the breast tissue of pre-menopausal women is denser and the mammograms are harder to read - so there is a greater risk of mistakes and cancers being missed or wrongly suspected.
DAIRY PRODUCTS CAUSE THE DISEASE
Not only dairy products. Meat, eggs and other foods high in saturated fats, as well as margarines and oils high in polyunsaturated fats, are thought to increase the risk.
The link between dairy products and breast cancer was promoted by Jane Plant, a doctor and breast cancer survivor who claimed in her book Your life in Your Hands that cutting out milk, butter and cheese denied the cancer the hormones and growth factors that promote the disease. However, her evidence is anecdotal. Most specialists believe her case has yet to be proved.
MOST BREAST CANCER IS INHERITED
Only a small percentage (5-10 per cent) of breast cancers are thought to be caused by abnormal genes. Two of these are BrCa1 and BrCa2, which give the women who carry them an 80 per cent lifetime chance of developing the disease.
Other genes are almost certainly implicated, but women with a family history of breast cancer are at only slightly increased risk.
The main risk factor is age. At least 80 per cent of breast cancers occur in post-menopausal women. Other factors are: a high-fat diet; obesity; previous, non-cancerous lumps; early start of menstruation or continuation past 50; not having children; having your first child over 30.
EVERY WOMAN MUST CHECK HER BREASTS
Nine out of 10 breast cancers are first spotted by women or their partners. But studies have shown that monthly self examination does not lead to earlier detection. The new advice is for women to be "breast aware" - conscious of any changes in the shape or texture of their breasts that may indicate the development of a tumour.
Nipple discharge is a frequent cause of worry to women, although most cases do not indicate cancer. Even when the discharge is bloody or watery, about 90 per cent of cases are due to a non-cancerous condition, such as papilloma or infection.
THE PILL CAUSES IT
No, it doesn't. This unfounded belief arises from the fact that the contraceptive pill contains small amounts of oestrogen, which is known to promote the growth of breast cancer. But the amounts are too small to pose a significant risk, especially since the development of the low-dose pill. Even for women who took higher-dose pills in the 1960s and 1970s, the risk will have returned to normal when they stopped.
IT'S THE FAULT OF ANTIPERSPIRANTS
As antiperspirants stop perspiration, the rumour has spread that toxins somehow become trapped inside the body, where they trigger cell mutations. But the body does not need to purge itself of toxins through the armpits, and the main function of sweating is to cool the body down. According to the National Cancer Institute in the US, there is no good evidence linking antiperspirants with breast cancer.