She wasn't looking for it, but there it was. A new and mysterious lump.
Theresa Harris found it in her breast one Friday when she was changing her clothes for bed at home in Damascus. And it wasn't just any day. It was the day in July that her sister underwent a double mastectomy to remove her breast cancer and prevent new tumors.
Shocked, Harris wondered how much one family should have to endure within 24 hours.
But a trip to her gynecologist three long days later and follow-up tests confirmed Harris' lump was not cancer. It was an ordinary cyst.
Like most people, she didn't know that the majority of strange lumps and bumps women, and some men, find in their breasts are not cancer. They're benign growths that don't always even require treatment - though they all need to be checked.
Harris and her doctors say the experience should sap the fear many women have about doing self-exams and going for regular checkups. In the smaller percentage who do have the disease, most professionals agree that early detection and new treatments are reducing the rate of death from the disease.
"Get checked, because odds are it won't be bad news," Harris said. "Finding out was such a relief."
October is Breast Cancer Awareness Month, and groups like the American Cancer Society and Susan G. Komen for the Cure are urging women to be vigilant.
While the lumps are not always tumors, breast cancer remains the most common cancer among women after skin cancer, according to the cancer groups. Among those with the disease, only lung cancer is more deadly.
Close to 178,500 women will be diagnosed with breast cancer this year and 40,460 will die.
Men can also get breast cancer, although the rate is far lower - 1.5 cases per 100,000 men in 2003 versus 124 per 100,000 women, according to the Komen group.
And, contrary to popular belief, a family history is not required, or even typical, in those who get the disease, say doctors such as Nazanin Khakpour, director of breast surgery and of the breast multidisciplinary cancer program at the University of Maryland Medical Center.
She said there are four steps to good breast health: Do self-exams monthly so you know what your breast feels like and if there is a change. Get a breast exam yearly from a professional. Starting at 40 years old, get an annual mammogram. And have abnormalities that show up on the mammogram checked or biopsied.
Many lumps don't need any treatment, such as cysts that tend to come and go, she said.
If the lump is cancer, a patient's prognosis is a lot better than someone who comes in with a large tumor that has already spread to lymph nodes or bones, she said.
"Cancer is a very scary word," she said. "It may deter women from getting a lump checked. But we don't like to sit and watch them grow."
Getting a good picture is the first step in naming the kind of lump, said Deirdre Coll, director of breast imaging at the University of Maryland Medical Center.
A mammogram is a set of images that are taken by squeezing the breast a bit uncomfortably between two plates. Coll said the squeezing part goes quickly and the whole process takes about 15 minutes.
The Maryland center recently replaced its mammogram machines with new digital technology that Coll said gives her clearer pictures of the breast.
Often, an ultrasound, or a more focused picture of the lump taken with a probe rubbed atop the breast, still is necessary to determine if it is fluid-filled and not cancerous, or solid and possibly cancerous. A MRI is an even finer picture of the lump and sometimes needed.
Using a needle to tap the mass, or a biopsy, is also done in the doctor's office to determine the substance of the lump.
The lump could be several noncancerous things, Coll said. Among the most common are fibroadenomas, which are rubbery and move around but are totally benign and don't need to be removed.
Also common are cysts, which fill with fluid and are soft. They can come and go and usually don't need to be drained unless they hurt.
A papilloma is less common. It's a tiny growth in the milk duct near the nipple. It typically has to be surgically removed. A fat necrosis is a scar left after a trauma like a car accident and is not usually removed. And an infection from breastfeeding can also occur when bacteria creep in through a break in the skin. It usually needs to be drained and the patient is given antibiotics.
Coll said these lumps shouldn't scare people.
"I see those first two every day, multiple times," she said. "I go into the room and say it's a cyst and they look at me in horror. I say, 'This is great.'"
Harris, 42, who had a cyst, couldn't agree more.
She knew she'd have her family to lean on if it was cancer, including her sister, Susan Granata, who is a year older and lives in nearby Olney. She said Granata had been "superwoman" for how well she dealt with pain, treatment and surgery of her cancer.
But Harris' lump wasn't cancer.
She'll need to be checked again in six months, and then annually. Her sister still will need care.
But they are both healthy, and Harris says her personal brush with the disease has been life-altering.
She'll still work as a financial analyst, spend time with her sister and raise her 5-year-old son with her husband.
"But finding out I didn't have cancer changed my outlook," she said. "It made me not sweat the small stuff. It's not worth it."
meredith.cohn@baltsun.com
Lumps and bumps
Most of the time, lumps and bumps found in breasts are not cancer. There are a host of other things they could be, but they are mostly harmless, and some even go away with no treatment. Doctors urge women, and men, to get suspicious lumps checked.
These are some common noncancerous growths:
Fibroadenomas. These are the most common types of lumps. They generally occur in women ages 20 to 35 and may be related to hormones. They're solid, but rubbery, move around in the breast and are benign. Usually, patients need an ultrasound and a biopsy to confirm they are not cancer. They usually do not need to be removed.
Cysts. These sacks of fluid are also common and occur in people ages 35 to 50. They are soft and often appear in numbers in both breasts, coming and going with a woman's menstrual cycle. Sometimes they require a mammogram to confirm they are benign. Usually, doctors do not drain them unless they become inflamed or painful.
Papillomas. These are less common and occur in women generally up to about age 50. They are tiny growths that occur in the milk ducts near the nipple. Generally, women can't feel the lump because they're so small, but they may have discharge. Patients usually have a mammogram, ultrasound and biopsy to confirm their presence. They often have to be surgically removed to ensure that no cancer is there.
Fat necrosis. These typically happen after a trauma such as a car accident. Some scar tissue is left after the bruise goes away. They can look suspicious if doctors aren't told about the trauma. But they are basically scars and not removed.
Breast infections. These develop when bacteria enter a break in the skin during breastfeeding. They tend to be hot and produce a smelly discharge. They usually need to be drained, and the patient needs antibiotics.
Meredith Cohn
Steps to good breast health
Do monthly self-exams to check for changes.
Get a clinical breast exam every year.
Get annual mammograms beginning at age 40.
Get lumps seen in mammograms or ultrasounds checked.
Getting checked
Women and men without insurance can get free screenings, under a program run by the Maryland Department of Health and Mental Hygiene's Center for Cancer Surveillance and Control. Funding comes from state and federal sources. Call 800-477-9774; or in Baltimore City call MedStar at 410-350-2001 or the University of Maryland Medical Center at 410-328-4673.
By County:
[Anne Arundel:410-222-6180]
[Baltimore:410-887-3432]
[Carroll:410-876-4423]
[Harford:443-643-0350]
[Howard:410-313-4255]
Sources: University of Maryland Medical Center and the state Department of Health and Mental Hygiene