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There are times in life when even the most empathetic person — the one who always seems to know the right thing to say — finds themselves at a loss for words.

Learning a friend has breast cancer can be one of them.

Dr. Shanthi Gowrinathan, a psychiatrist specializing in both women’s psychiatry and psycho-oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California, says there’s a reason for this.

“We still associate the word cancer with a tremendous amount of fear and a reckoning of our own mortality,” says Gowrinathan.

Breast cancer deaths decreased by 40 percent from 1989 to 2017, in large part because of early detection and improved treatment. But it’s still devastating to hear a loved one say the four words, “I have breast cancer.”

Though it’s emotional news to hear from a friend, experts say it’s important to center the conversation around what your friend needs.

“No matter how well you know someone, you don’t know where they are at in terms of their emotional or mental state,” says Dr. Regine Muradian, a licensed clinical psychologist, speaker, author, and mental health advocate. “You want to be supportive but want to find the right words… You want to make sure you are mindful and compassionate.”

There’s no one-size-fits-all approach. Some people may find certain words comforting, while others may be offended.

Your friend may want your advice if you’ve gone through breast cancer yourself, such as a recommendation for a doctor or a certain treatment plan.

But they may not.

Gowrinathan suggests allowing your friend to lead the conversation and giving them space to provide you with feedback on your approach.

“I don’t always know what’s right because I’m walking into a room with someone I’ve never met before,” she says. “I’m going to make mistakes and say the wrong thing. If I do, I say, ‘I am really sorry. That’s probably not what you wanted to hear. What would support look like to you?’”

Though there’s no perfect thing to say and people’s needs will vary, both Gowrinathan and Muradian agree that asking questions, offering to help, and just listening are good places to start.

They also agree that dismissing a friend’s emotions, giving unsolicited advice, or sharing negative stories about yourself, friends, or family who have had breast cancer aren’t great ideas.

Consider these tips if you’re struggling with what to say and how to support a friend with breast cancer:

Do you want to talk about it?

You may think that if a friend is telling you they have breast cancer that they want to talk about the diagnosis. The truth is, they may not. They may just be letting you know.

“Maybe they have been talking about it all day with doctors, and they don’t want to talk about it,” Gowrinathan says. “They may still be internalizing and processing the vast amount of medical information they get in those first few days.”

If they say they don’t want to talk about it, Gowrinathan suggests not taking it personally and leaving the door open to check in later.

“[Don’t feel] any sort of rejection because it really is something that people are actively processing when they are diagnosed,” she says.

I’m here for you. I’m listening

It’s common to feel pressure to find the right words to say, but sometimes the best thing is to let your friend do the talking.

“Everyone wants to feel heard and know there is someone on the other line who can be there to support them,” Muradian says. “That’s all you have to do sometimes, lend that ear, and it helps to purge out all these feelings… It’s so powerful.”

How can I help?

A breast cancer diagnosis can upend a person’s normal routine.

They’ll likely have to take off work for doctors’ appointments. They may be weak from treatment and unable to run errands, care for children, or drive.

“It can be so overwhelming, and they may feel paralyzed and not sure how to cope,” Muradian says. “They may be thinking, ‘How am I going to get all these things done?’ It feels like your world is collapsing… It’s nice to know you have someone there.”

Gowrinathan cautions that sometimes this question can go both ways, though.

“I’ve had patients tell me that they feel very supported by this, and I’ve had patients who are frustrated with that because they feel like it puts the pressure on them to figure out something that needs to be done,” she says.

You may want to offer something specific, such as going to an appointment with a friend.

“[Many] women would probably like some company on those appointments,” Gowrinathan says. “It’s a lot to handle alone.”

If the person turns down your offer, Muradian says to remind your friend you’re here if they need you.

“You can say, ‘I’m here, and I’ll check back with you tomorrow,’” she says.

That sounds like a good decision

Perhaps your friend chooses a doctor who you’ve heard mixed reviews about or isn’t the one another friend told you is the best in the region.

Gowrinathan advises to keep it to yourself. It’s best to validate your friend’s decision.

“It’s really easy to second-guess yourself in terms of who you choose to treat you,” she says. “Be supportive of people’s choices, even if it’s not what you heard.”

Unsolicited advice, even if you’ve had breast cancer, is often well-meaning but ill-received.

“I know we all come from a helpful place… but it’s invasive,” Muradian says. “It backfires. Now, you’re inundated with what to do and someone else’s experience. That pushes the other person away.”

If you’ve had breast cancer before and are open to sharing recommendations and experiences, it’s best to put the ball in your friend’s court. Let them process things at their own pace and make decisions that work best for them.

“[You can say] ‘Well, I understand what you are going through, and if you want to talk through my experience, I’m here for you,’” Muradian says. “You don’t know what stage [of grief] they’re in, so it’s all about being compassionate and mindful.”

Everything will be OK!

Though medical advances have lowered the death rates for breast cancer, the hard truth is no one knows how the disease will progress for your friend.

“It’s creating false hope because we don’t know what’s going to happen,” Muradian says.

It can also make your friend feel patronized, because they’re likely well aware that things may not be okay.

Just stay positive

Talking about a breast cancer diagnosis isn’t fun.

Think positive thoughts” may sound like good advice, but it can be dismissive of your friend’s feelings. It’s OK for them to take the diagnosis hard or have a bad day, week, or month.

“Expressing our fear, our anxiety, our sadness, and grief over this happening and changing our life trajectory should be allowed,” Gowrinathan says. “‘Stay positive’ is more protection for the person who has to hear the not-so-good stuff than it is for the person going through it.”

“If you want to be positive, wonderful, but if you have what my patients and I call ‘mush days,’ that’s allowed,” she adds. “That’s justified. That’s healthy.”

Instead of encouraging your friend to stay positive when they’re down, it’s best to listen and tell them you’re here to support them however you can.

My aunt lost both her breasts and died

This may seem obvious, but sometimes we blurt out a negative story in the shock of the moment. Try to take a moment to pause before responding with something like this.

“That’s just setting people into an alarm state, and that’s not helpful,” says Muradian.

Though your concerns are valid, they won’t help your friend.

When speaking with your friend, the conversation should revolve around their needs and feelings, but that doesn’t mean you’re not hurting.

Muradian suggests reading Cecil Murphey’s “When Someone You Love Has Cancer.”

“This book is for caregivers to seek peace and understanding and learn how to support and care for the breast cancer patient,” she says. has videos and information for caregivers. If you’re struggling to cope with your friend’s diagnosis, you might consider speaking with a therapist to help you process your feelings.

Learning a friend has breast cancer is difficult. It’s important to remember your friend needs your support, and what that means will vary from person to person. It’s best to try to gauge where your friend is and respond accordingly.

You can do this by listening, empathizing, and asking questions. If they turn down your offers to talk or help, continue to gently check in.

You may say the wrong thing — and that’s OK. Give yourself some grace and apologize. You’re only human.

Then, ask your friend how you can better provide support. If you’re struggling, don’t be afraid to reach out for help.

Beth Ann Mayer is a New York-based writer. In her spare time, you can find her training for marathons and wrangling her son, Peter, and three furbabies.