Breast Cancer Awareness, 2016

October 2016

Breast Cancer Awareness

The Best Protection

Is Early Detection

An advertising supplement to The Lewiston Tribune and Moscow-Pullman Daily News

BREAST CANCER AWARENESS

2 | October 1, 2016

You Deserve a more accurate Mammogram “I opted for the Genius™ 3D MAMMOGRAPHY™ exam because early detection saved my lifeâ€?

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SUPERIORITY OVER CONVENTIONAL 2D MAMMOGRAPHY

Genius ™ 3D MAMMOGRAPHY™ exams are clinically proven to provide more accurate breast cancer screenings1* When breast cancer is found early, the 5-year survival rate is almost 100%.2 Sheryl Crow understands the importance of early detection, having been diagnosed with early-stage breast cancer at age 44. “Women need to be advocates for their health,â€? she says. “That means getting annual mammograms starting at age 40 and taking advantage of the best, and most accurate, technologies available.â€? She says that early GHWHFWLRQ LV ´D ZRPDQ¡V EHVW FKDQFH DW VXUYLYDO DQG LW¡V D FKDQFH ZH DOO GHVHUYH Âľ

A MORE ACCURATE EXAM FOR DENSE AND NON-DENSE BREASTS3

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More accurate than conventional mammograms for both dense and non-dense breasts3

Having dense breasts can make it more difficult to see breast cancers on a conventional mammogram.3 A Genius™ 3D™ exam allows the doctor to view each layer of the breast like the pages of a book, allowing it to outperform conventional mammograms for women with both dense and non-dense breasts.3

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Detects cancer 15 months earlier4

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*Compared to 2D mammography alone REFERENCES: 1. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499-2507. 2. National Breast Cancer Foundation, Inc. Stages 0 & 1: what does it mean to have stage 1 breast cancer? http://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1. Accessed July 18, 2016. 3. Rafferty EA, Durand MA, Conant EF, et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts [research letter]. JAMA. 2016;315(16):1784-1786. 4. McDonald ES, Oustimov A, Weinstein SP, Synnestvedt MB, Schnall M, Conant EF. Effectiveness of digital breast tomosynthesis compared with digital mammography: outcomes analysis from 3 years of breast cancer screening. JAMA Oncol. 2016;E1-E7. http://oncology.jamanetwork.com/article.aspx?articleid=2491465. Accessed July 18, 2016. 5. Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R. Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol.

2013;200(6):1401-1408.

Detects 41% more invasive breast cancers1

Genius™ 3D MAMMOGRAPHY™ exams are only available on the Hologic SeleniaŽ DimensionsŽ system. Please consult your physician for a complete list of benefits and risks associated with mammography.

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BREAST CANCER AWARENESS

October 1, 2016 | 3

American Breast Cancer Foundation Green Shoot Media

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any organizations are involved in fighting breast cancer.

Each has its own unique goal, but overall, the focus is ultimately on ending the deadly disease. Breast cancer can strike anyone. Having to deal with a financial burden on top of the disease can cause stress that may affect your chances of recovery.

Fortunately, advocates across the country have built prestigious organizations dedicated to lessening the emotional and financial blow of breast cancer.

The American Breast Cancer Foundation centers its attention on providing financial assistance for screenings and testing for uninsured individuals. The ABCF offers several programs that benefit the fight against breast cancer. From financial assistance to emotional support and cancer education, it’s easy to see why the ABCF is such an influential force in the fight against breast cancer.

History of ABCF Formed in 1997, the ABCF uses more than 65 percent of its donations to assist with medical fees and fund fundraisers. In 2014, the ABCF was awarded a Gold Level Rating by the GuideStar Exchange for its strides to implement a best practice model.

When deciding on which organization deserves your support — and money — it’s important to look for these types of credentials.

Most breast cancer awareness organizations are legitimately committed to the cause, but unfortunately there are dishonest groups out there, too. Do your homework and choose an organization with

the history, testimonials and track record to make sure you’re putting your efforts and dollars in good hands.

ABCF Programs Through its Breast Cancer Assistance Program, ABCF provides cancer screenings for individuals who would otherwise not be able to afford them. By providing 45,700 screenings, 1,300 recipients have been diagnosed with breast cancer. The group’s Community Partnership Program works with medical clinics to provide discounted breast cancer services, such as mammograms and ultrasounds.

Like most charities, ABCF is donation driven. Through its website or 24/7 hotline, you can even donate your vehicle. They also accept cash donations, allowing you to make your donation in memory of those who lost their battle with breast cancer.

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Walk for Awareness Green Shoot Media

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ooking to make a statement in the fight against breast cancer?

Look no further than your legs. There are numerous organizations across the country devoted to setting up charity walks for breast cancer awareness. One such group, Making Strides Against Breast Cancer, encourages all races, ages and sexes to come together and raise money and draw attention to the disease.

Throughout the United States, nearly 300 Making Strides walks take place each year. This makes it the largest network of breast cancer fundraising and awareness events in the nation. The group’s initiatives put many helpful dollars into research that can end breast cancer.

Making Strides Program Since its inception in 1993, Making Strides has raised more than $528 million in the fight against breast cancer, according to the American Cancer Society. The money has been raised by more than 9 million walkers across the country.

Making Strides relies on its walkers finding sponsors for donations, so why not convince your employer to take part in the national effort? Many companies offer a matching gift program, according to Making Strikes. This means that your

contribution can be doubled.

If you’re not feeling up for the walk, Making Strides also looks for volunteers to donate their time to help with registration, water stations and other activities.

Sponsors are always welcome in the Making Strides program.

Your individual or business donation is taxdeductible and you will have the satisfaction of assisting in the fight against breast cancer.

Breast Cancer Awareness Month What better time than October to join Making Strides or a similarly focused organization in your neck of the woods? October is National Breast Cancer Awareness Month, giving advocates everywhere the opportunity to unite for a common cause.

You can wear a pink breast cancer ribbon during the month to show your support. You also can join a walk or personally show your support with a kind deed for a survivor.

During October and beyond, it’s important to show your respect to those who have lost the fight against breast cancer. Consult with your local advocacy organization for specific or unique ways to get involved.

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Start Your Own Group Green Shoot Media

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ave you asked yourself how you can help in the fight to stop breast cancer? Maybe your family members or friends have been affected by the disease. The good news is that it is easy to start your own group to help raise donations and awareness for breast cancer.

A smart thing to sort out before planning your group is how often you want your group to meet. Consider planning your meetings on a weekly or bi-weekly schedule. Once a month may be easier for everyone to plan around but may make it difficult to keep the group’s momentum going.

Make Your Group Unique Check to see if a similar group already exists in your area. It may be counterproductive to begin a new group instead of assisting an already established group.

Consider joining forces with like-minded groups to enhance your capabilities.

Your local oncology nurse or social worker can assist you in finding existing groups, or you can call the Cancer

Support Community Helpline (888-793-9355) to locate other local groups.

Look for ways to differentiate your group’s activities. This can include inviting educated guest speakers to offer their insights on the disease and how to overcome it.

Becoming a Great Leader If starting a group is your idea, you may be looked to as the leader. There are many factors to consider when deciding whether you should be a leader, or whether another member should take the helm of your group.

If you’ve got the passion for the group objective and are skilled in coaching others to success, a leadership role may be the perfect fit.

If you’re looking for someone else in the group to step into a director-type role, a current patient or survivor of breast cancer can make a great candidate. Someone who has experienced cancer can share in other’s struggles and convey their perspective of how to cope with the disease.

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Being a Caregiver Green Shoot Media

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oping with illness can be a difficult undertaking, especially with something as serious as breast cancer.

When someone close to you is suddenly diagnosed with breast cancer, you may be left wondering how to help.

Whether you’re giving emotional support, assisting with doctor appointments or doing everyday chores that your loved one is unable to complete, you are a caregiver.

Accepting the new role of caregiver may be tough. You may experience a total lifestyle change and try to put your loved one before your own needs. Ignoring your own needs can cause you to become less effective as a caregiver.

A Caregiver’s Role The role of a caregiver varies by situation. The National Cancer Institute defines a caregiver as “the person who most often helps the person with cancer and is not paid to do so.”

Caregivers typically serve as aides or companions and assist with cooking, transportation and everyday chores.

A good caregiver is crucial to the emotional and physical support system for a cancer patient.

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Caring for Yourself It may seem that your wants and needs are second-tier to those of your affected loved one. The experts at The National Cancer Institute point out that fulfilling your own needs will make you a more effective caretaker.

It may be hard to talk to your loved one about how you’re feeling when you know that they are dealing with so much already. But having an outlet to express yourself and your feelings can help you maximize your ability as a caregiver.

Support groups can offer a great amount of therapy as you can discuss your feelings with people in similar situations. Talking with others can be a way of forcing yourself to relax. This can be difficult with the amount of stress and feelings you may be experiencing, but even a weekly group setting can help you put things in perspective.

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Healthier Fats Green Shoot Media

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imply put, your body needs fat. t is crucial to supplying energy, helps process vitamins and delivers essential fatty acids that your body needs but cannot make itself.

While much debated in the healthcare and dietary sectors, the fact that fat is a helpful part of your diet is starting to gain major traction.

Where the dietary recommendations get muddled is in just how much fat you need, as well as what kinds are suggested as regular additions to your intake. When it comes to breast cancer, researchers have not been able to pinpoint a certain behavior that causes the disease. However, many have determined that a diet containing healthy fats can have great benefits in reducing your risk.

Why Fat is Important In the past, many studies concluded that it’s best to avoid fats when it comes to your diet. Did you know that there are certain fats that can promote your well-being?

Your body counts on vitamins A, D, E and K to operate properly. The only way these vitamins are able to be absorbed is with the help of fats. Eating foods that boast “unsaturated fats” will allow your body to process the vitamins without the

harmful risks of a diet high in “saturated fats.”

Incorporating Healthy Fats While diet alone will likely not cause or cure cancer, it is a factor that needs to be on your healthcare radar.

The Harvard School of Public Health has compiled the following tips on how to use fats to your advantage; • Avoid packaged food that is labeled “0g of Trans Fat.” • At least one meal a day should be packed with Omega-3, which can be found in salmon, walnuts and tuna.

• Lower your intake of saturated fat by eating chicken and fish instead of red meat and cheese.

• Read labels. Even if a food claims to be low fat, it may still include bad fats such as saturated and trans fats.

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Risk-Reduction Surgeries Green Shoot Media

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long family history of cancer may put you at a greater risk of contracting the disease. Usually, when cancer is hereditary, a family passes down mutated genes. These genes can become out of control and are likely to cause cancer.

If you do have a long-running history of cancer in your family, you should have regular check-ups with your doctor. Susan G. Komen reports that patients who discover their cancer during Stage I have a 90 percent survival rate. This statistic underscores the importance of staying on top of your health as you age.

One of the keys to beating breast cancer is catching it before it is able to spread to your lymph nodes.

If you are at high risk, there are many options to consider to remain cancer free. Risk-reduction surgeries are becoming a common option for those who are at the highest risk level for breast cancer.

hereditary breast cancers.

Your doctor will be able to determine if you have these gene mutations with a simple blood test, and can then walk you through your options.

Effectiveness of Risk-Reduction Surgery Bilateral prophylactic mastectomy — the surgery to remove both breasts in order to reduce the risk of breast cancer — has been shown to drop the risk of cancer by 95 percent, according to Cancer.gov.

This surgery is usually meant for women with family histories showing the BRCA1 or BRCA2 gene. According to the National Cancer Institute, these two genes account for 20 to 25 percent of

Risk Involved As with all major surgeries, the removal of both breasts is one with many factors to consider. Potential harms that may arise are similar to any major surgery, including major bleeding or infection.

Experts also note that receiving this surgery may cause anxiety concerning body image. Speak with your physician about the psychological side effects while you are deciding to commit to this surgery.

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If you decide that preventative major surgery is not the path you want to travel, there are still ways to keep your risk down.

Frequent check-ups will let you and your health professional know exactly where you stand. Talk with your physician or oncologist about how frequently they recommend you be tested.

Chemoprevention is the use of drugs to delay cancer’s development in high-risk patients. The Food and Drug Administration has approved several of these drugs and shows that they will reduce the risk of breast cancer in patients at higher risk.

Again, always consult with your physician to discuss the specifics of your health in relation to starting new drugs or treatments.

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By The Numbers Green Shoot Media

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he American Cancer Society estimates that in 2016, there will be 246,660 new cases of invasive breast cancer in U.S. women. When looking at a number that large, it is important to consider it as more than just a statistic.

These “numbers” could be your close family members, friends or colleagues.

Some of these diagnoses may be more serious than others, but one thing is constant: These patients need our support and love as they work through the difficult process of survivorship.

Consider the following numbers compiled by Susan G. Komen and pledge to make a donation or become involved in the fight against breast cancer.

• Breast cancer is the most common type of cancer developed during a pregnancy.

About one in 3,000 pregnant women will be diagnosed with breast cancer each year.

• Breast cancer incidences have increased slightly each year in African-American women.

• African-American women have the highest breast cancer mortality rate, while Asian-Americans have the lowest.

• Breast cancer causes more deaths than any other type of cancer in women ages 20-59.

• Cases of breast cancer in men has slightly increased in the past 30 years.

• Mortality rates are highest in Washington, D.C., Louisiana and Mississippi.

• 30,700 new cases of breast cancer are expected in African-American women this year.

• From 1990-2013 mortality rates have decreased by 37 percent.

• Most breast cancer diagnoses and deaths occur in women over age 50.

• Diagnoses in younger women usually have a mutated BRCA1 or BRCA2 gene that has mutated.

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The Stages Of Breast Cancer MetroCreative

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pon receiving a breast cancer diagnosis, patients will soon receive a pathology report that informs them about the stage their cancer is in. The stage indicates how advanced the cancer is and whether or not it is limited to one area of the breast or has spread to other tissue or even other parts of the body. Understanding the stages of breast cancer can help patients cope with their diagnoses more effectively.

Once the doctor has completed all the necessary testing, patients will then receive their pathology reports, which will include the stage of the cancer. The following rundown of the various stages of breast cancer can help breast cancer patients better understand their disease.

Stage 0 Non-invasive breast cancers are considered to be in stage 0. When doctors have determined the cancer is in stage 0, that means they have not seen any indication that the cancer cells or the abnormal non-cancerous cells have spread out of the part of the breast in which they started.

Breast cancer patients may hear the term “five-year survival rate” when discussing their disease with their physicians.

The five-year survival rate refers to the percentage of people who live at least five years after being diagnosed with cancer.

According to the American Cancer Society, the five-year survival rate for women with stage 0 breast cancer is nearly 100 percent.

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Stage I Stage I refers to invasive breast cancer and is broken down into two categories: stage IA and stage IB. Stage IA refers to invasive breast cancers in which the tumor is up to two centimeters and the cancer has not spread outside the breast.

The lymph nodes are not involved in stage IA breast cancers.

In some stage IB breast cancers, there is no tumor in the breast but there are small groups of cancer cells in the lymph nodes larger than 0.2 millimeter but not larger than two millimeters.

But stage IB breast cancers may also refer to instances when there is both a tumor in the breast that is no larger than two centimeters and small groups of cancer cells in the lymph nodes that are larger than 0.2 millimeter but no larger than two millimeters. The ACS notes that the five-year survival rate for stage I breast cancers is roughly 100 percent.

Stage II Stage II breast cancers are also divided into two subcategories: stage IIA and stage IIB. Both subcategories are invasive, but stage II breast cancers are more complex than stage 0 or stage I breast cancers. Stage IIA describes breast cancers in which no tumor can be found in the breast, but cancer that is larger than two millimeters is found in one to three axillary lymph nodes (the lymph nodes under the arm) or in the lymph nodes near the breast bone. But an invasive breast

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BREAST CANCER AWARENESS cancer can still be considered stage IIA if the tumor measures two centimeters or smaller and has spread to the axillary lymph nodes or if the tumor is larger than two centimeters but not larger than five centimeters and has not spread to the axillary lymph nodes.

Stage IIB breast cancer describes breast cancers in which the tumor is larger than two centimeters but no larger than five centimeters, and there are small groups of breast cancer cells in the lymph nodes. These small groups of cells are larger than 0.2 millimeters but no larger than two millimeters. Stage IIB may also be used to describe breast cancers in which the tumor is larger than two centimeters but no larger than five centimeters and the cancer has spread to between one and three axillary lymph nodes or to lymph nodes near the breastbone. Tumors that are larger than five centimeters but have not spread to the axillary lymph nodes may also be referred to as stage IIB breast cancers. The five-year survival rate for stage II breast cancers is about 93 percent.

Stage III Stage III cancers are invasive breast cancers broken down into three categories: IIIA, IIIB and IIIC. When patients are diagnosed with stage IIIA breast cancer, that means doctors may not have found a tumor in their breast or the tumor may be any size. In stage IIIA, cancer may have been found in four to nine axillary lymph nodes or in the lymph nodes near the breastbone. Tumors larger than five centimeters that are accompanied by small groups of breast cancer cells (larger than 0.2 millimeter but no larger than two millimeters) in the lymph nodes also indicate a breast cancer has advanced to stage IIIA.

October 1, 2016 | 11 But stage IIIA may also be used to describe breasts cancers in which the tumor is larger than five centimeters and the cancer has spread to one to three axillary lymph nodes or to the lymph nodes near the breastbone.

A stage IIIB breast cancer diagnosis indicates the tumor may be any size and has spread to the chest wall and/or the skin of the breast, causing swelling or an ulcer. The cancer may have spread to up to nine axillary lymph nodes or may have spread to the lymph nodes near the breastbone.

In stage IIIC breast cancer, doctors may not see any sign of cancer in the breast. If there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast.

To be categorized as stage IIIC, the cancer must also have spread to 10 or more axillary lymph nodes or to the lymph nodes above or below the collarbone or to the axillary lymph nodes or lymph nodes near the breastbone. The ACS notes that women diagnosed with stage III breast cancer are often successfully treated and that the five-year survival rate is 72 percent.

Stage IV Invasive breast cancers that have spread beyond the breast and lymph nodes to other areas of the body are referred to as stage IV. Stage IV breast cancer may be a recurrence of a previous breast cancer, though some women with no prior history of breast cancer receive stage IV diagnoses. The fiveyear survival rate for stage IV breast cancers is 22 percent.

More information about breast cancer is available at breastcancer.org.

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Potential Side Effects Of Breast Cancer Treatments MetroCreative

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reatments for breast cancer have evolved considerably in recent years. When breast cancer is detected early enough to be categorized as stage 0 or stage I, the fiveyear survival rate is 100 percent. That’s a testament to the hard work of cancer researchers who continue to develop effective ways to treat and defeat breast cancer.

Side effects may depend on which course of treatment cancer patients and their physicians pursue, but the following are some potential side effects breast cancer patients may encounter during treatment.

Armpit discomfort According to Breastcancer.org, a nonprofit organization dedicated to providing up-to-date information about breast cancer, patients may develop armpit discomfort after lumpectomy, mastectomy or lymph node removal surgeries. This discomfort may be characterized by pain, swelling, tenderness, or numbness. The numbness may result when nerves in the armpit are cut during surgery, while tenderness or swelling may occur when surgeons have to remove some of the tissue under the surface of the skin. Patients who receive radiation therapy may develop irritation or soreness in the armpit because the skin of the armpit is so close to the breast.

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Dry skin During treatment, breast cancer patients may experience dry skin that is uncomfortable and itchy. This side effect has been linked to chemotherapy, radiation therapy and hormonal therapy.

Dry skin tends to last as long as patients are in treatment, gradually subsiding once treatment has been completed.

Endometriosis Endometriosis occurs when the cells that make up the endometrium, or the lining of the uterus, grow outside of the uterus. Hormonal therapy may stimulate the growth of endometrial cells, triggering endometriosis, which is most often found on or under the ovaries, behind the uterus or on the bowels or bladder. Endometriosis may cause pain, fertility problems or heavy menstrual periods. Physicians who suspect their patients have developed endometriosis may perform a laparoscopy, a surgical procedure in which a small cut is made over the abdomen. Once that cut is made, the surgeon will insert a thin tube equipped with a viewing instrument so he or she can look inside the uterus to determine if endometriosis has developed.

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Breast cancer treatments such as chemotherapy, radiation therapy and hormonal therapy may contribute to memory loss.

Ovarian removal or shutdown may also result in memory loss.

Memory loss may also result from medications taken during breast cancer treatment. Breast cancer patients who plan to continue working during treatment should discuss with their physicians how to manage potential memory loss and may benefit from informing their employers about the potential for treatment-related memory loss.

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Some breast cancer patients experience constipation because their eating and exercise habits change during treatment.

Constipation is a side effect of pain medications such as ibuprofen, so breast cancer patients relying on medication to alleviate some of the pain associated with their disease and treatment may experience constipation as a result.

Chemotherapy and hormonal therapy are two breast cancer treatments known to cause constipation as well.

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(208) 743-6507 488585JA_16

Delilah & Diana

BREAST CANCER AWARENESS

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For 15 years, Gritman Medical Center and generous individuals and businesses have joined together to help more than 1,000 women in our area detect, ďŹ ght and survive breast cancer.

Join us for one of our annual events to learn more about how your support continues to positively impact our friends, families and communities.

[10:00 to 11:30 am]

[4:00 to 5:30 pm]

October 25, 2016 Best Western Plus University Inn, 1516 W. Pullman Rd., Moscow Seating is limited (individual up to tables of 8) and registration is required. Register online at: www.pinktea.eventbrite.com www.pinkcocktail2016.eventbrite.com or by phone at 208-883-6795 Donations in support of our programs are accepted at each event or online at gritman.org

gritman.org

14 | October 1, 2016

BREAST CANCER AWARENESS

How To Handle A Cancer Diagnosis MetroCreative

M

illions of people are diagnosed with cancer every year.

One of the leading killers of men, women and children across the globe, cancer affects those diagnosed as well as their families and friends.

Cancer treatments continue to evolve, which should come as welcome news to men and women diagnosed with this often treatable disease. That group figures to expand in the coming years, as the World Health Organization estimates the number of new cancer cases will rise by about 70 percent over the next two decades.

Regardless of how far cancer research has come, a cancer diagnosis remains a cause for concern. Handling such a diagnosis well can help patients in their fights against the disease and improve their chances of making a full recovery. · Learn about your disease. Physicians will make suggestions and recommendations to their patients, but it’s ultimately up to patients to make decisions regarding their treatments. Learning about your disease may help you feel more comfortable about the decisions you will be asked to make during your fight. The Mayo Clinic also advises men and women to determine their comfort levels with regard to their disease. Some may prefer to learn only the basics of their disease, trusting major treatment decisions to their physicians, while others want to know as much as possible so they can be the primary decision-maker regarding

their treatments. Don’t be afraid to leave major decisions to your physician if you find yourself becoming overwhelmed with information about your disease. · Embrace your support system. Friends and family members can be wonderful resources during your fight against cancer.

The Mayo Clinic advises cancer patients to keep the lines of communication with their loved ones open, sharing updates about your treatments and discussing any decisions you may be facing.

Feelings of isolation may grow if you stay tight-lipped about your disease, so embrace your support system, accepting any help your loved ones offer. · Prepare for change. Cancer treatments have come a long way over the last several decades, but they may still produce unwanted side effects, such as fatigue and hair loss. The Mayo Clinic notes that cancer support groups may be especially helpful as cancer patients prepare and ultimately deal with the changes that accompany their treatments. Ask your physician about the likely side effects of your treatment and if he or she has any suggestions regarding how to handle those side effects. · Revisit your priorities. Patients will have to devote a lot of time and energy to successfully navigate cancer treatments.

Revisiting your priorities to determine what’s truly important can help you clear away personal clutter so you have more energy as you fight your disease.

BREAST CANCER AWARENESS

October 1, 2016 | 15

THE REGION’S MOST COMPREHENSIVE BREAST CANCER TREATMENT PROGRAM Cancer Care Northwest’s comprehensive breast cancer treatment program combines the expertise of HIGHLYSKILLED CANCER SPECIALISTS, including medical, radiation and surgical oncologists, STATE-OF-THEART TREATMENT OPTIONS and innovative SUPPORT SERVICES. Our unique approach integrates world-class cancer treatment with compassionate care to heal the whole person... body, mind and spirit. When you are faced with a breast cancer diagnosis, you need Cancer Care Northwest.

509 228-1000 (WA) | 208 754-3100 (ID) Eastern Washington & Northern Idaho www.CancerCareNorthwest.com 488410J-16

BREAST CANCER AWARENESS

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