October is National Breast Cancer Awareness Month, and early detection often is cited as the most effective way to survive.
Yet in Mary Docken's case, early detection didn't help because the substitute teacher was struck with inflammatory breast cancer, a rare form of the disease.
Inflammatory breast cancer accounts for fewer than 5 percent of breast cancer cases in the United States, according to experts.
Instead of a lump, this cancer shows up as reddish or bruised skin, a burning sensation, swelling or an inverted nipple.
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Docken, 41, who lives in Kennewick, first noticed a problem in January 2009 because she had a swollen toe. By that April, she had swelling and pain throughout her body and was being treated for rheumatoid arthritis.
She was on "a ton of medicine," she said, which reduced the swelling enough to reveal a mass in her breast. By that June, she was at Columbia Basin Hematology & Oncology at the Tri-Cities Cancer Center in Kennewick.
Already, her cancer was stage 3B, and the next 16 months were harrowing.
"This is a pretty scary thing," she said. "If you don't get it right away, you can die pretty quickly. It's a fast-spreading cancer."
For the next two months, Docken endured heavy chemotherapy treatments to stop the cancer's growth, followed by two months of lighter chemo to shrink it. That October, surgeons performed a double mastectomy.
Doctors also removed 20 of Docken's lymph nodes, then found cancer in one more, so she faced three more months of chemotherapy and more than six weeks of radiation treatments.
In the meantime, she continued with a precautionary chemo until September 2010 and will be taking a pill for the next four years to control the protein in her body.
Through it all, Docken's family surrounded her with love. Her husband held her hand through all of the doctor appointments and chemo treatments, and her two teenage sons stayed strong for her.
Today, Docken feels good and is back to work as a substitute teacher in Kennewick and Pasco.
"Going back to work was hard, with the loss of my hair," she said.
School officials were great to work with, though, she said, allowing her to wear hats as her hair grew back.
Today, she is much more aware of her body, eating better and exercising more. And she wants others to realize that breast cancer doesn't always show up as a lump.
"I didn't think I had cancer," she said. "Everyone needs to know that it comes in different forms."