How do men screw up when their wife or girlfriend is diagnosed with breast cancer? Let me count the ways.

Some play the denial game: work late, hole up in the den, pretend nothing's different. Others prefer the take-charge route, figuring if they can mend other stuff, they can "fix" cancer. Good luck with that, buddy!

They take to brooding. Or they want their wives to be relentlessly upbeat. How dare she be pessimistic? Didn't the doctor say she has a 90 percent chance of living five more years!

The guys don't do enough around the house; they do too much around the house because it's easier to wash the dishes than to sit down and ask their wife how she's feeling.

They want to have sex even when she's feeling lousy after surgery or in the midst of chemotherapy. Or else they're afraid to flirt, which makes her feel sexless.

Believe me, I know all the mistakes, because I've been there and done that.

In August 2001, my wife, Marsha, called me at work with the news that she had been handed a near-diagnosis by a blunt radiologist, who eyeballed a mammogram and said, "Sure looks like cancer to me." I instinctively knew just the wrong thing to say: "Ew, that doesn't sound good." Then, instead of rushing home to her side, I signed off with, "See you tonight."

Well, at least I avoided sports metaphors. One breast cancer survivor told me her boyfriend kept saying, "This is the ninth inning, and there are two outs, but we are going to knock this ball out of the park." If there were a breast cancer umpire, he'd toss that guy out of the game.

The medical community is well aware that breast cancer husbands need coaching. Last year, the Centers for Disease Control and Prevention awarded a $1.1 million grant to Men Against Breast Cancer, a Rockville-based educational and fundraising group, to establish programs to enlighten husbands of newly diagnosed women, focusing on "underserved minority communities." The first sessions will start this fall.

As for my wife and me, we muddled through our year of fighting cancer. Marsha had bilateral breast cancer -- a tumor in each of her "girls." She underwent a pair of lumpectomies, followed by chemotherapy and radiation, and today she is feeling good. Since I wished for a book to help me out during those dark days, I wrote one myself. For all those clueless guys (like me) who need a crash course in caregiving, I have prepared a Cliff's Notes version. Here are nine ways that men mess up -- and how to get it right instead.

Bad response #1: "I know what you need."

Of course you don't. It's not about you. It's about your wife and her needs -- which may change from day to day, from hour to hour. Sometimes she might want a cheerleader in her corner; other times she might just want to rant (see #4 for more details).

That's why the breast cancer husband's motto should be, "Shut up and listen." If your wife isn't issuing instructions, swallow your manly pride and ask.

Here's a sample script for the tongue-tied guy, courtesy of Matthew Loscalzo, director of patient and family support at the University of California at San Diego Cancer Center: "We all know that men need a mission, and my new mission is to be there for you in any way I can. But I don't know how to help. You have to tell me what you want. Is there anything I can do for you right now?"

And then . . . shut up and listen.

2. "She told me I don't have to go with her to every doctor's appointment, so I'm obeying orders."

Don't let yourself off the hook so easily. Okay, there are exceptions. Perhaps your wife genuinely prefers the company of her sister the nurse in the doctor's office. One wife told me she banished her husband from appointments because he tended to cry. Let's face it, some guys are oafs when it comes to medical matters. And some bosses make it damned near impossible for the husband to take time off.

But those cases aside, as a rule, you can't go wrong by tagging along. A husband who listens carefully, takes notes or tape records the visit can be a huge help.

"We assume that, due to anxiety, half of what the patient hears goes in one ear and out the other," said Julia Rowland, a psychologist who runs the Office of Cancer Survivorship at the National Cancer Institute.

But there's another, deeper reason to be there. "Can you imagine her going, and coming back and telling you what the doctor said?" asked John Davis, 55, of Bowie, who accompanied his wife, Dorothy, 53, to doctor's appointments after her diagnosis seven years ago. "By going with her, you're part of the event. You're not sitting on the sidelines. You learn what she is going to experience."

3. "I'm running the medical show."

I remember thinking my job should be to choose the top doctor and a surefire treatment plan for Marsha. I mean, aren't husbands supposed to protect their wives? Eventually, I came to understand that wasn't my job at all. Your wife is in charge. (That's why the doctor should be making eye contact with her, not you.)

She will select doctors who make her feel confident, and treatment options that make sense to both the doctor and to her. Your wife may ask you what you think of a particular doc or of the doctor's advice. Go ahead, speak up.

"If a patient has an echo, a foil, it makes it much easier [to make decisions], even if she may not take the spouse's advice," explained my wife's oncologist, Frederick Smith, who is affiliated with Sibley Memorial Hospital. And if she doesn't, don't feel bad. Think of your workplace. You may propose ideas to your boss all the time. The boss will listen, and maybe even thank you. But in the end, the boss will do what the boss wants to do. And in the world of breast cancer, I don't have to tell you who's the boss.

4. "Cheer up, honey!"

"The lesson I have learned and keep learning," said Mike Malone, 35, of San Francisco, whose wife, Stacy, was diagnosed three years ago, "is that sometimes she just wants to say, 'This is how I am feeling.' And all she wants in response is, 'Yup, that sucks.' "

Medical science backs him up. Karen Weihs, a psychiatrist at George Washington University, has compared the emotional reactions of breast cancer patients in two small but significant studies. She looked at those who made no bones about the general crumminess of their situation, and those who kept negative emotions bottled up. Compared with the silent sufferers, the women who let out their feelings tended to cope better with the stress of treatment, and some even lived longer than their prognosis would have predicted.

5. "Stop crying about being bald -- your hair will grow back."

It drove me crazy that my wife was obsessed about her pending hair loss from chemo. I mean, what can you do about it? Nothing! And it's not as if the hair won't return. But as I spoke to breast cancer survivors while researching my book, I heard over and over -- much to my astonishment -- that losing a breast wasn't as traumatic as losing their hair. A loose-fitting blouse can conceal the loss of a breast, the women told me, but the bald head is a public symbol of everything that's wrong. And while guys aren't adept at spotting a wig, women sure are.

So then what do you say to your newly bald wife? Oncology social worker Hester Hill Schnipper, author of "After Breast Cancer: A Common-Sense Guide to Life After Treatment" (Bantam, 2003) thinks many women just want to hear five simple words: "You look beautiful to me."

6. "Sex is taking a holiday."

Not so fast, Mr. Celibate. There's nothing wrong with coming on to your wife, even in the middle of the chemo months. Just be gentle, and, if she's not interested, well, too bad for you. But that doesn't mean you should cancel all intimate contact.

"The loss of touch is just the biggest loss we can experience," said Bethesda psychologist Venus Masselam, whose clients include breast cancer patients. "There's nothing like a foot rub with a nice cream. There are so many other ways of connecting that we totally omit."

For the frustrated guy, there is one additional piece of advice I can pass on for months when your wife is definitely not in the mood. As a truck-driving breast cancer husband delicately phrased it, "Sometimes you have to be an owner-operator."

7. "I can do it all, and I don't need a break."

Oh yes you do. Otherwise, you'll be a cranky caregiver.

Tom Stern of Chicago, whose wife, Sandee, is a breast cancer survivor and who counsels husbands on the Y-ME breast cancer hotline, often asks a caller, "What do you do for yourself?"

The usual response: "Nothing."

And Tom will say: "You have to recharge your batteries. Take 10 minutes to shoot baskets, read, ride a bike. Do it."

When friends would call journalist Steve Roberts and ask what they could do to help during his wife Cokie's treatment for breast cancer, he'd say, "Play tennis." With him, that is.

As long as you get your wife's permission, it's fine. Really.

8. "Cancer is no laughing matter."

Actually, there's nothing wrong with a bit of humor. Sharon Manne, a psychologist who directs the psycho-oncologyprogram at the Fox Chase Cancer Center in Philadelphia, looked at how 150 breast cancer couples used humor to cope. "Lightening it up a bit" could reduce the woman's distress, she found.

It all, as you might expect, depends on the nature of the joke -- and the jokee. Some women do not want to be the butt of a barb. Others don't mind. When Brenda Moyer, 52, of Macungie, Pa., opted for a mastectomy to treat the three-centimeter cancer in her left breast, her husband Dave teased, "The other one was always my favorite anyway."

And when she went to buy a prosthesis, he said, "We're going for her tit fit."

Did she mind?

"No," Brenda said. "He does it in a loving way. And it's the greatest thing in the world to be able to laugh."

David added, "If you don't keep your sense of humor, cancer will worry you to death."

9. "When treatment ends, don't worry, be happy!"

"My husband was truly a saint," said Carole O'Toole, 48, of Kensington, a breast cancer survivor and author of "Healing Outside the Margins: The Survivor's Guide to Integrative Cancer Care" (Lifeline Press, 2002). "He never missed an appointment." But when she had her last treatment, he said, "It's behind us now."

O'Toole remembers her surprise -- and anger.

"I said, 'I have to live with this every day for the rest of my life. It's not something you can just close the door on or wrap up in a box and say it's gone.' "

At times (and as more time goes by), the disease may fade from her mind and your mind, like a distant relative you really can't stand. And the further out from diagnosis a patient is, the less likely it is that the cancer will come back. But there are no guarantees. That's why I'll occasionally remind my wife of the wise words uttered by Smith, her oncologist:

"You can spend all your time worrying about a recurrence. If you never have a recurrence, you've wasted all that time worrying. And if you do have a recurrence you've still wasted all that time worrying when you could have been enjoying life."


Marc Silver is an editor at U.S. News & World Report and the author of "Breast Cancer Husband: How to Help Your Wife (and Yourself) Through Diagnosis, Treatment, and Beyond" (Rodale, $14.95), published this month.

Marc Silver and wife Marsha, who was diagnosed with breast cancer in 2001. After multiple treatments, she's "feeling good."