What to say to someone with breast cancer

While there are recommended things you can say (and not say), it’s important to know that there is no single “right” way to talk to someone coping with breast cancer. You might make mistakes or missteps, and that’s normal. Something that seems like a mistake can also be an opportunity to open up a new kind of conversation with this person in your life.

To help navigate conversations about breast cancer, LBBC spoke with Kelly Grosklags, LICSW, BCD, FAAGC, a grief counselor and oncology psychotherapist, for communication tips based on her years of listening to people living with cancer.

What to say to someone newly diagnosed with breast cancer

When someone has recently been diagnosed or is within the first few weeks after diagnosis, there can be a lot that is unknown for everyone involved. Whether you are a caregiver or a friend, you’ll have your own individual reactions to this news. “Fear, anger, sadness — a variety of feelings are possible,” says Ms. Grosklags. “Acknowledge and honor them, but try not to project them onto the person who has just given you this information.”

You may need to find someone outside of the situation to hold space for you to share those feelings, “but in the immediate moment, focus on the person in front of you,” says Ms. Grosklags.

“People [diagnosed with breast cancer] want to know that they aren’t going to be alone, and to feel safe, and that they have a community to walk this with them,” says Ms. Grosklags. So, your initial reaction should focus on your desire to be there. But, she notes, it is very important not to overpromise. If you want to be of assistance, let your loved one know. But be realistic. If you’re not able to fulfill a promise, it can add to a person’s hardship instead of reducing it. If, at least at first, all you can offer is a prayer, go ahead and say that.

Things you might say:

• “I’m really sorry to hear this.”
• “I'm not sure what to say, but I want you to know I care.”
• “I'll keep you in my thoughts.”
• “Would it be okay if I call you after your next appointment?”
• “Would it be okay if I text you?”
• “It’s okay if you don’t call or text me back.”
• “Let’s get on a regular communication schedule.”
• “You may not know what type of help you need right now, but I will keep checking in to see if I can help.”
• “It’s okay to say ‘no’ and it’s ok to say ‘yes,’ but here’s what I’d like to do [insert your ideas on how you can be of support].” This may include thinks like periodic check-ins, dropping off meals, mowing the lawn, walking the dog, or taking children to their afterschool activities. Remember to keep it realistic and doable. Make it about the other person (not you), and allow room for your loved one to decline an offer.

What to say to someone newly diagnosed with metastatic breast cancer

If you learn that someone in your life has been diagnosed with metastatic breast cancer, which includes stage IV, you may already know that this is breast cancer that has spread to another part of the body. This news can trigger anger, fear, stress, or sadness for the person who’s been diagnosed and for the people who love and care for them. But many people with metastatic breast cancer are now living longer and leading active, productive lives. There are many treatment options available, with new medicines being tested every day.

As you support a loved one opening up about a metastatic diagnosis, it’s okay to show that you have feelings and are sad, says Ms. Grosklags, but try to ask questions such as:

• “How does this feel for you at this moment?”
• “What is the thing you are most scared of with this diagnosis?”

Or say something like:

• “I understand right now we may not know what this is all going to entail, but I want to try to be a support to you.” Then, offer real ways you feel you can help.
• “I want to be here…” says Ms. Grosklags, is a really important phrase, because it shows a genuineness in your offer and takes away the feeling that the person is a burden. It communicates that you want to be of help, not that you feel you have to.

What to say to someone in treatment for breast cancer

After the initial diagnosis and as cancer treatment gets underway, Ms. Grosklags says, “in all the days, weeks, and months that follow, people will continue to need support.” Active or ongoing treatment will bring new challenges. Remind your loved one that you want to be of help, and give concrete examples of things you are willing and able to do. Try to be flexible and adjust to the person’s changing needs and emotions. “Hold space for all of it,” says Ms. Grosklags. You might consider asking:

• “How can I help in the way that works best for you?”
• “If you have pain, is it being managed?”
• “Are you having trouble with any side effects?”
• “Are you feeling safe?”
• “Do you feel supported?”

Still not sure how to communicate with your loved one? You don’t have to be perfect — just lend a caring ear. Let your loved one know you’re there to listen whenever they feel like talking.

What to say to someone who has finished active treatment

If your loved one is being treated for early stage breast cancer, the initial, main part of treatment will come to an end. When treatments such as surgery, chemotherapy, radiation, or targeted therapy are finished, it’s normal to experience different feelings. Still, while supportive roles may shift, you are still vitally important.

Everyone’s reaction to the end of a treatment phase is different, says Ms. Grosklags. “Many are anxious. We put on them that they should be happy and celebrate, but people can get anxious about not seeing their healthcare provider as often, or they may be already worried about recurrence. Tune in to how the person is feeling and allow them to express all the variations, from excitement to trepidation about what is coming, or both.” Meet your loved one where they are.

Consider saying something like:

• “It’s okay however you feel.”
• “It’s okay that you are experiencing many emotions.”
• “Is there anything you wish I understood about how you are feeling right now?”
• “Even though you've finished a phase of treatment, I hope you know that you can still talk about it with me.”

It’s important to continue keeping the lines of communication open. Some people who’ve been diagnosed with cancer can experience post-traumatic stress any time during or after treatment — even years later. With post-traumatic stress, fear or anxiety can be triggered by sights, sounds, or smells linked to treatments or other cancer-related experiences. Post-traumatic stress can also show up as:

• Defensiveness, irritability, or fearfulness
• Trouble thinking clearly
• Sleeping problems
• Avoiding feelings or situations that are reminders of diagnosis and treatment
• Loss of interest in life

If you notice any of these in your friend or loved one, encourage them to get help. Post-traumatic stress can be treated, and starting treatment early can help reduce the risk of symptoms becoming more intense later. Treatments may include medicines, support groups, relaxation training, and more. The mental distress of living with a cancer diagnosis is a very real thing, and when you show your support and acknowledgement of this reality, you can have a meaningful impact on a person’s life.

What NOT to say to someone who has breast cancer

There are many ways to express your love and support for a person with breast cancer. Needs and feelings may change and evolve over time, and even within the course of single day. Mistakes will be made and feelings may be hurt, but remember, you are each doing the best you can, reassures Ms. Grosklags. “The best medicine is love and trust. Within caregiving and receiving relationships, a lot can go well if there is love and trust.”

To maintain that sense of trust, try to avoid:

• Expecting your loved one to take care of your needs instead of their own. You absolutely need to be able to communicate your feelings and fears with someone, but — especially at first — avoid placing that additional burden on the person with cancer. For example, avoid saying things such as, “I don’t know how I’m going to do this” and “How am I going to get through this?”
• Overpromising beyond your abilities. Avoid saying, “’I’ll be here for whatever comes up,’ or ‘You’ll never be alone,’” says Ms. Grosklags, unless you can really follow through.
• Commonly used phrases such as, “Call me if there is anything you need.” This is overused and under-utilized, says Ms. Grosklags, “No one is ever going to call. They don’t want to be a burden or they don’t have the energy to call.”
• Overused or “Pollyanna” phrases such as “Stay positive” or “Everything is going to be fine.” This can feel like pressure, and it can feel like vulnerable emotions are being dismissed.
• “I know what you are going through is hard.” This may seem appropriate at first, but in reality, no one can really understand what another individual is going through.
• “Maybe you should have exercised more or eaten more vegetables,” or “How did you get it?” This sounds like a judgment, as though cancer is somehow a person’s fault.
• Saying nothing. Once a person has let you know they’ve been diagnosed, saying nothing, or very little, can feel like abandonment and be very hurtful. Even if you're having trouble coping with the news, it’s better to be honest with the person and show that you still really want to try to be there for them.