The Public Health Institute's

Breast Cancer Answers Project

"A hand held my body from out of the earth as the sun healed my wounded breast."
Ethel Herst

Our Mission

Our mission is to improve access to and awareness of breast cancer clinical trial information, support patients receiving treatment, and improve the quality of life of patients with breast cancer.

Click on the flowers below to visit each area of the BCA web site.

Explore New Treatments

A Clinical Trials Matching System that matches breast cancer patients to clinical trial information in California based on stage of disease, prior treatment, and other specific criteria. All clinical trials in the database are IRB-approved.

Visit Our Art Gallery

A unique artwork collection from those touched by breast cancer.

Read Personal Stories from Breast Cancer Survivors

Stories from breast cancer survivors describing their experiences with breast cancer treatment.

More Breast Cancer Resources

Other online resources for breast cancer information

What is Herceptin and what are the Risks with Herceptin Therapy?


HER2/neu gene is present in one quarter of all breast cancer. This gene has a severe tendency to over produce and perform abnormally, so when this gene is present in breast cancer patients, the cancer is often very aggressive. Herceptin whose chemical name is trastuzumab is utilized to treat advanced breast cancers which have become overly aggressive due to this gene. This immuno-therapy bolsters and mimics the body's own immune system in order to fight the advanced aggressive cancer. In this manner, it specifically preys on the HER2/neu gene as does the bodyís own antibody proteins when they specifically attack foreign invaders and cater their attacks based on the type of invasive entity. The benefits are especially produced when this drug is given as a part of an overall chemotherapy regimen. In this case, some studies show by 40 percent initially and increased the 10-year disease free survival rate up 12 percent to 74 percent disease free survival.

Drastic benefits

The addition to this drug also drastically reduced the risk of breast cancer recurrence for certain breast cancer patients that were HER2/neu positive. The first signs that Herceptin was effective came in 2005 with additional studies finding more efficacy in further updates and study reviews conducted on the drugís usefulness in arresting advanced stage breast cancer. These new studies showed that Herceptin was effective in this pursuit when added to the chemotherapy regimens of these particular patients. The long terms benefits of the introduction of this drug to chemotherapy regimens was also bolstered by the extensive studies and reviews taking place after the initial success in Herceptin use. However, in the initial reports, the dire side effect of the development of fatal heart issues in people using Herceptin was cited as a corresponding side effect of Herceptin use.

Side effects

This fatal corresponding side effect has not been born out in further studies. Additionally, doctors pint out that the significant benefits of Herceptin use do not subside after initial success. This degradation of effectiveness over time has proven that some medications used to fight aggressive breast cancer especially do not have sustainable benefits, but Herceptin is bucking this trend in the new reports. Additionally, some drugs are effective dependent upon the age of the patient, but Herceptin was equally valuable to young and old patients. The drugs are also effective when the cancers are fueled by female hormones and in patients whose cancer had metastasized into the lymph nodes. There is a significant risk of developing congestive heart failure when Herceptin is combined with a certain chemotherapy drug called doxorubicin, but it has been successfully added to regimens in which this therapy is not used.

Information About Benefit Events for Breast Cancer

Breast cancer awareness is not a concept that has always existed. Breast cancer awareness has been pioneered by the families and friends of those that were hopelessly lost or impaired by this disease and early on, the lack of an organizing motivating force made breast cancer an issue that not many people had heard of, so it did not have much attention given to the issue by the medical establishment.

Breast cancer awareness

However, because of the efforts of individuals and concerned groups, the medical community as well as the public has placed the disease in the fore and much of the money to fight the disease and to garner awareness comes from benefit events organized by large well established foundations devoted to breast cancer awareness, prevention and cure. However, individuals play a real part in fundraising both by organizing events themselves to donate to their chosen breast cancer causes or in support of one of the well-organized breast cancer foundations. The necessity fulfilled Breast cancer is such an impactful disease that these events also serve as a conduit for families and friends of those most affected by breast cancer to fellowship and find solace in their active participating together in these events. In many cases, these events are formed, participated in and supported by a network of friends and families, and even the large well established foundations had this humble but very effective start. Those that are just experiencing the disease may wonder how to find events to attend that best suit their abilities, interests and sometimes logistics. There are benefits to attending events of large organizations. These organization have to disclose information about how their organizations are run, who benefits, how much of the money donated is given to the actual cause versus operating costs, taxes expenditures and other pertinent information, but this is not to discourage grass roots organizing by individuals. However, people giving to foundations and participating in events should do their due diligence in determining scam organizations as well as poorly run ones of any size.

Find your interests first

Organizations understand the power of individuals and tailor events accordingly. One such credible and esteemed organization fighting breast cancer is the National Breast Cancer Foundation. They allow individuals to host events sponsored by their organization. They honor the efforts of the individuals, groups and organizations giving the NBCF events by branding their efforts as well as the program Catalysts for Hope. Finding a breast cancer event is a Google search away, but sometimes events can be found according to a personís interests. For example, active and athletic people can find multiple breast cancer events organized around running or walking. Walks or runs for cures are effective means of organizing and fundraising, and some famous ones exist by popular national organizations. The Susan G. Komen organization has a 3-Day marathon event, and a very famous walking event. Additionally, Avon and Revlon have walk and run events.

What happens at a Chemotherapy?

Chemotherapy is utilized to treat many diseases, but most notably it is utilized in the treatment of cancer. Specifically, it is used to arrest the spread of metastasized cancer. Metastasized means the cancer has spread from the primary tumor throughout the body. When the cancer has spread, radiation therapy and surgical techniques are ineffective because they can only inoculate cancer in particular areas, but chemotherapy can eliminate the cancerous cells throughout the entire body. Cancer treatment utilizing chemotherapy can cure cancer, but it is often used to control cancer and in the palliation of the symptoms associated with advanced stage, untreatable cancer. Cure means the cancer is eliminated completely and without the possibility of recurrence, but this is an operating definition because it may take years to know if cancer is actually cured.

The reality

When this is not the reality of the diagnosis, controlling the disease may be the only option. Chemotherapy can stop the spread and propagation of cancer to help patients live longer with a suitable quality of life. In this way, cancer is managed like other chronic diseases like diabetes. In many cases with chemotherapy, the disease may disappear and then return, and in these cases, chemotherapy is reengaged. Symptoms caused by advanced stage cancer are eased by palliative chemotherapy or palliation. In many cases in which the cancer has metastasized, improving quality of life may be the only course left to utilize, and this is called palliation. It should be noted very clearly that palliative care utilizing chemotherapy has the goal of only creating comfort for the patient because a cure or control are impossible. Oncologists and a patientís medical dynamics determine the chemotherapy drug or drug combination used in treatment. The oncologist designates dosages, amounts, frequency of dosages and length of treatment, and these specifications are dependent upon the cancerís type, location, and the size of the area affected. Additionally, how chemotherapy affects normal, overall health is a serious consideration taken into account by oncologists when determining treatment. In some cases, a single drug can be effective, but often a cocktail of chemotherapy drugs is required because various drugs work differently to arrest a higher percentage of cancer cells. Additionally, a combination of drugs prevents a resistance to a singularly utilized chemotherapy drug enhancing the treatmentís effectiveness. Often, chemotherapy is used in combination with surgical and radiation therapies to completely eliminate cancer. Sometimes the best course is clear because of the patients or prior patientís circumstances, but effective scheduling and dosages for specific cancers have been discovered in clinical trials also. Often chemotherapy has serious side effects, so the treatments require a period of adjustment to the particular dosages and scheduling, and this requires patients to need a recovery period after the treatment also. However, there are medicines to make recovery quicker and easier on the patient.

What is Tamoxifen and what are the Side Effects of Tamoxifen?

Tamoxifen or Nolvadex is a hormone therapy that is utilized as a treatment for early stage as well as advanced stage or metastatic breast cancer among other diseases. It is available in pill form and is given in daily doses lasting from five to ten years. Five years was the former length of dosage, but studies show an increased survival and an even greater alleviation of breast cancer recurrence in ten-year dosing. Breast cancer utilizes estrogen or progesterone and sometimes a combination of both of these female produced hormones in order to proliferate to an advanced or metastatic state.

Starvation

Tamoxifen blocks the cancer cells from being fed this progesterone, estrogen, or combination by acting as a barrier as the tamoxifen attaches to the cancerís hormone receptors first thereby preventing the female hormones from attaching themselves to these receptors and nourishing the cancer cells. This deters or eliminates the growth of the malignant tumor or tumors which in turn can also prevent developing cancer in the additional breast, recurrence of and death from the breast cancer, and these benefits last far after dosing is abated.

Side effects

However, there are side effects, and they are in some cases exacerbated by the extensive length of tamoxifen dosing. This extended exposure is especially detrimental to some segments of pre-menopausal women. Two of the issues that these groups incur due to this exposure is endometrial cancer and certain negative effects in this groupís fertility especially in premenopausal women for which aromatase inhibitors cannot be prescribed. However, there are other less severe common side effects associated with tamoxifen, and most are symptoms commonly associated with menopause. Additionally, if women are in a premenopausal state, the drug can push them into menopause. The symptoms include psychological issues such as mood swings and a much-decreased libido, but others are physiological like nausea, vaginal dryness and hot flashes. Although, the reaction to tamoxifen varies per woman, blood clots and benign uterine changes may occur also. Sometimes doctors do not recommend tamoxifen or any other kind of hormone replacement therapy and in other times, the menopausal symptoms are so obstructive to the patient that other alternatives are suggested in managing menopausal symptoms or in effective alternative cancer treatments. For women without a predisposition to aromatase inhibitors, this type of drug may be used instead of tamoxifen, but sometimes drastic changes may have to be made like surgically removing the ovaries. However, tamoxifen can be combined with ovarian suppressors that may stem the symptoms while also allowing a patient to incur the beneficial effects of tamoxifen as a breast cancer treatment. Additionally, the benefits are significantly reduced if the patient does not complete the entire course of tamoxifen treatment.

Clinical Trials for Breast Cancer and Breast Cancer Support Groups?

Clinical trials are necessary in the development of new techniques to diagnose, detect and treat breast cancer. Researchers also use this effective tool to determine what does or does not work in this effort. However, another very important reason for clinical trials is determining if medicines and treatments have side effects and how severe these side effects are. The information garnered in these trials determines if the benefit of the drug is great enough to advise patients to endure the negative side effects of the proposed treatment. In doing so, doctors are able to prescribe the most effective treatments with the least amount or severity of side effects. These are carefully supervised and proctored trials, and people elect to take part in the process.

Information

In spite of the effectiveness of clinical trials in delivering better treatment and advanced techniques of fighting this disease, and in many cases offering participants the opportunity to imbibe the beneficial effects of new medications or medications of last resort first, more than 95 percent of breast cancer patients have not participated in the process. This is due in part to a lack of information among other things concerning the process and locating pertinent credible trials, but because of the personal nature of a choice such as this, it is a patientís doctors that are the proper authorities and sources to discuss the possibilities in utilizing trials in their particular regimens.

What are support groups?

Support groups are as the name states, groups of supportive people, but it also means the role is to support as well as be supported. This makes these groups a great place to outlet emotions and find solutions to the difficult issues surrounding families, friends and individuals dealing with breast cancer. These people facing similar situations meet regularly either personally, by telephone, or online, and these meetings can be open or closed membership. There is no long-term commitment in open membership, but closed membership requires registration and attendance in a set quantity of sessions. Those whose schedules are inconsistent may choose open membership. Closed memberships are also called closed because after a certain size group is registered, registration closes. This is to establish consistency and to allow personal relationships to become established, so members are encouraged to attend the entire number of group meetings.

Benefits

Benefits include information gathering from very credible sources, and also information disseminated from people wishing to share their experiences. These qualities in support groups cause these groups to break through the isolation that sometimes occurs with this devastating diagnosis and subsequent treatment. Distance often occurs either from people becoming distant because of the myriad complicated issues involved with a breast cancer diagnosis, or sometimes patients simply need to have fellowship with people experiencing some of the same unique things. In order to find groups in your area, network with fellow survivors, check with due diligence online, or consult medical professionals involved in treatment for recommendations.

How are they set up?

Support groups are conducted in many ways but commonly there is always a group leader. Some are organized by medical professionals like psychologists, psychiatrists, nurses and social workers while others are organized by survivors or their support structures. Professionals groups have trained professionals, but may lack personal breast cancer experience. Survivors groups bring personal experience, but may lack some skill training in some cases, but this often is an overrated critique of survivor led support groups. In professionally led groups, prospective registrants should make sure group officials are licensed in their respective fields, and in survivor led groups, leaders should have the requisite life experience to handle the groupís dynamics.

What are the Side Effects of Chemotherapy? An effective cancer treatment, butÖ

Chemotherapy is an effective cancer treatment, but the treatments have multiple and often dire side effects. The existence or severity of the negative side effects are dependent upon the dosage, the type of drug or drugs used in treatment, a patientís overall health, the cancer type and location. The side effects are produced on a cellular level because it is at this level at which chemotherapy affects a patient. Cancer cells are actively growing and multiplying constantly as are healthy normally functioning cells. When these normal cells are damaged by the chemotherapy treatments, the negative side effects associated with these treatments are produced. Managing side effects includes preventing or treating the side effects themselves, and this management is often a part of the palliative care process. Common side effects are specific to certain types of chemotherapy, but the effects vary greatly because experiences differ per patient, and each drug utilized produces different side effects.

Side effects

When side effects occur, they should be reported to a patientís doctor, but it is important for the patient to understand the common side effects produced by the drug or drugs being taken. This is necessary in order to better identify a treatment path for alleviation of these issues. Some side effects can be concerning, but the side effects in themselves do not reveal the efficacy or the lack thereof of the particular chemotherapy treatments themselves. Many types of pain are associated with chemotherapy treatments, and some of these pains are very specifically identified like the numb, piercing pain in the fingers and toes called peripheral neuropathy. This pain occurs when the chemotherapy treatment prescribed damages nerves in these areas, but muscle and stomach pain as well as headaches also occur regularly with chemotherapy. One of the most common side effects associated with any traditional chemotherapy treatment is fatigue. Fatigue is basically defined as a constant state of physical and mental exhaustion, and the type of fatigue related to chemotherapy is much more pronounced than being commonly tired and in need of rest. This is especially true in the case of a patient under a cocktail of chemotherapy drugs or when that patientís chemotherapy is combined with other therapies like radiation. Cell damage caused by chemotherapy occurs in the mouth and throat producing painful lesions and abscesses in this area that abate at the termination of the treatment course. Chemotherapy also produces several bowel or stomach related issues such as diarrhea, constipation, vomiting and a constant general feeling of nausea, but because these issues are pervasive, the treatment course often features medications designed to prevent or reduce these and their related issues. Additionally, oral issues can be minimized by following strict oral hygiene regimens. A healthy diet and sufficient hydration assists in abating the oral and also the bowel symptoms associated with chemotherapy related side effects. However, chemotherapy itself produces a brain fog associated with being induced shortly after the therapies are given, and women can suffer some reproductive as well as sexual issues. All these and any other feeling of abnormal feelings that are incurred by a patient receiving chemotherapy should trigger a report to the doctor.

Signs of Breast Cancer

A breast lump or pain and tenderness in the breast tend to be scary affairs today for women and even men with all the information and spotlight rightly cast on breast cancer. However, because breast cancer shows no outward signs in its earliest stages, people suffering from pain and lumps can often safely assume that they are in no trouble from cancer at least. However, early detection can make breast cancer a survivable ordeal, so prompt attention to any changes, pain or lumps in the breast is key in arresting cancer in a treatable stage.

What to watch for

Pain and tenderness in the breast is termed mastalgia, and there are multiple causes for this issue beyond breast cancer. Mastalgia can be caused by certain medications related to fertility like the medicines included in fertility treatment and birth control. It can also be caused by changing levels of hormones due to menstruation as well breast cysts. Some other issues that may initiate mastalgia as a negative side effect rather than breast cancer are improperly fitting bras and large breasts. Stress has also been known to be a contributor of mastalgia in many cases.

Check all lumps

When people are self-examining for signs and symptoms of breast cancer, they are told to look for lumps as simply one part of the examination, but because of the amount of press surrounding this portion of a self-exam, breast lumps solely are associated with breast cancer. However, the truth is that lumps found in this area are not cancer in a vast amount of the cases of the lumps. Teen hormones and damaged fat tissue account for all but 10 percent of all breast lumps found in women, and this is the case for women in their twenties continuing into the early fifties. These noncancerous lumps are called benign and are caused mostly from damaged tissue also known as fat necrosis, breast infection, fibrocystic breast disease also known as lumpy breasts and noncancerous tumors.

However, in the case of fat necrosis, masses are not able to be eliminated from a positive diagnosis without a physical collection from the mass itself through an invasive tissue collection procedure called a biopsy. Additionally, although 90 percent of existing lumps are found to be noncancerous or benign, new lumps that appear without pain is a common breast cancer symptom. Because a woman may be familiarizing themselves with the normal contours and features of the breast when they first begin monthly examinations, even minor pain may begin to be noticeable because there are natural constant changes occurring to the body. However, there are definite signs of problems that are indicators for women that a closer look form a doctor sooner rather than later may be in order.

Alarm is warranted

Pain and new lumps in the breast that would normally be associated with menstruation but that does not abate when the cycle is complete and before the next cycle should require special noting, as does any changes in nipple shape. Discharge from a single nipple should cause due alarm especially when the discharge is red, clear, yellow or brown. Additionally, women should be vigilant for swelling or lumps in the collarbone and underarm area as well as rashes, swelling or any other inexplicable itchiness or skin irritation in the breast may signal an issue. Hard, irregular shaped lumps are often cancerous, and later stage breast cancer has noticeable physical changes occurring in the breast like enlargement of existing lumps, enlarged skin with exposed pores, growth of one breast, and inward facing nipples as well as armpit and vaginal pain.

Worried About Lump in Breast?

In the US currently, breast cancer deaths are declining, but it is still the second leading cause of death in women attributable to cancer. Early detection, improved screening, better treatment and women being armed with better information is credited with the decline in death rates, and while all lumps occurring even in the region of the breast should be evaluated in order to get a proper diagnosis that excludes breast cancer, 80 to 90 percent of breast lumps are benign. Additionally, there are myriad causes of benign breast lumps, and many being painful, they are caused by trauma and infection, and others are non-cancerous growths that may or may not be dangerous in themselves.

Be calm but verify

Injuries to the breast caused by trauma ruptures vessels in the breast causing a hematoma in the injured area characterized by a noticeable lump. When this damage occurs in the fat cells, fat necrosis occurs forming lumps in the breast. When breast tissue becomes inflamed that inflammation is termed mastitis, and this condition may occur in women whose breast are incurring infection. Certain trauma is elected like body piercings, and infections caused by these elective procedures are exceedingly hard to eradicate, but some are the side effect of very natural reasons like breastfeeding. When a condition called clogged milk, duct occurs causing a suspected lump, it is the result of an infection sustained around the nipple from the suckling action of babies. These infections can also cause abscesses in the breast, and when the infection spreads impacting a larger area of the skin causing irritation and redness, the condition is termed cellulitis.

Most are benign

 Other benign lumps can be a group of hyperactive breast cells, or breast cysts. Cysts are fluid-filled sacs, and they may occur within the breast tissue. Cysts are not often found in women younger than 35 years of age, and they often occur during menstruation in women exceeding this age. The lumps presented by this condition vary in size, but often they present sensitive places on the breast. Fibrocystic changes also cause lumps and associated pain, and the condition called fibrocystic breasts occur when women breasts are sensitive due to hormonal fluctuations. Additionally, benign tumors in the breast that cause lumpiness are termed fibroadenomas. These tumors are firm and often mildly tender, and they form faster in teens and in pregnant women. Fibroadenomas can occur in those under 30, but most commonly, they occur in women ages 30 to 35.

One very effective method of alleviating the fear involved in performing a monthly breast self-exam and discovering lumps is familiarizing oneself with the natural contours and feel of the body when breasts are concerned. The area of the breast nearest the armpit accrues lumps and bumps often. The lower breast section can feel like small grains of sand while the texture underneath the nipple can feel like larger grains. Discovering what is normal, what is not and at what times of the month will make people more sensitive to the changes that may be cancer forming.

Can Benign Cysts Become Cancerous?

Tumors and cysts are distinctly different. A tumor is a mass of tissue, and they can form in any part of the body. Tumors can be benign or malignant, but cysts rarely progress into any form of cancer. A cyst is a fluid or air filled sack and like tumors, they can form in any part of the body, and this includes bones and organs. Although most cysts are benign, they can become cancerous. It is important to have any lumpy feature in the breast examined closely even for people with histories of benign cysts. Lumps are not necessarily cysts by any means, but if they get larger or remain for an extended period measured in weeks, it is important medically to investigate further.

Techniques for confirming or denying

Ultrasounds are the most accessible method for determining cysts, but routine mammograms are important independent of a woman’s history of cysts or any other temporary or long term lumpiness in the breast. Additionally, biopsies via the insertion of a needle into the affected potential lump will determine if the mass is a cyst. If the sac is fluid filled, the inserted needle has the ability to also drain the cyst of fluid. This fluid is further examined for the presence of cancer cells. However, if the lump is made of tissue, the needle can also extract a sample for cancer testing and diagnosis of cause also, so when a person detects a lump in the breast or associated area, simply have it examined by a doctor.

Possible alternative issues

Epithelial hyperplasia is a harmless, somewhat heavy proliferation of breast cells, but atypical hyperplasia, are breast cells that may be changing, and because of this change in normal healthy cells, atypical hyperplasia corresponds with a slight risk of breast cancer developing sometime in the future. Although as stated before, some cysts can become cancerous, both types of hyperplasia are possibilities for growths determined to not be cysts.

Some cysts are cyclical, and these are generally harmless. They start at the beginning of menstruation and then subside greatly or vanish altogether. However, they should always be evaluated by the proper doctor. Other variations of cysts include hepatic or liver cysts, renal or kidney cysts, epidermoid or cysts that occur underneath the skin, and ovarian and breast cysts. Cysts determined uniform by ultrasound or a CT scan commonly are not cancerous although monitoring is strongly advised. Cysts that are more solid deserve further evaluation because some malignancy is possible. Sometimes an entire area may be removed through a biopsy for further analysis. This is necessary because all types of cancer are capable of producing cysts.

Can I Inherit Breast Cancer? Simple answer, yes, but...?

When families face the reality of a close family member incurring cancer, people concerned also for their families often ask if their cancer is hereditary, and any conclusion on the matter from the scientists, researchers and doctors fighting cancer is that the connection is unclear at best. The facts are that abnormalities in someone’s gene pool can be passed down generationally, but it is also a fact that 90 percent of breast cancer is not inherited. When this cancer is of the inherited form, the disease usually reveals itself early in life, and medically, this age is deemed under 40. Another issue is that the problem will usually show up in multiple relatives including one’s children, and in many cases, affects both breasts. However, when a mother or other female relative receives a diagnosis of cancer it does not mean their child will have the disease. This is because there are multiple risk factors with familial ties being only one, and only five to ten percent of breast cancer has this type of origin. When considering options related to the hereditary nature of cancer in one’s own family or in general consult a physician and have personal risk factors identified. Genetic abnormalities deliver a group of instructions that are flawed, and this process is repeated throughout the building of the DNA structure causing the gene to reproduce this abnormality rather than a healthy cell functioning appropriately. There are two genes in particular associated with the onset of inherited breast cancer.

.... there are no simple answers

These are the BRCA1 and BRCA2 genes because of their propensity to carry the genetic abnormality and how their malfunctioning impairs the body. These genes are present in all people and when functioning appropriately, they heal cells when damaged and keep certain cells functioning according to their purpose. Because of this, the appropriately functioning genes actually protect the body from certain cancers, so when they are discovered in an impaired state, this condition correlates to a higher risk in women with the abnormal gene whether the gene is inherited or not. However, when it is discovered that women with breast cancer have the abnormal BRCA1 or BRCA2 gene, in many cases, there is a history of some type of cancer in the family. However, it is also to be noted that people with paternal or maternal associations of familial cases of cancer or that have female family members incurring certain cancers including breast cancer before the age of 60 will likely also have the abnormal gene. This is also true if a family member has triple-negative breast cancer, cancer in both breast, is of Jewish heritage or is an African American who has incurred cancer before the age of 35. Additionally, families with a member or members who have had ovarian cancer as well as cancer in both breast on either the paternal or maternal family only most often have the impaired form of BRCA1 or BRCA2 gene, as well as families who have a case of male breast cancer. Genetic testing is necessary to determine any correlations.

The Breast Cancer Answers Project was created under funding by the Office of Women's Health and continues under funding from the Breast Cancer Fund to the Public Health Institute's C/NET Solutions Project in Berkeley, California. The Public Health Institute is a non-profit organization.

Warning: The information on the Breast Cancer Answers web site is intended for educational purposes only and is not intended to be used for diagnosis or treatment of a health problem or disease. The information on this web site is not a substitute for professional care. If you have or suspect you have a health problem, please consult a health care provider.

All works on this web site © 1996-2001 Public Health Institute. All rights reserved. Use and transmission of the individual artists' works that appear in the following Web pages is by the artists' permission.

Klinikerfahrungen.de