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Therese Bevers, MD
ThereseBeversMD (Physician - Family Medicine (Verified) )| Communities: Breast Cancer , Prostate Cancer | Answers: 8 |
| Member Since: May. 2012 |
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Dr. Therese B. Bevers is professor of Clinical Cancer Prevention and the medical director of the Cancer Prevention Center and prevention outreach programs at M. D. Anderson Cancer Center. In her role as medical director, Dr. Bevers has overseen the growth and program development of the Cancer Prevention Center—the first comprehensive clinical cancer prevention service program in the country—since its opening in 1996.
Her clinical and research interests are in the area of breast cancer prevention, screening, diagnosis and survivorship. She was an investigator on the groundbreaking Breast Cancer Prevention Trial which demonstrated that tamoxifen reduced the risk of developing breast cancer by one half and currently serves as the institutional principal investigator (PI) for the STAR trial which showed that raloxifene had similar benefits but fewer risks. She is currently the institutional PI of a breast cancer prevention study of polyphenon E, an active substance of green tea, in women at increased risk for breast cancer. In addition, she is collaborating on a breast cancer prevention study of Lipitor, a cholesterol-lowering drug, in women at increased risk for breast cancer. Dr. Bevers chairs the National Comprehensive Cancer Network’s guideline panels on Breast Cancer Screening and Diagnosis and Breast Cancer Risk Reduction.
A native Texan, Dr. Bevers completed her medical school and residency in Family Practice at The University of Texas Health Science Center at San Antonio. She is the recipient of many awards including the Julie and Ben Rogers Award for Excellence in Prevention in 2006.
Her clinical and research interests are in the area of breast cancer prevention, screening, diagnosis and survivorship. She was an investigator on the groundbreaking Breast Cancer Prevention Trial which demonstrated that tamoxifen reduced the risk of developing breast cancer by one half and currently serves as the institutional principal investigator (PI) for the STAR trial which showed that raloxifene had similar benefits but fewer risks. She is currently the institutional PI of a breast cancer prevention study of polyphenon E, an active substance of green tea, in women at increased risk for breast cancer. In addition, she is collaborating on a breast cancer prevention study of Lipitor, a cholesterol-lowering drug, in women at increased risk for breast cancer. Dr. Bevers chairs the National Comprehensive Cancer Network’s guideline panels on Breast Cancer Screening and Diagnosis and Breast Cancer Risk Reduction.
A native Texan, Dr. Bevers completed her medical school and residency in Family Practice at The University of Texas Health Science Center at San Antonio. She is the recipient of many awards including the Julie and Ben Rogers Award for Excellence in Prevention in 2006.
Professional Info
Credential: MD
Primary specialty: Family Medicine
Areas of expertise: Breast cancer prevention, screening, diagnosis and survivorship.
Awards and publications: She is the recipient of many awards including the Julie and Ben Rogers Award for Excellence in Prevention in 2006, the Kathryn S. Stream Award for Excellence in Women’s Health in 2011 and the Faculty Achievement Award in Prevention in 2011.
Hospital affiliation: The University of Texas MD Anderson Cancer Center
Practice address:
1155 Pressler, Unit 1322
Houston, Texas
77030
Practice phone number: (713) 745-8048
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http://twitter.com/drbevers
ThereseBeversMD Activities
The Gail model, also called the National Cancer Institute (NCI) Breast Cancer Risk Assessment Tool, is a computerized tool that estimates a woman’s risk of developing breast cancer. This program is available online at the NCI website (www.cancer.gov/bcrisktool) or at www.breastcancerprevention.com.
Risk factors used in the Gail model include age, age at menarche (when a woman started her menstrual cycle), age at first live birth (or never having a full-term pregnancy), family history of breast cancer in first-degree relatives (mother, sister or daughter), history of breast biopsy and if any biopsies identified atypical hyperplasia. Because the incidence of breast cancer differs by race, the current, modified version of the Gail model includes race-specific incidence data. The program prompts the user to input information about each of the risk factors and provides a printout showing projected breast cancer risk in the next 5 years and projected lifetime risk. For comparative purposes, the printout also includes the average 5-year and lifetime risk for a woman of the same age as the woman evaluated. Increased risk is defined as a 5-year calculated risk of 1.7% or greater. This is the average risk of a 60-year-old woman which was the median age of diagnosis of breast cancer in the United States at the time the model was developed.
The NCI Breast Cancer Risk Assessment Tool does not estimate risk for women known to be at increased risk of breast cancer based on a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS) or prior thoracic radiation therapy to the chest for treatment of Hodgkin’s lymphoma. In addition, it uses only a limited number of risk factors and does not take into account such risk factors as current or former use of hormone therapy or breast density. The model does not consider any paternal family history, maternal family history other than first-degree relatives, personal or family history of ovarian cancer or other familial factors of concern for an inherited mutation such as male breast cancer, bilateral breast cancer in a relative and an early age of diagnosis of breast cancers in the family. As a result, the model may significantly underestimate breast cancer risk, especially for women with a genetic predisposition (e.g., BRCA1 or BRCA2). For these reasons, the risk calculation cannot be taken outside of the context of the patient’s overall personal and family history.
Women without a personal history of breast cancer, DCIS, LCIS, prior thoracic radiation or a strong family history should ask their doctor to calculate their risk of breast cancer using the Gail model. If the 5 year risk is 1.7% or greater, the woman can be considered for tamoxifen or raloxifene to reduce her breast cancer risk.
Risk factors used in the Gail model include age, age at menarche (when a woman started her menstrual cycle), age at first live birth (or never having a full-term pregnancy), family history of breast cancer in first-degree relatives (mother, sister or daughter), history of breast biopsy and if any biopsies identified atypical hyperplasia. Because the incidence of breast cancer differs by race, the current, modified version of the Gail model includes race-specific incidence data. The program prompts the user to input information about each of the risk factors and provides a printout showing projected breast cancer risk in the next 5 years and projected lifetime risk. For comparative purposes, the printout also includes the average 5-year and lifetime risk for a woman of the same age as the woman evaluated. Increased risk is defined as a 5-year calculated risk of 1.7% or greater. This is the average risk of a 60-year-old woman which was the median age of diagnosis of breast cancer in the United States at the time the model was developed.
The NCI Breast Cancer Risk Assessment Tool does not estimate risk for women known to be at increased risk of breast cancer based on a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS) or prior thoracic radiation therapy to the chest for treatment of Hodgkin’s lymphoma. In addition, it uses only a limited number of risk factors and does not take into account such risk factors as current or former use of hormone therapy or breast density. The model does not consider any paternal family history, maternal family history other than first-degree relatives, personal or family history of ovarian cancer or other familial factors of concern for an inherited mutation such as male breast cancer, bilateral breast cancer in a relative and an early age of diagnosis of breast cancers in the family. As a result, the model may significantly underestimate breast cancer risk, especially for women with a genetic predisposition (e.g., BRCA1 or BRCA2). For these reasons, the risk calculation cannot be taken outside of the context of the patient’s overall personal and family history.
Women without a personal history of breast cancer, DCIS, LCIS, prior thoracic radiation or a strong family history should ask their doctor to calculate their risk of breast cancer using the Gail model. If the 5 year risk is 1.7% or greater, the woman can be considered for tamoxifen or raloxifene to reduce her breast cancer risk.
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10 months ago
ThereseBeversMD (Physician - Family Medicine (Verified)) asked the question
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The National Comprehensive Cancer Network is a not-for-profit alliance of 21 of the world's leading cancer centers. The NCCN provides resources for clinicians and other health care entities on the management of cancer patients. Such resources include a compendium of disease-site specific guidelines on cancer prevention, screening, diagnosis, treatment and supportive care. The Breast Cancer Screening and Diagnostic guideline and Breast Cancer Risk Reduction guideline are developed and updated by panels that are comprised of multidisciplinary, disease-site specific specialists who are both clinicians and researchers. These specialists are chosen from the 21 NCCN Member Institutions and their affiliates. Each guideline undergoes annual institutional review where it is circulated among the multidisciplinary faculty for comment at each Member Institution. The NCCN Guidelines are composed of recommendations based on the best evidence available at the time they are derived.
The guidelines are composed of several components:
- a list of panel members providing institutional affiliations and specialties,
- an algorithm or decision pathway outlining the step-by-step clinical decision-making process for patient management,
- a discussion describing the data the recommendations are based upon and the important issues considered in interpreting the data and developing the algorithm,
- references providing evidence on which recommendations are based, and
- disclosure of potential conflicts of interest of panel members, staff, and NCCN itself.
The guidelines are composed of several components:
- a list of panel members providing institutional affiliations and specialties,
- an algorithm or decision pathway outlining the step-by-step clinical decision-making process for patient management,
- a discussion describing the data the recommendations are based upon and the important issues considered in interpreting the data and developing the algorithm,
- references providing evidence on which recommendations are based, and
- disclosure of potential conflicts of interest of panel members, staff, and NCCN itself.
New answer by ThereseBeversMD (Physician - Family Medicine (Verified))
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10 months ago
The U.S. Food and Drug Administration has approved the use of tamoxifen and raloxifene for breast cancer risk reduction therapy. These approvals have been based on findings from multiple randomized, controlled efficacy trials conducted both within and outside the United States. Specifically, in the Breast Cancer Prevention Trial, the risk of invasive breast cancer was halved in women at increased risk of breast cancer who received tamoxifen compared with placebo; this finding was largely consistent with those of other tamoxifen efficacy trials. In addition, the initial findings of the Study of Tamoxifen and Raloxifene (STAR), an equivalency trial that compared the efficacy and safety of these two agents in women at increased risk of breast cancer showed that these agents had similar efficacy but that raloxifene resulted in a lower incidence of serious adverse events (SAEs). Long-term follow-up studies have demonstrated that these agents have continued efficacy after discontinuation of therapy with tamoxifen having greater persistent efficacy compared to raloxifene and the occurrence of SAEs is limited to the treatment period. Because of the occurrence of SAEs such as endometrial cancer, thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism), and cataracts, careful selection of women for chemoprevention therapy is critical. Currently, tamoxifen is believed to be the most beneficial agent for younger, premenopausal women and especially those who have had a hysterectomy with no history of or risk factors for SAEs, whereas raloxifene may be most beneficial for older, postmenopausal women without these contraindications.
Women at increased risk of breast cancer should talk to their doctor about whether a one of these medications might be appropriate for her.
Women at increased risk of breast cancer should talk to their doctor about whether a one of these medications might be appropriate for her.
New answer by ThereseBeversMD (Physician - Family Medicine (Verified))
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10 months ago
Up to two-thirds of all cancers may be prevented by avoiding tobacco and adopting healthy lifestyle habits. Regular screening exams can help detect many cancers in the earliest stages, when they can be treated successfully. MD Anderson was among the first comprehensive cancer centers to develop a clinical program emphasizing cancer prevention.
The Cancer Prevention Center offers a comprehensive cancer prevention program that includes cancer risk assessment, screening exams based on cancer risk, age and gender as well as personalized risk reduction strategies. It also provides the infrastructure and support for clinical and translational cancer prevention research. Services that are offered include:
Site-Specific Cancer Screening
Cancer risk assessment, counseling and screening for the most common types of cancer in adults without symptoms:
· Breast cancer: clinical breast exam and screening mammogram
· Gynecologic cancer: Pap and HPV testing
· Prostate cancer: digital rectal exam and prostate specific antigen blood test
· Skin cancer: skin exam
· Colorectal cancer: convention or virtual colonoscopy
· Lung cancer screening: low-dose CT scan
Risk Assessment and Risk Reduction
· Genetic Testing and Risk Counseling: for individuals at increased cancer risk due to a family history of disease; services include counseling, testing and risk management.
· Chemoprevention: drug therapy to reduce cancer risk in high-risk patients; research studies are underway for patients at risk for oral, prostate, cervical, lung, colorectal and breast cancers.
· Nutrition Counseling: a dietary evaluation with personalized counseling for cancer risk reduction
· Tobacco cessation services for current smokers desiring to quit or recent quitters desiring assistance with relapse prevention.
Diagnostic Evaluation Services
· Undiagnosed Breast Clinic: comprehensive clinical and diagnostic evaluation of breast abnormalities, including a lump, other breast changes and abnormal mammograms
· Undiagnosed Dermatology Clinic: diagnostic evaluation of skin abnormalities, including a change in a mole or freckle or other skin changes
· Undiagnosed Gynecology: diagnostic evaluation of abnormal Pap smear or abnormal uterine bleeding
The Cancer Prevention Center offers a comprehensive cancer prevention program that includes cancer risk assessment, screening exams based on cancer risk, age and gender as well as personalized risk reduction strategies. It also provides the infrastructure and support for clinical and translational cancer prevention research. Services that are offered include:
Site-Specific Cancer Screening
Cancer risk assessment, counseling and screening for the most common types of cancer in adults without symptoms:
· Breast cancer: clinical breast exam and screening mammogram
· Gynecologic cancer: Pap and HPV testing
· Prostate cancer: digital rectal exam and prostate specific antigen blood test
· Skin cancer: skin exam
· Colorectal cancer: convention or virtual colonoscopy
· Lung cancer screening: low-dose CT scan
Risk Assessment and Risk Reduction
· Genetic Testing and Risk Counseling: for individuals at increased cancer risk due to a family history of disease; services include counseling, testing and risk management.
· Chemoprevention: drug therapy to reduce cancer risk in high-risk patients; research studies are underway for patients at risk for oral, prostate, cervical, lung, colorectal and breast cancers.
· Nutrition Counseling: a dietary evaluation with personalized counseling for cancer risk reduction
· Tobacco cessation services for current smokers desiring to quit or recent quitters desiring assistance with relapse prevention.
Diagnostic Evaluation Services
· Undiagnosed Breast Clinic: comprehensive clinical and diagnostic evaluation of breast abnormalities, including a lump, other breast changes and abnormal mammograms
· Undiagnosed Dermatology Clinic: diagnostic evaluation of skin abnormalities, including a change in a mole or freckle or other skin changes
· Undiagnosed Gynecology: diagnostic evaluation of abnormal Pap smear or abnormal uterine bleeding
New answer by ThereseBeversMD (Physician - Family Medicine (Verified))
1
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10 months ago
Prophylactic mastectomy is not appropriate for all women at increased risk of breast cancer. Typically, this procedure is recommended for women with a genetic predisposition, such as a mutation in the BRCA1 or BRCA2 genes. Women with a BRCA mutation have as high as 50-80% lifetime risk of developing breast cancer. In the past, prophylactic mastectomy was offered to women with lobular carcinoma in situ (LCIS), a condition that is not cancer or precancer but is associated with a significantly increased risk of developing breast cancer. However, women with LCIS are now best managed with breast cancer risk reducing medications such as tamoxifen or raloxifene.
Prophylactic mastectomy reduces a woman’s risk of developing breast cancer by as much as 90%. While it is a highly effective means of reducing a woman’s breast cancer, it does not prevent all breast cancers. There also risks associated with the procedure. This includes the surgical risk from the prophylactic mastectomy and any reconstruction, if done. There are also long-term psychosexual effects that a woman may experience.
Any woman considering a prophylactic mastectomy should have a very good understanding of her risk of developing breast cancer. For women with a strong family history of the disease, this would likely involve a genetic counseling visit to determine the probability of a genetic mutation in the family and whether genetic testing is recommended. Once a woman understands her risk of developing breast cancer, she should be counseled on all of her options for risk reduction, including healthy lifestyle recommendations, chemoprevention with tamoxifen or raloxifene as well as, for very high risk women, prophylactic mastectomy. Finally, she should have an understanding of the screening tests that would be recommended to detect breast cancer at an early stage, when it is more treatable.
Prophylactic mastectomy reduces a woman’s risk of developing breast cancer by as much as 90%. While it is a highly effective means of reducing a woman’s breast cancer, it does not prevent all breast cancers. There also risks associated with the procedure. This includes the surgical risk from the prophylactic mastectomy and any reconstruction, if done. There are also long-term psychosexual effects that a woman may experience.
Any woman considering a prophylactic mastectomy should have a very good understanding of her risk of developing breast cancer. For women with a strong family history of the disease, this would likely involve a genetic counseling visit to determine the probability of a genetic mutation in the family and whether genetic testing is recommended. Once a woman understands her risk of developing breast cancer, she should be counseled on all of her options for risk reduction, including healthy lifestyle recommendations, chemoprevention with tamoxifen or raloxifene as well as, for very high risk women, prophylactic mastectomy. Finally, she should have an understanding of the screening tests that would be recommended to detect breast cancer at an early stage, when it is more treatable.
New answer by ThereseBeversMD (Physician - Family Medicine (Verified))
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10 months ago
In 2009, the USPSTF in their update on breast cancer screening recommended against clinicians teaching women how to perform BSE, noting that teaching BSE does not reduce breast cancer mortality (deaths) and that the harms of BSE outweigh the benefits. This recommendation was based on a large study conducted in Shanghai, China which reported that women taught how to conduct a breast self-exam and given reminders to do BSE were not any more effective at finding breast cancers than were women who had not received instructions or reminders for BSE. In addition, there was no difference in the stage of breast cancers diagnosed or in the number of deaths between these two groups. However, there was a significantly greater risk of a false-positive finding in the women who had received BSE instruction and reminders than in the control group. Given that no benefit was seen with BSE (i.e., there was no difference in deaths between women taught BSE and those who were not) and that there are risks (harms) associated with the practice, this lead the USPSTF to make this recommendation.
When the findings from the Shanghai study were published in 2002, it evoked ardent opposition from women and breast cancer advocacy groups. BSE is an emotionally charged topic because many women can identify someone who found her own breast cancer. In fact, it is recognized that women are more likely to identify a palpable mass than even their own health care provider. However, studies have shown that the majority of palpable masses identified by women were detected during routine activities of daily living (e.g., showering, dressing, etc) and not during a structured BSE session. While women still need to be encouraged to identify any palpable breast masses, we now know that they do not need to be taught how to do this. For that reason, the concept of BSE has evolved to one of breast awareness. Breast awareness encourages a woman to be aware of her breasts and promptly report any changes that she identifies to her health care provider. It is important to understand that women are encouraged to be actively involved in their own breast health and that the concept of breast awareness is a broader, more inclusive approach that empowers a woman to do this, whatever way works best for her.
When the findings from the Shanghai study were published in 2002, it evoked ardent opposition from women and breast cancer advocacy groups. BSE is an emotionally charged topic because many women can identify someone who found her own breast cancer. In fact, it is recognized that women are more likely to identify a palpable mass than even their own health care provider. However, studies have shown that the majority of palpable masses identified by women were detected during routine activities of daily living (e.g., showering, dressing, etc) and not during a structured BSE session. While women still need to be encouraged to identify any palpable breast masses, we now know that they do not need to be taught how to do this. For that reason, the concept of BSE has evolved to one of breast awareness. Breast awareness encourages a woman to be aware of her breasts and promptly report any changes that she identifies to her health care provider. It is important to understand that women are encouraged to be actively involved in their own breast health and that the concept of breast awareness is a broader, more inclusive approach that empowers a woman to do this, whatever way works best for her.
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ThereseBeversMD (Physician - Family Medicine (Verified)) asked the question
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10 months ago
In 2009, the US Preventive Services Task Force (USPSTF) recommended against routine screening mammography in women aged 40-49 years. It was noted that the decision to perform screening mammography on women in this age group should be based on individual risk factors and specific harms and benefits. This met with immediate controversy as it interpreted that women in their 40’s should not be screened for breast cancer. The USPSTF has acknowledged that the wording was poor and could be misinterpreted. They noted that while that screening women in their 40s led to a 15% reduction in breast cancer mortality (deaths), harms associated with screening were seen. Based on this, the USPSTF had concerns that the benefits were outweighed by the risks (or harms) of mammographic screening.
Experts associated with breast cancer screening continue to recommend annual mammographic screening beginning at age 40. There is convincing evidence that mammographic screening reduces a woman's chance of dying from breast cancer by at least 15%. In fact, breast cancer death rates began to decline in the early 1990's, shortly after widespread mammographic screening was implemented, and have continued to this day. While there are risks associated with screening mammography, such as false positives that can result in unnecessary biopsies, it is felt that the benefit of fewer women dying from breast cancer far outweighs this potential harm.
As many as 70% of breast cancers diagnosed in women in their 40’s occur in women with no risk factors. By recommending that only women at increased risk of breast cancer in their 40’s get mammograms, as suggested by the USPSTF, the majority of breast cancers will not be detected at the earliest possible stage, when treatments are most effective. There is concern that eliminating mammograms for women in their 40’s will erode the progress that has been made in reducing the number of women who die from breast cancer.
Annual mammographic screening is recommended to begin at age 40 for average risk women, continuing as long as a woman is in good health. Women at increased risk of breast cancer may need to begin mammographic screening at an earlier age and may be considered for additional screening such as breast MRI.
Experts associated with breast cancer screening continue to recommend annual mammographic screening beginning at age 40. There is convincing evidence that mammographic screening reduces a woman's chance of dying from breast cancer by at least 15%. In fact, breast cancer death rates began to decline in the early 1990's, shortly after widespread mammographic screening was implemented, and have continued to this day. While there are risks associated with screening mammography, such as false positives that can result in unnecessary biopsies, it is felt that the benefit of fewer women dying from breast cancer far outweighs this potential harm.
As many as 70% of breast cancers diagnosed in women in their 40’s occur in women with no risk factors. By recommending that only women at increased risk of breast cancer in their 40’s get mammograms, as suggested by the USPSTF, the majority of breast cancers will not be detected at the earliest possible stage, when treatments are most effective. There is concern that eliminating mammograms for women in their 40’s will erode the progress that has been made in reducing the number of women who die from breast cancer.
Annual mammographic screening is recommended to begin at age 40 for average risk women, continuing as long as a woman is in good health. Women at increased risk of breast cancer may need to begin mammographic screening at an earlier age and may be considered for additional screening such as breast MRI.
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10 months ago
ThereseBeversMD (Physician - Family Medicine (Verified)) asked the question
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10 months ago
There is good data that obesity now rivals the use of tobacco as a modifiable cause of cancer. It is estimated that 2/3 of Americans are either overweight or obese. Being overweight has been linked to the following cancer types: postmenopausal breast, endometrium (lining of the uterus), esophagus, pancreas, colon, rectum, kidney, thyroid and gallbladder. Maintaining a healthy weight will not only reduce a woman’s risk of developing cancer but also reduces her risk for a number of other diseases (e.g., cardiovascular disease, diabetes, etc).
Weight control is done by balancing calories consumed (diet) against calories expended (exercise). To lose weight, a person would need to expend greater calories than are consumed. This could be done by exercising more, choosing more strenuous forms of exercise or by decreasing the amount of food eaten. Making healthier food choices can also reduce the number of calories consumed.
The American Cancer Society (www.cancer.org) is an excellent resource for specific recommendations on diet and exercise to help reduce a woman’s risk of cancer.
Weight control is done by balancing calories consumed (diet) against calories expended (exercise). To lose weight, a person would need to expend greater calories than are consumed. This could be done by exercising more, choosing more strenuous forms of exercise or by decreasing the amount of food eaten. Making healthier food choices can also reduce the number of calories consumed.
The American Cancer Society (www.cancer.org) is an excellent resource for specific recommendations on diet and exercise to help reduce a woman’s risk of cancer.
New answer by ThereseBeversMD (Physician - Family Medicine (Verified))
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10 months ago
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