 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Breast Cancer / June 2007Breast cancer treatment may fail most women
Breast cancer treatment may fail most women Researchers say common chemotherapy drugs too risky for many patients ANALYSIS By Robert Bazell Chief science and health correspondent Updated: 2:52 p.m. PT June 5, 2007 What if an estimated 100,000 breast cancer patients got drugs that did nothing to combat their cancer, but put them at risk for heart failure and leukemia? That is the implication of new research that was presented in private session at this week's meeting of the American Society of Clinical Oncology(ASCO) in Chicago. The research, from Dr. Dennis Slamon, chief of oncology at the University of California, Los Angeles, suggests that the most widely used chemotherapy drugs may not benefit most women. Although the research hasn't been published or peer-reviewed yet, it is expected to be soon. The drugs are a common class of treatments called anthracyclines, including doxorubicin, epirubicin, and mitoxantrone. Since their introduction in the 1980s anthracyclines have replaced older chemotherapy drugs in the combination therapies given to women. Administered in the months after surgery and radiation, the chemotherapy is intended to reduce the chances of a life-threatening recurrence of cancer, especially in women at high risk for relapse. Early on, researchers understood that anthracyclines could cause heart failure in some patients. Recently, evidence has accumulated about the additional risk of leukemia, which can strike years or decades after the treatment. Evidence for the effectiveness of anthracyclines versus the older drugs remained murky. Then, a 1998 meta-analysis (a study of all the previous studies) found the anthracyclines did a 4 percent better job at preventing recurrence. Despite their side effects, that study elevated the drugs to the standard of care. Treating many to help few The UCLA research questions that treatment. Slamon played a key role in the discovery and development of the hugely successful breast cancer drug Herceptin. Herceptin, which changed the way the disease is treated, specifically targets a gene called Her-2 that is overexpressed in 20 percent to 25 percent of breast cancers (a gene is overexpressed when its effect becomes excessive in the body). Herceptin's success proved that breast cancer is not one disease, but many, with each benefiting from a tailored treatment. In this latest study, Slamon looked at a more recently discovered gene called Topoll-2, which is sometimes, but not always, overexpressed along with Her-2. Anthracyclines stop breast cancer because they target Topoll-2. Slamon examined tissue samples from more than 2,000 women who took part in seven clinical trials. His analysis showed that anthracyclines work only in women who overexpress the Topoll-2 gene. Such women account for 8 percent of breast cancer cases. The anthracyclines - with all their side effects - have almost no effect in 92 percent of breast cancer cases. "It seems apparent that we are treating patients who don't need the drug to get at that group who have a huge benefit," Slamon told me. "And now we need to direct our therapy and target it more specifically." 'Exciting result' Even when other cancer doctors were willing to use anthracyclines only as targeted therapy, they couldn't. There is no commercial test yet for the Topoll-2 gene, although there likely will be in a few months. Nevertheless, Johns Hopkins breast cancer specialist Dr. Nancy Davidson calls the findings "an exciting result." "It's early; it's provocative. We are waiting to see it go through peer review in the usual fashion," says Davidson, who is incoming president of ASCO. "But there's a lot of buzz." Fran Visco, a cancer survivor and president of the National Breast Cancer Coalition, agrees the work needs to be published and peer- reviewed - very soon. "This is going to be a sea change in how we treat breast cancer," she told me. "There is no reason we shouldn't be moving very quickly to publish it and quickly to figure out how we're going to implement it in practice. Women deserve no less." URL: http://www.msnbc.msn.com/id/19048185/ > Breast cancer treatment may fail most women > Researchers say common chemotherapy drugs too risky for many patients "may" ? The get out word. "most"? I don't think that most women with bc get chemotherapy. I haven't researched but I know far more bc survivors than I've known non-survivors. Posting this sort of thing on this ng doesn't do any one any favours. Mary > > Researchers say common chemotherapy drugs too risky for many patients > [quoted text clipped - 12 lines] > > Mary ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Mary, >From perusing the article it seems to scientifically speak of evolving treatments and how (though women do survive cancer using the anthracyclines) the risk of heart attacks or lukemia later on is the issue. Researchers are working on identifying specific genes which can be targeted for streamlined treatment (I'm assuming reduced risk of heart attacks/lukemia later on). The titles of some articles directed toward professionals can be startling to laymen. It is wonderful to know that new treatments are evolving to fight the disease for us women, with the least side affects. God bless, Coleah >> cancer treatment may fail most women >> > Researchers say common chemotherapy drugs too risky for many patients [quoted text clipped - 34 lines] > > Coleah Coleah, The headline "Breast cancer treatment may fail most women" does nobody any good service. Mary >The headline "Breast cancer treatment may > fail most women" does nobody any good > service. >Mary Thank you, Mary. I certainly do agree! I have had chemo and surely don't need anything else to be concerned about until they have PROVEN their theories! What about "BC women MAY drown if they go swimming" or "choke on a bone while eating" etc. etc. Why don't they take the time to research how many women DO survive bc inspite of the stuff we have to endure? I want to get information I need when I read these posts but I think people should be thoughtful enough not to post stuff unless it has been fully proven first. Bea 'NO FORWARDS OR SPAM, PLEASE" > >The headline "Breast cancer treatment may >> fail most women" does nobody any good [quoted text clipped - 12 lines] > > Bea Thanks, Bea. I hope I can remember the drowning part :-) Trouble is, since my bc treatment my memory isn't too good <G> Mary > Trouble is, since my bc treatment my memory isn't too good <G> > > Mary First person to suggest it's my age gets it!!!! Mary > I haven't researched but I know far more bc survivors than I've known >non-survivors. > Posting this sort of thing on this ng doesn't do any one any favours. > > Mary I agree with you Mary, I also know many more survivors than I've known non-survivors. In fact, I only recall two women off the top of my head that didn't make it. One was a close friend of mine, who had a very agressive rapidly growing bc. The other was a co-worker, who fought her insurance company for the right to be implanted as part of her reconstruction. She held off on surgery until she won that "right." In the end, I feel, it was the delay caused by the fight with her insurance company, that probably contributed to her loss of life. The good news, I know a number of survivors. They are very brave women. Some are quite physically active, run marathons, 10K races, etc. Others swim or walk! Since this newsgroup deals with this topic, I don't think that ignorance is bliss! Information is power! Myrl http://www.webstarmagic.com/wisletter.htm >> I haven't researched but I know far more bc survivors than I've known >>non-survivors. [quoted text clipped - 20 lines] > Since this newsgroup deals with this topic, I don't think that > ignorance is bliss! Information is power! I agree. But I still say that the headline, which you cut, is inappropriate to any group. It's red top stuff and while most of us here has enough common sense and experience to know that there will be others who are newly diagnosed, vulnerable and scared who read it. They won't gain anything. Reproducing the results of proper research is empowering but not when it's summed up as a tag line which is meaningless. > >> I haven't researched but I know far more bc survivors than I've known > >>non-survivors. [quoted text clipped - 28 lines] > Reproducing the results of proper research is empowering but not when it's > summed up as a tag line which is meaningless.- You may be right about how the headline was tagged. I had cut and pasted it as it was presented by MSNBC. > But I still say that the headline, which you cut, is inappropriate to any > group. It's red top stuff and while most of us here has enough common [quoted text clipped - 3 lines] > Reproducing the results of proper research is empowering but not when it's > summed up as a tag line which is meaningless. I agree that the headline was tabloid journalism stuff, and I was quite peeved when I read it. But I found the article more interesting and informative than the headline suggested. It wasn't news I wanted to hear (having been non-Her2Neu positive and treated with anthracyclines, with substantial side-effects). While we'll want to wait for a peer-reviewed version of actual research results, a presentation at ASCO isn't exactly a pitch to an easy or ill-informed audience. If it holds up to scrutiny, this would be a very significant research result. It might narrow the number of women who take these risky drugs, targeting only the smaller population that could truly benefit. Personally, once I read the whole thing (and calmed down <g>), I was glad it was posted here. I regret the frightening effect of the headline, though, especially for the newly diagnosed. It would've been more accurate to say "One breast cancer treatment MAY fail most women who take it". Given what's scientific "truth" right now, I'd take the anthracycline, given all its "proven" risks & benefits. If this research result is scientifically valid, though, I wouldn't take it unless I was in the sub-population. I guess we'll see. Ann T. Remove 'dontsendspam' from address to reply by email > Personally, once I read the whole thing (and calmed down <g>), I was glad it > was posted here. [quoted text clipped - 7 lines] > scientifically valid, though, I wouldn't take it unless I was in the > sub-population. The headline isn't only misleading, it's just plain wrong because it misinterprets the objective of chemotherapy. The aim of adjuvant chemotherapy is not to kill cancer cells or to cure cancer. It is to reduce the risk of cancer recurrence. If the drug regime does more good than harm overall then that is not a failure for anyone. And in fact by this sub-editor's interpretation, anthracyclines "fail" far more than 92%, as most people given chemotherapy don't have cancer anyway - they are the ones who wouldn't get a recurrence even without chemotherapy - the empty chambers in that game of Russian Roulette. What we should be saying is that the drugs are given unnecessarily to more than 92% of patients. We knew that, it's just that we didn't know which ones, so we give it to a lot to save a few lives. The fact that these researchers have possibly found a way of narrowing down the treatment to those patients that will benefit from it is a good step forward, but not a fault with the existing regime. One might equally say that over 95% of women are "failed" by mammograms or biopsies because they don't have cancer. Or a similar number of ER (UK: A&E) patients are "failed" by X-rays because they don't have broken bones. These also are interventions with a risk of long term side effects that are given (with hindsight) unnecessarily in most cases. OK we call them tests, not treatments, but the risk analysis is the same. Tim Jackson [cross-posting snipped] > The headline isn't only misleading, it's just plain wrong because it > misinterprets the objective of chemotherapy. [quoted text clipped - 3 lines] > regime does more good than harm overall then that is not a failure for > anyone. ---------------- However, I was given this drug as part of my *neoadjuvant* chemotherapy, in combination with Cytoxan ("A & C"). The objective *was* to kill cancer cells, to shrink the tumor, and that objective was met. The A & C shrank my enormous tumor down to slightly less than half of its original size. Of course I cannot know whether some other drug would have done as effective a job. Also, since Adriamycin and Herceptin are both cardiotoxic, I doubt that they could ever be given in combination as the article suggests. That had to be wrong. Eva It has scared me to death, because that is what my daughter is now on. > It has scared me to death, because that is what my daughter is now on. Don't panic. Many of us had anthracyclines, and have no material heart damage or any leukemia. They're both pretty rare side effects. Low single-digit percentages, from what I've read. I've taken up strenuous athletic activity since my treatment, and regularly see my maximum heart rate during hard workouts. The ol' ticker takes it just fine. I've known dozens of survivors. I think I may know one who had some noticeable heart damage. It's unusual. There's no question that chemotherapy involves very dangerous drugs. It's designed to kill the rogue (cancer) cells, but not us. But they are willing to accept higher risks from chemo drugs than (say) OTC headache medicine, because the cancer, untreated, stands such a good chance of killing us. Extensive research is done to try to demonstrate that the treatment saves more lives than the side effects risk, before the treatement becomes standard. The study's basically saying that new research may help better target which patients will benefit from this particular type of chemo, which would make the benefit-to-risk ratio even better than it is now. Consensus here seems to be that the headline is just fear-mongering. So, try not to worry excessively - things are tough enough for you & your daughter. Ann T. Remove 'dontsendspam' from address to reply by email As of May 21st, I have been a survivor of breast cancer for 32 years. I underwent the seldom used Halstead radical mastectomy at the age of 27. I never had chemo or radiation. My surgeon had served two tours of duty in Vietnam and one at Walter Reed Hospital, and his goal was to teach me to fight to live. For 32 years I have remembered the tears that streamed down his cheeks when he told me he removed my breast because of a malignancy. When my nerves were shot, he sat by my bed and rubbed my legs. When family members had a "hard time", he reminded me that his concern was for my physical and mental health and he didn't give a damn (his word) for those who were "having a problem" with it. As some of you reading the group may mostly know survivors of breast cancer, I am one of those who knows many who underwent various combinations of chemo and/or radiation and did not live beyond the 5-7 years. Many of them left behind children who still needed their mother's touch. Most of the patients I visited during my years of reach to recovery are deceased now. Only those who opted for more aggressive forms of surgery are alive today. When I questioned an oncology center after the sudden death of a friend who had undergone multiple rounds of chemo, I asked two questions. "What information do you give women to help them choose the lesser surgeries and chemo?' and "Why do the studies of breast cancer patients not call for women who have survived 5 years or more?" The response to the first question was, "We tell them to search the Internet." When I heard the answer to the second question, I wished I had a tape recorder running. The answer..."They don't ask for those beyond 5 years because they don't live that long." Today I picked up the paper and again found the name of a good friend my age who did not survive. She went through a lesser disfiguring surgery, opted for the chemo, and now she is gone. She had the most wonderful supportive husband I have ever seen...yet all he did could not keep her alive. Yes, a radical is disfiguring, but that surgery was the surgery that gave me back my life. We are are not included in studies, nor are we even being tracked by cancer centers. No one wants to know about us. No one wants to talk about the long-term success rates of radical mastectomies. It just might "frighten" women. My two Reach to Recovery volunteers had radicals and both lived over 35 years after their surgeries, dying well into their late 70's. Contrary to plastic surgeons and their staff members who read this group and want to further remind women they aren't complete unless they have lesser surgeries, chemo and, God forbid, barbaric reconstructions, I have a different outlook on surviving breast cancer. My approach to survival of breast cancer is that women need to be scared into making choices that gives them life. And breast cancer survivers need to learn to love themselves without a breast before some money-grubbing plastic surgeon seduces them into toxic implants and barbaric flap surgeries. Pam Dowd Implant Veterans of Toxic Exposure Breast Cancer Survivor since 1975 Breast Reconstruction Veteran since 1980 > Breast cancer treatment may fail most women > Researchers say common chemotherapy drugs too risky for many patients [quoted text clipped - 91 lines] > > URL:http://www.msnbc.msn.com/id/19048185/ >As some of you reading the group may mostly > know survivors of breast cancer, I am one of [quoted text clipped - 3 lines] > years. Many of them left behind children who > still needed their mother's touch. Well another reason why I should quit reading this "support" group! You see, I asked my surgeon to remove the breast but he refused to. He said he only takes what is absolutely necessary and nothing more. So I guess he was not educated enough to know he was giving me a death sentence from your post. I hope your post is not causing all those who didn't get masectomies to now live their lives in greater fear than they already have with bc. Is your post just a "misery loves company" post in your instance? Somehow I don't think others who post on here who have had removals would have been so blunt about scaring the rest of us. The idea of this group is to help alleviate our concerns and fears, not to increase them. I think you should have thought twice before posting your information. Bea "NO FORWARDS OR SPAM, PLEASE" >As some of you reading the group may mostly > know survivors of breast cancer, I am one of [quoted text clipped - 3 lines] > years. Many of them left behind children who > still needed their mother's touch. Well another reason why I should quit reading this "support" group! NO, Bea! > You see, I asked my surgeon to remove the breast but he refused to. He said he only takes what is absolutely necessary and nothing more. So I guess he was not educated enough to know he was giving me a death sentence from your post. :-) > I hope your post is not causing all those who didn't get masectomies to now live their lives in greater fear than they already have with bc. Well I don't, for one. I wanted an all-off, the surgeon would have done whatever I wanted but insisted that I thought about it for two weeks. He was right to make me consider. And I'm still thriving after nine years :-) > Is your post just a "misery loves company" post in your instance? Somehow I don't think others who post on here who have had removals would have been so blunt about scaring the rest of us. The idea of this group is to help alleviate our concerns and fears, not to increase them. I think you should have thought twice before posting your information. You're right. But not everyone does think before posting that's why the old hands among us must be vigilant and explain to newbies that doom and gloom aren't inevitable. The very best part of the programme for bc is the diagnosis. Without it we almost definitely wouldn't survive. Hugs to all, Mary >I wanted an all-off, the surgeon would have done >whatever I wanted but insisted that I thought about it for two weeks. He was >right to make me consider. It was a little more difficult for me, as we're all supposed to have a "choice" nowadays and I was left wondering what to do. In the end I asked my lovely lady GP to find out as much as possible about my case from the consultant and then tell me honestly what she thought she would do in my situation. I *did* realise that the consultant thought a full mastectomy would be better, but, not being up to speed with all the difficulties involved in my particular case, I would have welcomed more guidance. Of course, it may be that he *did* give me more guidance but I was too shell-shocked to take it all in. After I made my choice, it was obvious he thought I'd made the correct decision, but even so, I envy all you ladies who still have *something* to fill out both cups without a horrid prosthesis. It's all more difficult because of the current fashion for more cleavage. I used to have a really good cleavage when it wasn't fashionable to display it!  Signature"It's easier to get forgiveness than permission." Rear Admiral "Amazing" Grace Hopper >> As some of you reading the group may mostly >> know survivors of breast cancer, I am one of [quoted text clipped - 17 lines] > to help alleviate our concerns and fears, not to increase them. I think > you should have thought twice before posting your information. The relative merits of mastectomy versus lumpectomy have been fairly extensively studied. As I understand it the statistics indicate that there is no measurable difference in survival rates. Each has its own advantages and disadvantages in other ways. Mastectomy is structurally simpler as it involves "cutting along the dotted lines", so the healing can be easier. It removes pretty much all the breast tissue, so the chance of an new cancers occurring are greatly reduced. In some cases radiation can be omitted. Lumpectomy obviously has less impact upon body shape and imbalance, for small tumours there is simply less cutting, and it can be a relatively small scar. While the risk of local recurrence is higher this is a matter of follow-up surgery, they are always treatable and statistically have no impact on overall outcome. I hope you will not leave the group just because someone posts an opinion that you do not agree with. The beauty of this medium is that posts reflect a spectrum of views, and that one can draw a consensus over time, and see which views are mainstream and which are extreme. If you disagree strongly with a post, or feel that it leaves the overall impression unbalanced, then the answer is to post an opposing view for the benefit of the readership, not to walk away and leave them misinformed. I am sure we all know that statistically, medical "testimonials" are meaningless, for one reason because they are self-selecting. However in the interests of balance I'll mention that I have personally (beyond this group) over the years known a handful of cancer patients, three (including my wife) have died, two after about 3 years and one from a recurrence 20 years later. On the other hand about half a dozen (including my mother) have recovered and suffer no more than a scar. Contrary to Pam's experience, mostly the ones who died had mastectomy. This is to be expected, they had the most advanced cancers at the time of treatment, so lumpectomy was not an option, and their prognoses were much worse. Tim Jackson >I hope you will not leave the group just > because someone posts an opinion that you [quoted text clipped - 3 lines] > and see which views are mainstream and > which are extreme. Thank you Tim and Mary for helping to alleviate my fears. I hope to be able to read and post in this wonderful group for many years inspite of what poster Pam seems to think. I know the "old" <g regulars of our group will give us the real info because they do not post to scare but to truly educate and help us. After I calmed down last night from reading Pam's post it occured to me that recently I had read a report that a study was done on lumpectomy vs mastectomy for bc and it said a lot of the doctors were opting for lumpectomy whenever possible (due to, as you stated, what the situation was with the tumor) because the survival rate was not necessarily better for those who had mastectomies. My stating this does not mean to concern the "m" gals but just to say I think when it comes to bc we are all riding in the same boat but it depends upon "many" issues and what type of bc we get as to when the captain will call out our number. This group is about "survival" and I appreciate and thank all of you who give people like myself the strength to believe we "can" survive inspite of what bc treatment we got and are getting. Bea 'NO FORWARDS OR SPAM, PLEASE" > >I hope you will not leave the group just >> because someone posts an opinion that you [quoted text clipped - 25 lines] > > Bea Hurrah! XM > After I calmed down last night from reading Pam's post .... ---------------- Bear in mind that her post was *cross-posted*, and probably originated in the breast implant group, where--there's no other way to put this--there are a lot of kooks. It pays to check the headers of a suspicious post. If it's cross-posted, you have more reason to be suspicious, as it usually means the poster has some sort of missionary zeal to "get the message out." No, not always. But usually. Eva >> After I calmed down last night from reading Pam's post .... > ---------------- [quoted text clipped - 9 lines] > > Eva That may be true of the original post, which was a news clipping from NBC about anthracyclines. However it says nothing about Pam's post which really started this branch of the thread on the subject of mastectomy versus lumpectomy. She is a contributor to the breast-implant group (rather than here), she probably just left the default headers on: the cross posting doesn't really tell you anything about her intent. But posts on that group do seem to tend to be more aggressive. Tim What are we supposed to do - not take chemo and risk it coming back My sister had non-hodgkins lymphoma and went through chemo. Admittedly, it returned and she had the stem cell transplant and bone marrow transplants and happily, she is in remission after nearly 9 years - so we all hope for the best. I for one when diagnosed was so confused the oncologists telling me that my treatment (FEC and Taxotere) is the best for my condition - Grade 2 bilateral breast cancer no node involvement it is apparently the strongest chemo for advanced breast cancer and their opinion was to" nip it in the butt and be around till im 80"! I prefer not to take any chemicals as I would suppose all of you in this support group would agree - especially given all the side effects to boot. Yes, reading all the comments does make you frightened. Mary E. >> After I calmed down last night from reading Pam's post .... > ---------------- [quoted text clipped - 10 lines] > > Eva > As of May 21st, I have been a survivor of breast cancer for 32 years. Congratulations. > When I questioned an oncology center after the sudden death of a > friend who had undergone multiple rounds of chemo, I asked . . . > "Why do the studies of breast > cancer patients not call for women who have survived 5 years or > more?" . . . > When I heard the answer . . . , > I wished I had a tape recorder running. The answer..."They don't ask > for those beyond 5 years because they don't live that long." Did you consider the possibility that the doctor's answer was more-or-less inaccurate, or at best misleading? Just because one idiot with an advanced degree says something, that doesn't make it true. It's true that many studies only go on for 5 years. It's quite difficult to keep track of a statistically valid sample of people much longer than that, especially if you were working with a limited population in the first place. Five year follow-ups seem to be quite common for cancer studies, and many other cancer types are considered "cured" if one has not recurred by the 5-year mark. But it's also true that the majority of BC survivors (cross grades/stages/treatments) are alive at the 5-year mark, so it's inane to say that studies don't go beyond 5 years because survivors don't live that long. And it *is* true that with BC commoner as we age, there does tend to be significant mortality among the subjects after 5 years -- not necessarily due to BC. But in the studies of recurrence/mortality from BC that I've seen, the rate of BC recurrence/death has definitely declined dramatically by the 5-year mark. There have been 10-year studies, and there're substantially more deaths from BC within 5 years than between 5 & 10 years. Though BC remains the leading source of mortality (compared with other causes) past 5 years, that doesn't mean that most die by the 5 year mark. If you want to play the anecdotal game, I can go there. I know several women who had lumpectomies who have vastly exceeded 5-year survival. In fact, I had lunch today with an 18 year survivor, and a 9.5 year survivor of stage III. Almost no one these days has radical mastectomies. I'm a 6.5 year survivor (stage III) with one MRM and one simple mastectomy (had one tumor in my right breast, five in my left). The woman who rows double with me is a 20+ year survivor of MRM. I even know a woman who had stage IV (regional spread beyond axillary nodes) who is alive and NED more than 6 years after diagnosis, with lumpectomy (plus *two* rounds of high dose chemo with bone marrow implant). (She just had mastectomies prophylactically about a year ago because she was getting weary of mammography scares.) I've known women across the spectrum of treatment & stage who died of it, too. My mom died about 6 years after after MRM. Another fellow rower died a couple of years after MRM, yet another several years after lumpectomy. I could go on, but all it proves is who I know. Most of us probably know many 5-year-plus survivors of lumpectomy, but don't realize that these women ever had cancer. We notice the deaths, but the survivals may be less visible. I've known dozens of women who survived, and only a handful who died. OTOH, it's hard to make the acquaintence of someone who died of the disease, so one would meet more survivors, wouldn't one? Botton line: Anecdote is useless, except for its inspirational value (if any). The UK cancerhelp site has a good page about BC survival stats, written for average person. See http://www.cancerhelp.org.uk/help/default.asp?page=3317 > My approach to survival of breast cancer is that women need > to be scared into making choices that gives them life. No, we don't need to be scared into anything. We're intelligent people. We need unbiased and scientifically valid information. And frankly, if we *did* decide, fully informed, that we'd rather be cute than long-lived, that'd be our business (however sad), wouldn't it? Doncha just love it when first-time/once-only (or close to it) posters in ASCB post some kind of forcefully-worded, ignorant, frightening drivel? Jeesh. Pam seems to be a regular in the implant group, though, and as others have noted, the social norms may be different over there. Ann T. Remove 'dontsendspam' from address to reply by email >> As of May 21st, I have been a survivor of breast cancer for 32 years. > [quoted text clipped - 82 lines] > > Ann T. Thanks for all of that, Ann. I have nothing to add except that I'll stay here :-) Mary |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.