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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2007Rant
I am a 5-year breast cancer survivor. Publicity, articles, advice and research on breast cancer are endless and well-publicized. Every informed woman knows what to look for and what routine tests to have done. Why isn't the same publicity given to prostate cancer? Why isn't there more of a publicized emphasis on men getting tested? Why aren't more men speaking up about this? The average man, except for groups such as this when a man subscribes once he joins the "club", knows very little about Pca and the importance of screening, especially if his primary is lax (as ours was). For goodness sake, how does this scourge get some widespread notice? Articles? "Prostate runs", like the Susan Komen runs? Keeping after our own M.D.s? Help save a life. Dora  Signaturelimey113@yahoo.com > I am a 5-year breast cancer survivor. Publicity, articles, advice and > research on breast cancer are endless and well-publicized. Every [quoted text clipped - 14 lines] > > Dora You know, I think to a certain extent, there is already lot of publicity out there about PCa. In the past, I just tuned it out. Now, after my diagnosis, I keep noticing mentions on TV, in magazines, etc. I think they have been there all along, but prostate cancer was just not on my radar. You can send the message, but getting people to pay attention is another matter. > I am a 5-year breast cancer survivor. Publicity, articles, advice and > research on breast cancer are endless and well-publicized. Every [quoted text clipped - 12 lines] > Articles? "Prostate runs", like the Susan Komen runs? Keeping after > our own M.D.s? Help save a life. Screening oversold < http://www.boston.com/yourlife/health/articles/2007/09/30/cancer_scares_grow_as_ screening_rises/?page=1 "But the pressure to be aggressive in the war on cancer is powerful, both because the disease remains the nation's second leading killer and because doctors know they will be punished more for inaction than excessive action." J (snip) > Screening oversold > [quoted text clipped - 4 lines] > and because doctors know they will be punished more for inaction > than excessive action." Just another ignoramus reporter huffing and puffing (especially puffing). And being very careful that quotations fit his scheme, which is commercial in nature. I'll take my medical advice from people who are qualified to give it, thanks very much. It would be interesting to know whether the reporter has screening tests. I know people who refuse. They are fools. And BTW, rather than posting a URL link that is >100 characters long, and which some folks are unable to use, I recommend taking a minute or so to translate it using www.tinyurl.com In this case, the 100+ characters were translated to http://tinyurl.com/2hljt9 Regards, Steve J > I am a 5-year breast cancer survivor. Publicity, articles, advice and > research on breast cancer are endless and well-publicized. Every [quoted text clipped - 24 lines] > I'll take my medical advice from people who are qualified to give it, > thanks very much. It's not off point - limey's text reinserted. Quotes from premier doctors/places for cancer care.... "Cancer scares grow as screening rises Better tests sought to reduce anxiety By Scott Allen, Globe Staff | September 30, 2007 Jane Lee Johnson thought her swelling waistline was just an unwelcome sign of menopause. But when the 49-year-old's abdominal pain grew so severe that she could scarcely breathe earlier this month, doctors at Falmouth Hospital told her that she had something far more frightening: A CT scan had detected a large tumor on her ovaries. "I was really upset," said Johnson, who underwent surgery at a Rhode Island cancer center a few days later. "I always heard that, once ovarian cancer is detected, it must be serious, because it usually goes undetected. I thought it might be fatal." But she did not have cancer at all. The large growth on her ovaries was benign, which could have been determined early if doctors had a reliable test for ovarian cancer. The growth needed to come out, but Cape Cod doctors could have removed it without all the anxiety. Cancer specialists are proud that the United States is home to more cancer survivors than any other nation, 10.5 million people. But there is a darker side to that success. For every cancer survivor, there are several "cancer scare survivors" such as Johnson, who have been told, based on imperfect tests, that they may have cancer when they do not. False alarms are not only stressful, but they also often force patients to undergo uncomfortable follow-up tests or even surgery, only to discover that they are cancer-free. Doctors perform an estimated 2 million biopsies, in which a needle is inserted to extract a tissue sample, on healthy breasts in women and prostate glands in men each year because of suspicious test results. In one study, more than 500 women with no symptoms of ovarian cancer underwent unnecessary abdominal surgery because a blood test wrongly suggested they had the disease. Unfortunately, in a nation where "early detection" is a mantra and where new high-tech screening tests are being promoted for lung and breast cancer, despite high error rates, it is increasingly possible that everyone will experience a cancer scare. A National Cancer Institute study released in June showed that within three years, nearly half the healthy men and women 55 and older who underwent regular screening for four leading cancers received at least one test result incorrectly suggesting they might have cancer, called a false positive. Women who diligently get annual mammograms face a 50 percent risk of a false-positive test result within a decade, another study found. "I think that's just the risk of so many screenings, but the figures are pretty staggering," said Dr. Judy Garber, director of the cancer risk and prevention clinic at Dana-Farber Cancer Institute in Boston. Tests intended to detect cancers early, before patients have symptoms, are made to be exquisitely sensitive, so as not to miss potential cancers. The result is that they wrongly indicate potential cancer of the breast, colon, cervix, and other organs 5 to 15 percent of the time, which translates into a cancer scare for at least 20 million Americans as a result of routine screening, according to a Dartmouth College researcher. Page 2 of 3 -- Even after symptoms appear, tests used to determine whether a patient has cancer are often inconclusive, leading to more invasive testing and aggressive treatment. The blood test for ovarian cancer misses early-stage cancers half the time, studies show, frequently causing doctors to suspect cancer even when results are normal, as in Johnson's case. "In a serious disease like cancer, not doing the most aggressive thing is seen as taking a chance," said Dr. James Talcott, director of the center for outcomes research at the cancer center at Massachusetts General Hospital." Cancer scares grow as screening rises Better tests sought to reduce anxiety By Scott Allen, Globe Staff | September 30, 2007 Jane Lee Johnson thought her swelling waistline was just an unwelcome sign of menopause. But when the 49-year-old's abdominal pain grew so severe that she could scarcely breathe earlier this month, doctors at Falmouth Hospital told her that she had something far more frightening: A CT scan had detected a large tumor on her ovaries. "I was really upset," said Johnson, who underwent surgery at a Rhode Island cancer center a few days later. "I always heard that, once ovarian cancer is detected, it must be serious, because it usually goes undetected. I thought it might be fatal." But she did not have cancer at all. The large growth on her ovaries was benign, which could have been determined early if doctors had a reliable test for ovarian cancer. The growth needed to come out, but Cape Cod doctors could have removed it without all the anxiety. Cancer specialists are proud that the United States is home to more cancer survivors than any other nation, 10.5 million people. But there is a darker side to that success. For every cancer survivor, there are several "cancer scare survivors" such as Johnson, who have been told, based on imperfect tests, that they may have cancer when they do not. False alarms are not only stressful, but they also often force patients to undergo uncomfortable follow-up tests or even surgery, only to discover that they are cancer-free. Doctors perform an estimated 2 million biopsies, in which a needle is inserted to extract a tissue sample, on healthy breasts in women and prostate glands in men each year because of suspicious test results. In one study, more than 500 women with no symptoms of ovarian cancer underwent unnecessary abdominal surgery because a blood test wrongly suggested they had the disease. Unfortunately, in a nation where "early detection" is a mantra and where new high-tech screening tests are being promoted for lung and breast cancer, despite high error rates, it is increasingly possible that everyone will experience a cancer scare. A National Cancer Institute study released in June showed that within three years, nearly half the healthy men and women 55 and older who underwent regular screening for four leading cancers received at least one test result incorrectly suggesting they might have cancer, called a false positive. Women who diligently get annual mammograms face a 50 percent risk of a false-positive test result within a decade, another study found. "I think that's just the risk of so many screenings, but the figures are pretty staggering," said Dr. Judy Garber, director of the cancer risk and prevention clinic at Dana-Farber Cancer Institute in Boston. Tests intended to detect cancers early, before patients have symptoms, are made to be exquisitely sensitive, so as not to miss potential cancers. The result is that they wrongly indicate potential cancer of the breast, colon, cervix, and other organs 5 to 15 percent of the time, which translates into a cancer scare for at least 20 million Americans as a result of routine screening, according to a Dartmouth College researcher. Page 2 of 3 -- Even after symptoms appear, tests used to determine whether a patient has cancer are often inconclusive, leading to more invasive testing and aggressive treatment. The blood test for ovarian cancer misses early-stage cancers half the time, studies show, frequently causing doctors to suspect cancer even when results are normal, as in Johnson's case. "In a serious disease like cancer, not doing the most aggressive thing is seen as taking a chance," said Dr. James Talcott, director of the center for outcomes research at the cancer center at Massachusetts General Hospital. > It would be interesting to know whether the reporter has screening > tests. I know people who refuse. They are fools. Don't like the message - don't shoot the messengers. > And BTW, rather than posting a URL link that is >100 characters long, > and which some folks are unable to use, I recommend taking a minute or > so to translate it using www.tinyurl.com > > In this case, the 100+ characters were translated to > http://tinyurl.com/2hljt9 Not long enough (to bother) - and does not tell the reader what one is pointing to. J > And BTW, rather than posting a URL link that is >100 characters long, > and which some folks are unable to use, I recommend taking a minute or > so to translate it using www.tinyurl.com > > In this case, the 100+ characters were translated to > http://tinyurl.com/2hljt9 Thanks for this, Steve, I saw, on my next post , why it's better to follow your suggestion. J On October 7 Dora wrote: (snip) > The average man, except for groups such as this when a man subscribes > once he joins the "club", knows very little about Pca and the [quoted text clipped - 4 lines] > Articles? "Prostate runs", like the Susan Komen runs? Keeping > after our own M.D.s? Help save a life. I'll try to answer. Fundamentally, it's because men are fools about their genito-urinary system. They don't want to be educated about it and will simply stare past any information about PCa. Until the thousand of bricks falls on them..... And even then, only a tiny minority try to learn about their disease. Or they leave the heavy lifting to their wives/SOs. Mostly, they hide from the truth and go baaaaing along with their medic's orders, which in itself can be dangerous. I understand that it is said by idiots that if one must have cancer, prostate cancer is the one to have. Oh sure. Tell that to the man such as Hugh Kearnley, recently deceased, who had extensive bone mets and was prescribed 24/7 morphine and Fentanyl to relieve the pain. He he was dxd in December 2006 with a PSA of 160 and the terrible mets. He suffered and suffered and suffered. Until at the urging of us Yanks (he was a Scot) he prevailed upon his *third* onc since dx in December '06 to rx a palliative tx common in civilized countries: RT of the mets. He had wonderful results. Put aside his cane. Planned to resume playing the organ, which he did very well. Then he died. He had been told that RT of the mets was not appropriate. Thank you National Health Service for your cookbook medicine. Yabbut it's "free." Uh huh. Do I seem bitter? That's because I am. Back to the point: A little progress is made from time to time getting the message out to men at risk. But it must be admitted that the ladies have done a masterful (mistressful?) job of promoting their BCa message and I wish them the best. I have noted that September was "Prostate Cancer Month." Oh really? Not one word in the press, nothing at all anywhere that I saw. October is "Breast Cancer Month." There are exhibits all over my local supermarket, along with product promotions such as specially-marked cans of Campbell's Soup. A bin into which I place surplus clothing from time to time is owned and serviced by a BCa club. Well, men won't take care of themselves; women know that and I respect them for their patience with such childish fools. Now my rant is over. Until next time. Thanks, Dora. Regards, Steve J Hello Dora, I do try in my little town to discuss prostate cancer issues frankly with men of my age and older, and younger. I have directed some on this news group to seek qualified help and to this day they have been helped. To be honest with you, when I was 49 I did not know what a prostate did. I have found out also that Dr.s still do not know all the function of a prostate gland in men. I know it is for partial reproduction but apparently it has other functions that are not well understood. I do try to make this prostate cancer something to be aware of and not afraid of. Men are hardly ever probed or inspected all through there lives in the sexual arena. The most a man may have had was a ball squeeze at a health physical. Anyway, if more men do this, it may help spread the news........ I speak to men all the time and tell them my ordeal in depth and matter of factly so as to treat the problem like something that can be repaired.... Men understand repair work, and when you talk to them in those terms....... they listen. Thanks, John Loomis >I am a 5-year breast cancer survivor. Publicity, articles, advice and >research on breast cancer are endless and well-publicized. Every informed [quoted text clipped - 13 lines] > > Dora From: limey113@yahoo.com (limey) I am a 5-year breast cancer survivor. Publicity, articles, advice and research on breast cancer are endless and well-publicized. Every informed woman knows what to look for and what routine tests to have done. Why isn't the same publicity given to prostate cancer? Why isn't there more of a publicized emphasis on men getting tested? Why aren't more men speaking up about this? The average man, except for groups such as this when a man subscribes once he joins the "club", knows very little about Pca and the importance of screening, especially if his primary is lax (as ours was). For goodness sake, how does this scourge get some widespread notice? Articles? "Prostate runs", like the Susan Komen runs? Keeping after our own M.D.s? Help save a life. Dora Signature==> hi dora - you might find this interesting........ on the day that i left to have my prostate removed, an 85 year friend of my dad's had stopped by to do some fishing. when i told him where i was going and the reason why, his response was, "that's no big deal. i know of 4 men who have prostate cancer and there doing fine......" i thought to myself, here's an 85 year old man telling me that cancer is no big deal and 4 of his friends have it and so what??? you wouldn't hear that come from the female side, but i heard it on the male side. now, on to breast cancer........ be forewarned, this is a rant/warning..... they did a news article about how breast cancer is being used to rip off the public. they went on to show how companies are using pink labels and "think pink" slogan to push their products and that NONE of what you pay for goes toward breast cancer. so, tonight, as i was standing in line at walmart, there was a BIG display of hersey kisses, all done up in pink and in bold letters, "pledge to the cause" when you first see it you think that this company is giving to breast cancer and that purchasing their product will help the breast cancer cause. but as i read the package, it was the farthest thing from the truth. on the package in not so large letters, was an event, "race for the cure" and that the money will go toward the cancer foundation and to visit their website to learn more. nowhere on the package - that was all done in pink - did it say that their profits was going toward the cause. so, here we are.......... on the one side.... the general population is not fully aware of prostate cancer and the push/drive is not there. on the other side.... we have a cause that has been exploited and is being used to line the pockets of the large corporations. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > I am a 5-year breast cancer survivor. Publicity, articles, advice and > research on breast cancer are endless and well-publicized. Every [quoted text clipped - 17 lines] > -- > limey...@yahoo.com Dora - I think there are some generational things at work here as well as male/female. Men the generation before mine (i am 44) subscribe to the strong, silent type as a make archetype. They are also scared to death to think clinically about their genital/uro systems. This is too close to the bone. On the other hand, women of my mother's generation (including mom a 20 year breast cancer survivior) seem much more practical about their breasts. My generation is only a little better about thinking through the implications of prostate cancer. We have a better,but spotty, understanding of the essential nature of the organ in sexual reproduction due to more sex education throughout our school years. As the average age of diagnosis decreases with increased PSA screening, I think you will see a great deal more general interest in this cancer. My concern upon diagnosis was soley about sexual and erectile function - Death, Incontinence, pain - were all secondary. This attitude was corrected by, among others, my wife and the folks on this site. Still, as a younger member of this club, I still feel that this aspect of the disease is not explored enough due to the average age of diagnosis. Another factor is the state of the art in treatment and diagnosis for PCa is at least 20 years behind that of breast cancer. My diagnosis came because in the words of my primary " I can stick my finger in your a.s once a year and hope to feel something smaller than a pea, or I can add a test to the blood work I am doing anyway and know for sure." I have had a PSA test since 40. The test spiked from 2.6 to 3.3 last October. We ruled out all the potential causes for this increase in PSA (prostatitus, injury) and had Pca confirmed in June. Let's assume that theses were all false positives - I would have had a biopsy for no reason. Biopsies are not fun and probably increase medical expenses across the economy. I am willing to bet that I will more than pay that back in productive years to come. I have kept my diagnosis and treatment out in the open. If any of my friends, clients, colleagues etc learn of my diagnosis and insist that their primary order a simple PSA test and this results in early diagnosis, my approach will have potentially saved a life. I am all for more education, I just think it should be focused on younger as well as older men. How about PCa Bike rides!? Good luck. This topic has come up many times over the years. It's out there ,but not quite like breast cancer. Yes, Susan G. Komen's name is synonymous with breast cancer. So far we don't have the same thing with prostate cancer. I think the guys here have touched on several things, but the bottom line is prostate cancer has been hushed for years. Treatment years ago almost always left men impotent and therefore it stuck a certain fear. Men who had been treated wouldn't talk about it, not even to their sons. They didn't want the world to think that they were no longer viral. Sexual function (SF) has been a basic part of a man's ego for probably thousands of years. Prostate cancer still seems to rob men of this basic need to perform. SF starts when males are very young. Even a toddler learns very quickly to "pull" on what he has. Males grow up and with them so does their SF. The loss of SF is felt so deeply and causes a real depression. PC still destroys the SF on so many men. Not many men want to admit they have problems. This makes it hard for many males to openly discuss PC even with their wives. To make matters worse PC tends to hit about the same time as females go through menopause or are post menopausal. Many women no longer have the desire for a sexual relationship so they don't comprehend why the loss of a man's SF would be such a big deal. But unlike females, a male will retain his SF for all or most all of his life. The stigma of SF loss is so great that until men can get past it, PC will be hidden in a closet for another 20 years. The good news is that the new, educated, younger generation of men are learning about PC. Many of today's young males are much more aware of their health then probably any other generation before them. They are often portrayed as beer swigging, pizza maniacs, the truth is a large portion of them are already aware of cholesterol levels and are jogging or working out several times a week. They know about STD's, testicular cancer, and prostate cancer. They no longer look at getting a flu shot as something for sissies. Just as menopause was considered the end of a woman's life, there's a new breed of women talking about the new fifty. Instead of feeling as if their life was over they are recognizing that it is the beginning of a "new" life for them. Men are just a wee bit behind the curve, but it is happening. The 55 + generation is still talking in whispers about PC. This older generation was part of the society that kept husbands in the waiting room while the wife delivered the baby. There are plenty of men that have never actually seen their wife's genitals. (No, I'm not joking.) And we wonder why this older generation isn't talking about PC? Yes, prostate cancer needs a Susan G. Komen. We need to remove the stigma and concentrate more on finding a cure, early testing, and better treatments. We need to drag the men (and the women who love them) out of the closet and get them to stand up and say, "There is life after PC!" I know this sounds crass, but women are more than just boobs and baby factories. And men are more than just a hard cock! We all might miss what we once were, but that doesn't make us less worthwhile. And until that message is ingrained into everyone's brain PC will remain in the closet. Bev > I am a 5-year breast cancer survivor. Publicity, articles, advice and > research on breast cancer are endless and well-publicized. Every [quoted text clipped - 14 lines] > > Dora Thanks, everyone, for helping me let off steam. Special thanks go to El Woody and Bev, who have hit the nail right on the head. I'll do my part on spreading the word, even if I have to tackle a group of women and persuade them to keep after their partners to get tested. Our primary doesn't believe in giving routine DRE or PSA tests - says they're not reliable. My husband had to ask, then the M.D. had a small fit when he saw the results (even though Henry had lost 40 pounds). In the meantime, my son and my son-in-law have PSA tests as part of yearly physicals and I'm sure they'll keep that up. I agree that except for groups such as this, Pca and even DRE's are non-subjects, hence my rant that it doesn't get the heads-up coverage that breast cancer does. Example - a two-page spread this week in our local Sunday paper was devoted to various types of cancer - breast, pancreatic, GI, leukemia - but not one word about prostate cancer. It will be through education that men are concerned enough to do something. That's precisely what happened with breast cancer - which was an off-limits subject at one time, too. Thanks for listening. Dora I think that newspaper needs a letter to the editor! Bev > Thanks, everyone, for helping me let off steam. Special thanks go to El > Woody and Bev, who have hit the nail right on the head. [quoted text clipped - 20 lines] > > Dora >I am a 5-year breast cancer survivor. Publicity, articles, advice and >research on breast cancer are endless and well-publicized. Every informed [quoted text clipped - 13 lines] > > Dora Just for kicks I searched Google News... Google search run for breast cancer: Results 1 - 10 of about 1,760 for run for breast cancer. (0.26 seconds) Google search "run for breast cancer" : Results 1 - 6 of 6 for run-for-breast-cancer. (0.09 seconds) Google search run for prostate cancer: Results 1 - 10 of about 240 for run for prostate cancer. (0.28 seconds) Google search "run for prostate cancer" : Your search - "run for prostate cancer" - did not match any documents. So it looks like the ratio is around six or seven to one as far as running events in the news. I don't know that it is a meaningful study, except to confirm the impression that there is certainly less chatter about prostate cancer than there is about breast cancer. An interesting side note on the topic: A friend of mine who is a news commentator found out he had prostate cancer and did a special on it which was broadcast on the local TV station where we work. When I found out I had it I turned to him for some advice and we have often talked about it since. I approached some of our radio folks about it (some of our programming is slanted towards the male audience) and there was no interest at all in dedicating even a minute of air time on the topic. I am convinced that most guys just don't want to hear about it... period. In the entertainment sector the most you will hear about it is jokes about getting a finger stuck up the butt. God Bless, Steve >> I am a 5-year breast cancer survivor. Publicity, articles, advice >> and research on breast cancer are endless and well-publicized. Every [quoted text clipped - 53 lines] > God Bless, > Steve Sad. I think a lot of men are immediately turned off screening when they learn they might lose their virility if treatment is needed. Virility isn't very important if your life's at stake. Don't think for a minute that a woman isn't stricken when she has to lose a breast, either. It's just one of those things in life which has to be done, given the alternative. Dora > Just for kicks I searched Google News... > [quoted text clipped - 24 lines] > slanted towards the male audience) and there was no interest at all in > dedicating even a minute of air time on the topic. Pink/breast cancer is commercial http://www.newstarget.com/020740.html http://www.blogher.org/node/11554 Prostate Cancer Awareness /'Runs UK March 2007 http://www.realmendo.org.uk/press_mands.htm http://www.prostate-cancer.org.uk/what/awareness07/ Over 700 groups across the country organised events to raise awareness of the most common cancer in men and raise money to support our work. http://motorcycleridefordad.org/ Canada - I think the news said they were across Canada. Canada - welcome to the 2007 Vancouver Underwear Affair http://www.uncoverthecure.org/index.html I've seen at least 2 cities in the US who have buses who park in certain areas of their city and screen for prostate cancer. There might be more that only hit the local news? Type in awareness campaigns october and/or awareness campaign october Maybe the wrong month was picked ? There's so many others in October... Bottom line, breasts get the headlines almost every day. J > Prostate Cancer Awareness /'Runs > UK March 2007 http://www.realmendo.org.uk/press_mands.htm [quoted text clipped - 7 lines] > Canada - welcome to the 2007 Vancouver Underwear Affair > http://www.uncoverthecure.org/index.html Hooray for the UK and Canada! > I've seen at least 2 cities in the US who have buses who park in > certain areas of their city and screen for prostate cancer. There > might be more that only hit the local news? Let's hope that gets more widespread. The same thing was done for breast cancer many years ago (maybe 20?) by the Univ. of Maryland Medical Center and a lot of women who felt "I really should do something" actually took advantage of the screening and "did something". I know it turned up something odd with me which was screened further (fortunately benign). I've often wondered how many women were first alerted by those screening buses. We put our money on things that are important to us. This includes research money. Breasts are "lovely to look at and delightful to hold" (like the signs in antique and gift shops say). We all - men and women - place great value on them. A prostate, on the other hand, is neither lovely to look at nor delightful to hold (I think). They are only seen by surgical teams and lab techinicians. And no one wants to even touch one. Docs do it because it's part of their job. So, research for breast cancer gets more money and research for prostate cancer gets relatively little. Seriously, all the other reasons that have been given are all correct. Just thought I'd try to add a bit of levity into this thread. My best to all. >I am a 5-year breast cancer survivor. Publicity, articles, advice and >research on breast cancer are endless and well-publicized. Every [quoted text clipped - 14 lines] > >Dora Burney dot Huff at Mindspring dot com Ah, yes, what you say about breasts is true, even a man's chest is important, but the prostate has such "control" on the those wonderful male parts that are just as "lovely to look at and delightful to hold". Bev > We put our money on things that are important to us. This includes > research money. [quoted text clipped - 33 lines] > > Burney dot Huff at Mindspring dot com :-) >Ah, yes, what you say about breasts is true, even a man's chest is >important, but the prostate has such "control" on the those wonderful male [quoted text clipped - 38 lines] >> >> Burney dot Huff at Mindspring dot com Burney dot Huff at Mindspring dot com |
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