AP PHOTOS: Simple surgery heals blind Indonesians

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PADANG SIDEMPUAN, Indonesia (AP) — They came from the remotest parts of Indonesia, taking crowded overnight ferries and riding for hours in cars or buses — all in the hope that a simple, and free, surgical procedure would restore their eyesight.

Many patients were elderly and needed help to reach two hospitals in Sumatra where mass eye camps were held earlier this month by Nepalese surgeon Dr. Sanduk Ruit. During eight days, more than 1,400 cataracts were removed.

The patients camped out, sleeping side-by-side on military cots, eating donated food while fire trucks supplied water for showers and toilets. Many who had given up hope of seeing again left smiling after their bandages were removed.

"I've been blind for three years, and it's really bad," said Arlita Tobing, 65, whose sight was restored after the surgery. "I worked on someone's farm, but I couldn't work anymore."

Indonesia has one of the highest rates of blindness in the world, making it a target country for Ruit who travels throughout the developing world holding free mass eye camps while training doctors to perform the simple, stitch-free procedure he pioneered. He often visits hard-to-reach remote areas where health care is scarce and patients are poor. He believes that by teaching doctors how to perform his method of cataract removal, the rate of blindness can be reduced worldwide.

Cataracts are the leading cause of blindness globally, affecting about 20 million people who mostly live in poor countries, according to the World Health Organization.

"We get only one life, and that life is very short. I am blessed by God to have this opportunity," said Ruit, who runs the Tilganga Eye Center in Katmandu, Nepal. "The most important of that is training, taking the idea to other people."

During the recent camps, Ruit trained six doctors from Indonesia, Thailand and Singapore.

Here, in images, are scenes from the mobile eye camps:

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Marc Anthony comes to aid of Dominican orphanage

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SANTO DOMINGO, Dominican Republic (AP) — Singer Marc Anthony is coming to the aid of an orphanage in the Dominican Republic.

A foundation run by Anthony with music and sports producer Henry Cardenas plans to build a new residence hall, classrooms and a baseball field for the Children of Christ orphanage in the eastern city of La Romana. Anthony attended the groundbreaking ceremony Friday with his model girlfriend Shannon de Lima.

Children of Christ Foundation Director Sonia Hane said Anthony visited the orphanage previously and decided to help. His Maestro Cares Foundation raised $200,000 for the expansion on land donated by a sugar company. The orphanage was founded in 1996 for children who were abused or abandoned or whose parents were unable to care for them.

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Powerful gas explosion levels Mass. buildings; at least 18 hurt

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SPRINGFIELD, Mass. (AP) — A natural gas explosion in one of New England's biggest cities on Friday destroyed two buildings, including one housing a strip club, and damaged others beyond repair but didn't kill anyone, authorities said.

Firefighters, police officers and gas company workers in the area because of an earlier gas leak and odor report were among more than a dozen people injured, authorities said.

"This is a miracle on Worthington Street that no one was killed," Lt. Gov. Tim Murray said at a press conference.

The explosion in a downtown area of Springfield, 90 miles west of Boston, blew out all windows in a three-block radius, leaving three more buildings irreparably damaged and prompting emergency workers to evacuate a six-story apartment building that was buckling.

Police Sgt. John Delaney marveled at the destruction at the blast's epicenter, where a multistory building was leveled.

"It looks like there was a missile strike here," he said.

Officials at two nearby hospitals said at least 18 victims were transported there with injuries but none was critical.

Firefighters responded to the scene at 4:20 p.m. and were investigating the gas leak when the blast happened shortly after 5 p.m. The cause of the explosion hadn't been identified but was under investigation, they said.

Springfield, which has about 150,000 residents, is the largest city in western Massachusetts. It's known as the home of the Basketball Hall of Fame, which is not in the vicinity of the blast.

The explosion, in an area of downtown Springfield with commercial properties and residences, destroyed a building that housed a Scores Gentlemen's Club.

Area resident Wayne Davis said he felt his apartment building shake a block away.

"I was laying down in bed, and I started feeling the building shaking and creaking," he said.

The Navy veteran said the boom from the explosion was louder than anything he'd ever heard, including the sound of a jet landing on an aircraft carrier.

The blast was so loud it was heard for miles around. Video from WWLP-TV showed the moment of the explosion, with smoke billowing into the air above the neighborhood.

Mayor Domenic Sarno said it was through "God's mercy" that nobody had been reported killed in the explosion.

"My thoughts and prayers are with the individuals that have been injured and the people who have been displaced," he said, adding that emergency shelter was being set up for those unable to go home.

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Associated Press writers Bridget Murphy and Bob Salsberg in Boston contributed to this story.

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US troops in Afghanistan celebrate Thanksgiving

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KABUL, Afghanistan (AP) — It was Army Sgt. Keith Wells' first Thanksgiving Day away from his family and despite a cornucopia of food provided for the troops, his taste buds were craving his wife's macaroni and cheese back home.

"My wife's a foodie — you know the Food Network, cooking shows. Everything she makes is golden," Wells of Charlotte, N.C., said Thursday at a large international military base in the Afghan capital, Kabul.

The dining hall served up mac-and-cheese along with traditional Thanksgiving Day fixings. Wells was thankful for the good food, but he still missed his wife's home-cooking.

Huge hunks of beef greeted the estimated 2,500 diners as soldiers lined up in the dining hall. Red-white-and-blue decorations filled the room. Brochures titled "Learn about combat stress" served as table centerpieces.

There was roast turkey, sliced turkey, ham and rib-eye steaks. The troops were served steaming side dishes of dressing, corn, collard greens, yams and mashed potatoes and gravy that some lapped up with spoons. For dessert, there was a massive cake with a turkey etched in icing, pumpkin spice cookies and scores of pies.

A short walk from the dining hall, service members were playing a modified version of American football.

Parts of the scene could have come from a snapshot of any U.S. city: American guys in sweats tossing the pigskin, a scoreboard, a coin toss to start the game.

But on this military base, concrete barriers surrounded the field. The referees wore camouflaged shirts and the spectators carried rifles. The artificial turf was frayed and so dusty that when one player spiked the football, a puff of dirt rose from the field.

The players used a regulation football, but the game was a mix of football, soccer and rugby to fit the short field.

Some soldiers commented about the 11-year-old war that has claimed the lives of 2,029 American service members.

Army Chief Warrant Officer 4 Chuck Minton of Monroe, Ga., who has traveled extensively across Afghanistan, was optimistic. "It's been progressing here, getting better. The Afghans have taken over more missions," Minton said.

President Barack Obama pulled 10,000 troops out of Afghanistan in 2011 and 23,000 more this year, leaving about 66,000 American service members still deployed in the country. Nearly all international combat troops are to withdraw by the end of 2014 when Afghan forces will be fully in charge of securing the nation.

Army Maj. Rodney Gehrett of Colorado Springs, Colo., said he was surprised that the war was barely mentioned during the last U.S. presidential election — evidence that some Americans had tuned out the news from the front line a half a world away.

"The war in Afghanistan wasn't even brought up as a topic of conversation" during the election, Gehrett said. "It was a little surprising to me. Hopefully, that will change and people will realize that we still have troops here and they are fighting every day."

Army Sgt. Adam Draughn of Denver, Colo., said some people back home have the impression that the Afghan people don't want American troops in their country.

"Honestly, I think the biggest misconception in my opinion is that, you know, we actually are loved here," Draughn said. "The nationals do care about us. They do want us here to help them. We're not here uninvited."

Most of the holiday chatter, however, was focused on family.

Taking a break from the game, Army Capt. Robert Mikyska of North Aurora, Ill., pulled out a photocopied photo that was taken of he and his wife just before he deployed to Afghanistan nine months ago.

"Hi, honey!" Mikyska said, looking at the picture. "In a couple weeks, I'll be home. I can't wait to be back."

"My family's here," Army Spc. Ricky Clay, also of Monroe, Ga., said as he smiled and embraced his teammates on the sidelines of the football field.

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AP PHOTOS: Simple surgery heals blind Indonesians

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PADANG SIDEMPUAN, Indonesia (AP) — They came from the remotest parts of Indonesia, taking crowded overnight ferries and riding for hours in cars or buses — all in the hope that a simple, and free, surgical procedure would restore their eyesight.

Many patients were elderly and needed help to reach two hospitals in Sumatra where mass eye camps were held earlier this month by Nepalese surgeon Dr. Sanduk Ruit. During eight days, more than 1,400 cataracts were removed.

The patients camped out, sleeping side-by-side on military cots, eating donated food while fire trucks supplied water for showers and toilets. Many who had given up hope of seeing again left smiling after their bandages were removed.

"I've been blind for three years, and it's really bad," said Arlita Tobing, 65, whose sight was restored after the surgery. "I worked on someone's farm, but I couldn't work anymore."

Indonesia has one of the highest rates of blindness in the world, making it a target country for Ruit who travels throughout the developing world holding free mass eye camps while training doctors to perform the simple, stitch-free procedure he pioneered. He often visits hard-to-reach remote areas where health care is scarce and patients are poor. He believes that by teaching doctors how to perform his method of cataract removal, the rate of blindness can be reduced worldwide.

Cataracts are the leading cause of blindness globally, affecting about 20 million people who mostly live in poor countries, according to the World Health Organization.

"We get only one life, and that life is very short. I am blessed by God to have this opportunity," said Ruit, who runs the Tilganga Eye Center in Katmandu, Nepal. "The most important of that is training, taking the idea to other people."

During the recent camps, Ruit trained six doctors from Indonesia, Thailand and Singapore.

Here, in images, are scenes from the mobile eye camps:

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Australian author Bryce Courtenay dies of cancer

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CANBERRA, Australia (AP) — Australian best-selling author Bryce Courtenay has died of stomach cancer. He was 79.

His publisher Penguin Group said Friday that the South African-born writer died at his family home in the Australian capital Canberra late Thursday surrounded by his family and pets.

Courtenay had a successful career in advertising before writing his first novel, "The Power of One," which was published in 1989 when he was 56. The story became a movie starring Morgan Freeman.

His 21st novel, "Jack of Diamonds," was published this month.

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Sandy victims cheered by NYC's Thanksgiving parade

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NEW YORK (AP) — Victims of Superstorm Sandy in New York and elsewhere in the Northeast were comforted Thursday by kinder weather, free holiday meals and — for some — front row seats to the annual Macy's Thanksgiving Day Parade.

"It means a lot," said Karen Panetta, of the hard-hit Broad Channel section of Queens, as she sat in a special viewing section set aside for New Yorkers displaced by the storm.

"We're thankful to be here and actually be a family and to feel like life's a little normal today," she said.

The popular Macy's parade, attended by more than 3 million people and watched by 50 million on TV, included such giant balloons as Elf on a Shelf and Papa Smurf, a new version of Hello Kitty, Buzz Lightyear, Sailor Mickey Mouse and the Pillsbury Doughboy. Real-life stars included singer Carly Rae Jepsen and Rachel Crow of "The X Factor."

The young, and the young at heart, were delighted by the sight and sound of marching bands, performers and, of course, the giant balloons. The sunny weather quickly surpassed 50 degrees.

Alan Batt and his 11-year-old twins, Kyto and Elina, took in the parade at the end of the route, well away from the crowd and seemingly too far away for a good view. But they had an advantage: Two tall stepladders they hauled over from their apartment eight blocks away — one for each twin.

"We're New Yorkers," the 65-year-old Batt said. "We know what we're doing."

With the height advantage, "I get to see everything!" Kyto said.

At nearby Greeley Square, social worker Lowell Herschberger, 40, of Brooklyn, sought in vain to tear his sons, 8-year-old Logan and 6-year-old Liam, from a foosball table set up in the tiny park as the balloons crept by on the near horizon.

"Hey, guys — there's Charlie Brown," he said, pointing at the old standby balloon.

The boys didn't look up.

"I guess they're over it," the father said with a shrug.

Mayor Michael Bloomberg was reflective Thursday as he praised police, firefighters, armed services personnel, sanitation workers and volunteers involved in the storm response. His office was coordinating the distribution of 26,500 meals at 30 sites in neighborhoods affected by Sandy, and other organizations also were pitching in.

The disaster zones on Staten Island were flooded — this time with food and volunteers from Glen Rock, N.J., organized using social media.

"We had three carloads of food," volunteer Beth Fernandez said. "The whole town of Glen Rock pitched in. ... It's really cool. It's my best, my favorite Thanksgiving ever."

On Long Island, the Long Beach nonprofit Surf For All hosted a Thanksgiving event that fed 1,200 people. Carol Gross, 72, a Long Beach native, said she went to volunteer but was turned away because of a surplus of helpers.

"A lot of people like me, old-timers, we've never seen anything like this horror," she said, recalling the destruction.

Gross' brother, Jerry, who moved to Arizona in the 1960s, was stunned by what he saw when he returned for Thanksgiving.

"To come back and see the boardwalk all devastated like it is, it's like going to Manhattan and finding Times Square gone," he said.

George Alvarez, whose Toms River, N.J., home suffered moderate damage when Sandy hit the coast, said his family usually does "the traditional big dinner" on Thanksgiving. But this year, they chose to attend a community dinner held at an area church.

"This storm not only impacted us, it impacted a lot of our friends, our community, our psyche," Alvarez said shortly before his family headed out for their meal. "We could have had our usual dinner here at home, but this year it felt like we should be with others who are experiencing the same concerns we are. We made it through this devastating storm, and that's something to celebrate."

Across the country, other cities offered a mix of holiday cheer and acts of charity.

Thousands of people made the most of the mild, sunny fall weather to watch Detroit's Thanksgiving parade, hours ahead of the Lions' annual home game.

Floats and marching bands poured down Woodward Avenue on Thursday morning, with many spectators forgoing the cold-weather gear of past parades. Detroit's temperature hit 52 degrees at 11 a.m., with a warm wind blowing from the south.

Parade participants included NASCAR driver Brad Keselowski, a 28-year-old Rochester Hills native and the first Michigan-born driver to win the Sprint Cup Series.

In San Francisco, lines of the homeless and less fortunate began forming late Wednesday outside a church in the city's tough Tenderloin district that expected to serve more than 5,000 meals, said the Rev. Cecil Williams.

"We must make sure people can overcome all adversities," Williams said. "You can, you will and you must."

On New York City's Rockaway Peninsula, convenience store owner Mohamed Razack said he was able to open again Wednesday for the first time since the storm.

"At first, I was very depressed, but now, I'm proud," said Mohamed Razack, 50. "We are the first store to open around here."

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AP radio correspondent Julie Walker, AP video journalist Ted Shaffrey and Associated Press writers Kiley Armstrong and Karen Matthews in New York, Alison Barnwell on Long Island, Bruce Shipkowski in New Jersey and Terry Collins in San Francisco contributed to this report.

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Deaths of 5 runaways prompt soul search in China

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BEIJING (AP) — On the day China unveiled its new leadership in Beijing with promises of a better life for all, five runaway boys died in a garbage bin where they had sought shelter and warmth on a cold, damp night in the south.

The boys were all brothers or cousins aged 9 to 13. Surnamed Tao, they were the sons of three brothers — two of whom are migrant workers with jobs far from home — and most of them lived largely unsupervised in the care of their blind grandmother.

They had been missing for more than a week when, police say, they lit a fire to stay warm on the night of Nov. 15 in the southern city of Bijie and died from carbon monoxide poisoning.

As details of the tragedy emerged this week, it touched off the country's latest soul-searching about social responsibility. It renewed concern over the "left-behind" rural children who often stay with grandparents while parents seek work in thriving coastal cities, and the failure of the country's social services to adequately care for them.

"Though you departed from us in a garbage bin, you are not garbage," children's book author Zheng Yuanjie wrote in his microblog, adding that the fault lies with "adults who failed their responsibilities."

Questions have been raised about how the children — found about 25 kilometers (15 miles) from their home village of Caqiangyan — could have gone missing for 10 days without more of an effort launched to find them. Six local officials, including two school principals, were sacked on Tuesday.

"We have failed in our management work," said Tang Guangxing, a spokesman for Bijie city, where the boys' bodies were found Friday. "Our work was not attentive enough."

State media outlets, giving the deaths broad coverage, have joined in the hand-wringing.

"This is a shame that cannot be washed away by a civilized society," the Beijing Youth Daily wrote in an editorial.

The official Xinhua News Agency said the boys had poor grades at school and had essentially dropped out of their classes. It faulted China's education system for putting too much stress on academic excellence at the expense of caring for less successful students.

"Please do not forget the mission of compulsory education. Please spread love and responsibility like sunshine," Xinhua wrote in an editorial. "This is also a tragedy of 'left-behind children,' which is a sign of the time and requires introspection from family, society and government."

Many critics in China have fretted over decaying public morality as the country's economy rapidly grows and its people enjoy unprecedented wealth. A similar outcry erupted last year when a toddler in Guangzhou was run over by two vehicles and then ignored by at least 18 passers-by.

The latest incident has focused concern on the plight of families in impoverished rural areas. An estimated 58 million children countrywide lack sufficient supervision or stay in the care of grandparents when their parents seek work in China's booming cities.

Some details of the boys' home life remain unclear. Their relatives lack telephones and could not be contacted, though some were quoted by Chinese media outlets who sent journalists to the extremely poor, mountainous region of mud huts where farmers earn about 3,000 yuan ($475) a year.

The boys — Zhongjin, Zhonghong, Zhonglin, Chong and Bo — were found in a 1.5-meter-by-1.3-meter (5 foot-by-4 foot) garbage container in Bijie after a night of drizzling rain when temperatures were about 4 Celsius (40 Fahrenheit).

Two of the fathers, ironically, are garbage collectors in the boom city of Shenzhen near Hong Kong, according to a Xinhua report. One of the mothers lives in Shenzhen and another reportedly left the family. The third brother and his wife are farmers in the Bijie area, though they apparently often left the boys to fend for themselves, Xinhua said.

Former journalist and Bijie resident Li Yuanlong posted online that the children had been spotted living in a temporary shelter with plastic cloth, bricks and plywood at a nearby demolition site.

Li, who broke the story on the deaths in an online posting, told The Associated Press on Wednesday that local officials in Bijie were not pleased with the coverage and that police escorted him out of the city and told him to stay away for four or five days.

Some observers have faulted the family for not keeping closer watch over their children.

"How could grandparents take care of your child when you are away?" asked Beijing parking attendant Liang Hongjin, a migrant worker from Henan province.

However, much of the criticism has been directed at the government and educational system.

The family reported the boys missing Nov. 5. Beijing lawyer Li Fangping said the failure of local officials to launch a proper search was "horrific."

The boys died hours after Xi Jinping gave his first speech as China's new leader in Beijing's Great Hall of the People. Xi underlined the Communist Party's mission to improve the country's education, employment, social security, housing and health care.

"Our people have an ardent love for life," Xi said in the speech. "They want their children to have sound growth, have good jobs and lead a more enjoyable life."

The boys' deaths reflect a systematic failure of children services, Beijing Normal University social welfare expert Wang Zhenyao said on state-run China Central Television. The system lacks shelters, social workers and volunteers, and there is poor communication with those in need, he said.

"That's a blank in China," he said.

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Some gifts fall into the love-it-later category

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NEW YORK (AP) — Have you ever said “thank you” through clenched teeth? The gift in that nicely wrapped box was so not what you wanted: comfy clothes instead of designer duds, or a kitchen gadget instead of a shiny piece of jewelry.


Sometimes, though, the best gifts are the ones you use, and, frankly, most of us probably wear hoodies more than haute couture.













With a closet full of beautiful boots and gravity-defying heels, flat-foot, furry Uggs weren’t at the top of celebrity stylist-designer Rachel Zoe‘s shopping list. They were OK for other people — she might even have suggested them — but she didn’t see them fitting into her closet until someone gave her a pair.


“Once you put them on, you can’t go back,” Zoe says. “In my house, it’s now the family at-home shoe. I wear them all the time. My son has 10 pairs and my husband has 10 pairs.”


Bradford Shellhammer, founder of Fab.com, which sells unusual items like canvas carryalls screen-printed with images of designer handbags, says gifts fit into three categories: the things everyone knows you want, the bad surprises and the amazing things that make you wonder, “How did I live without it?”


A. Mitra Morgan, founder and chief curator of decorative home-goods website Joss & Main, can’t imagine her busy life without the wallet-phone case wristlet her mother gave her last year.


Morgan has almost unlimited access to the pretty things on so many gift lists. Her mother, however, thought her daily necessities were too scattered. She didn’t know it at the time, Morgan admits, but mom was right.


Morgan received another love-it-later gift, this one from her husband. He gave her flat-bottomed pizza scissors.


“Coming from my husband, this was at the level of receiving a vacuum. I thought, ‘Really, this is what we’ve come to?’” Morgan says. “But it’s awesome!”


Christine Frietchen, a shopping expert who is advising TJ Maxx and Marshall’s this year on their gift-giving programs, says a gift is something you wouldn’t get for yourself. And the best way to know you’ve given a successful gift, she says, is if the receiver becomes an evangelist for it.


Adam Glassman, creative director at O, The Oprah magazine, was never at risk of buying the Patagonia fleece sweatpants his brother got for him a few years ago. “Never in my life did I think I’d need sweatpants, but I live in them,” he gushes. “When I come home from work, they are my go-to item. I wear them more than any other clothes in my closet.”


The only gift he might treasure more is the Eddie Bauer silk long johns his other brother gave him, something else he didn’t think he needed or wanted.


“Where was the Tom Ford, the Gucci?” Glassman says with a laugh.


But after a few winters of layering the long johns under his more fashionable pieces, he’s now buying them as gifts for other people.


Shellhammer says friends and family can’t ask for the items offered on Fab.com because the website sells things people don’t know exist. Items such as a shower curtain with a map of Paris (what enthusiastic traveler wouldn’t want one?) or a pug T-shirt for your favorite dog lover. (Shellhammer predicts the Mountain Pug Tee will be a top seller this season. The entire shirt becomes the face of a pug, wrinkles, jowls and all.)


And Shellhammer says it’s OK to be playful and show a little sense of humor when giving a gift. You’d be surprised how many positive comments the website has received about a hedgehog dish brush, he says. “It just gives you that crack of a smile.”


Brian Berger says the Yumaki toothbrush his business partner gave him is a present he’ll always remember — and appreciate. And, it’s something he uses every day.


His partner was trying to make a point as he and Berger recently launched a men’s undergarment and socks business called Mack Weldon that also is courting customers with the idea of “elevated basics,” Berger explains.


Some other gift ideas from the experts:


—Kitchen knives.


—Comfortable earbuds.


—Colorful tights and leggings.


—Berry bowls.


—Miniature flashlights that fit in pockets and purses.


—Pretty soaps.


—Personalized tote bags.


A lot of people do skimp on themselves, especially in a season where they are spending so much money, so an upgrade of something mundane to luxurious — or at least more fun — can be a very thoughtful gift, says gift advisor Frietchen.


“Have you ever had a really nice hairdryer, a REALLY good dryer? You think a hairdryer is a hairdryer until you have a good one in your hand. It can change your life,” Frietchen says.


Gadgets News Headlines – Yahoo! News



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Study finds mammograms lead to unneeded treatment

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Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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