Your best friend just told you she has been diagnosed with breast cancer. You have been friends for years, but now you dont know what to say. Your mind goes into overdrive, suddenly thinking up and casting off all kinds of remarks and platitudes. So, what exactly do you say and how do you say it?

This scenario is being played out every day across the country. According to the National Cancer Institute, an estimated 213,000 American women will be diagnosed with breast cancer in 2006. With numbers like that, it is critical that women get the support they need right from the beginning.

What a breast cancer patient wont tell you is that those first reactions and subsequent comments made early in her diagnosis have a huge impact on her state of mind throughout her cancer journey. Not all comments are helpful, and in fact, many well-meaning statements can actually be hurtful.

The first thing to keep in mind is that a newly-diagnosed person is not her usual self. Her sense of who she is has just been turned upside down. Theres no way to sugar-coat it: she has just been told she may be dying. She experiences panic, dread, fear, depression, despair, hopelessness, and other emotions, often from one minute to the next. Her grounded world has fallen away leaving her brittle and vulnerable.

Later on her the cancer journey, a survivor may become acclimated to a new identity of a woman with breast cancer and a different sort of normalcy will start to form. It doesnt take the place of that once-secure reality, but it allows life to go on.

I was diagnosed with breast cancer on a cold January morning via the telephone. Yes, thats right: by telephone. I then called family and friends for support. Heres a few of the first reactions people had to the news of my breast cancer. I like to call this, What NOT to say to a woman who just told you she has breast cancer.

You will be OK. I promise! (Lets be real. No one can promise you that you will be OK. Youre already not OK.) While a lot of women are successfully pushed breast cancer out of their lives, some will die. You dont have to say anything about that, but just remember that the woman knows she faces a journey of the unknown, so dont lie. Just simply say you will be there for her every step of the way.

There are so many things medicine can do these days. The treatments are so much better than they used to be. While that sounds encouraging, my mother, who died of breast cancer in 1979, was treated with surgery, chemo, radiation, which was exactly what I was treated with last year. If you arent an oncologist, avoid statements about what treatments can and cannot do these days. Support her choice of treatment even if you dont like it.

You got it early, didnt you? Dont ask this question! OK, first, what if she didnt get it early? Do you want to make her feel worse about that? Secondly, what if it was detected early, but early detection doesnt save her? In spite of what you may think, not all women survive cancer with early detection. Dont push her to tell you the stage at which her cancer was detected. Keep your curiosity to yourself. If she wants to talk about it, she will.

You have to keep a positive attitude. It helps you heal. What a load of malarkey. Lets be real: if being positive was all it took to have a good medical outcome, we could wish away all our illnesses. The American Cancer Society notes that although optimism has been promoted by some as a path to longer survival for cancer patients, in reality the scientific evidence of its true role has been (at best) mixed. So dont dump that extra burden on her. What if she doesnt feel positive, but instead feels sick, fatigued, puffy, depressed, angry, or drugged? Negative feelings are entirely appropriate under the circumstances. Let your friend express her feelings around you without the pressure to be a Pollyanna. Thats you being a real friend.

Having said that, dont become Debbie Downer either. Since most people are just plain frightened by the topic of death, they react to cancer in ways to make themselves, not the cancer patient, feel better. Bad news dredges up memories of surgeries, emergencies, and/or traumas for some people, and they just cant seem to stop themselves from sharing all about those experiences, usually in vivid detail.

If the urge is there to tell a newly diagnosed woman about your sisters breast cancer, please repress it. Dont blab about other traumas to an already-worried person. Hospitals, doctors, needles, procedures, the euphemistic discomfort are not areas that she needs to dwell on right now. She could be on her last nerve and have no more resources to absorb these stories. Trust me; you are not the only one telling her. The accumulation of such tales over the course of a day would send the strongest of us to hide under the covers.

In my breast cancer support group we joke that we could make big money making smiley-face tee-shirts for breast cancer patients that say: Thank you for NOT being compelled to tell me your (or other person you have known) disease, surgery, illness, death, dying, trauma, injury, loss, or similar story. Talk less and listen more.

Show her she has real, tangible help. If you are close enough, offer to go with her as her as an advocate through the medical and/or insurance system. Take notes for her at doctor appointments. Make meals for her and her family so she doesnt have to cook. Buy loungewear sets so she can rest without being in t-shirt and pajama pants all the time. Run the vacuum on Tuesdays. Read to her or tape her favorite shows. Tune in to her likes and needs. Send her chocolates if she likes them; peanut brittle if she doesnt.

And most of all, dont make a big show of concern in the beginning of her cancer journey and then forget about her over the subsequent months or years. Yes, being a support person for someone with cancer isnt easy, but you can find great joy in it, too.

Help the woman you know with breast cancer by laying a foundation of support and love that she can return to in her mind over and over again. Heres one of my favorites: You are an exceptional, irreplaceable person in my life. You are rare and matchless. I want you to be as healthy and happy as you can possibly be, and I plan to do whatever I can to make that happen for you. You can count of me. Im not going anywhere.