Dear Dr. D.,

I was reading the State News article about breast cancer, and it talked about a woman who was only 33 years old and had a very advanced form of breast cancer. That seems so young! I always knew breast cancer was a problem, but it's not something I really think about. If I'm 23, should I already be doing breast exams? What am I even looking for? What's normal?

Sincerely, Deeply Concerned

Dear DC,

As I begin to think about how to answer your question, I am overwhelmed by emotions and memories of a friend.

During my doctoral program here at MSU, I met a promising graduate student with whom I eventually co-taught. Her name was Lorrie Ryan, and she had a very kind soul. We became good friends.

After a four-year absence — when she went away and became Dr. Lorrie Ryan — she came back into my life and also became best friends with my wife. We loved listening to Lorrie's laugh and enthusiasm.

About 10 years ago, at the age of 30, Lorrie called me from her doctor's office in tears to tell me she had been diagnosed with breast cancer. All I could do was listen.

I visited her after her first partial mastectomy, as she struggled with the loss, and all I knew I could do was listen. I traveled to see her during bone marrow transplant surgery, as she balanced precariously between life and death, and all they would let me do was listen.

Four years ago, I stood up at her wedding as she agreed to live her life with a soulmate who knew she had breast cancer. As they both said "I do," I joyfully listened.

Late last summer, confined to her house, she spoke to us through a haze of delusions brought on by heavy doses of morphine, and I sadly listened. In mid-September of last year, I had to stop listening, for Lorrie stopped talking. She died of breast cancer at the age of 39.

You are never really too young to know the facts about breast cancer and how to get involved in early detection.

Breast cancer is the most diagnosed form of cancer in women in the United States, with nearly 2 million women having been treated for the disease. Additionally, nearly 2,000 men will be diagnosed with breast cancer this year in the U.S.

If breast cancer is diagnosed and treated early, it can greatly reduce loss of life and suffering.

According to research, your chance of getting breast cancer is increased if you have one or more of the following factors: family history of cancer, defects in one or two inherited genes, early onset of menstruation or late onset of menopause, never experiencing childbirth and use of hormones. The risk of breast cancer increases as women age.

At your age, you should be doing breast self-exams (BSE) monthly and should continue through your 20s and 30s. Clinical breast exams (CBE) should be done every three years or as deemed appropriate by other factors. Once you turn 40, or earlier if indicated, you should have a high-quality mammography done every year. Although the BSE can't always detect breast cancer, it will help you get to know what your breasts normally feel like and might help you notice if there are any changes or differences. You should check both breasts completely and include the armpit. Do it at approximately the same time of every month. Use the pads of your finger and make circular motions using variable pressures so you can feel the entire breast while checking for lumps, thickness or other changes.

Although most breast lumps are not cancer, if something feels different, don't wait — go see your clinician. Go to www.breastcancer.org/breast_exam_picture.html to learn more and view diagrams.

Sometimes the most important thing we can do is listen. After all, that's all Lorrie ever wanted from me. So now I ask you to listen and then act.

Peace, Dr. D.