Protests Erupt After Egypt’s Leader Seizes New Power


Tara Todras-Whitehill for The New York Times


Egyptians in central Cairo ran from tear gas during clashes with the police on Friday. Protesters took to the streets in several cities. More Photos »







CAIRO — Protests erupted across Egypt on Friday, as opponents of President Mohamed Morsi clashed with his supporters over a presidential edict that gave him unchecked authority and polarized an already divided nation while raising a specter, the president’s critics charged, of a return to autocracy.  




In an echo of the uprising 22 months ago, thousands of protesters chanted for the downfall of Mr. Morsi’s government in Cairo, while others ransacked the offices of the president’s former party in Suez, Alexandria and other cities.


Mr. Morsi spoke to his supporters in front of the presidential palace here, imploring the public to trust his intentions as he cast himself as a protector of the revolution and a fledgling democracy.


In a speech that was by turns defensive and conciliatory, he ultimately gave no ground to the critics who now were describing him as a pharaoh, in another echo of the insult once reserved for the deposed president, Hosni Mubarak.


“God’s will and elections made me the captain of this ship,” Mr. Morsi said.


The battles that raged on Friday — over power, legitimacy and the mantle of the revolution — posed a sharp challenge not only to Mr. Morsi but also to his opponents, members of secular, leftist and liberal groups whose crippling divisions have stifled their agenda and left them unable to confront the more popular Islamist movement led by the Muslim Brotherhood.


The crisis over his power grab came just days after the Islamist leader won international praise for his pragmatism, including from the United States, for brokering a cease-fire between Hamas and Israel.


On Friday, the State Department expressed muted concern over Mr. Morsi’s decision. “One of the aspirations of the revolution was to ensure that power would not be overly concentrated in the hands of any one person or institution,” said the State Department spokeswoman, Victoria Nuland.


She said, “The current constitutional vacuum in Egypt can only be resolved by the adoption of a constitution that includes checks and balances, and respects fundamental freedoms, individual rights and the rule of law consistent with Egypt’s international commitments.”


But the White House was notably silent after it had earlier this week extolled the emerging relationship between President Obama and Mr. Morsi and credited a series of telephone calls between the two men with helping to mediate the cease-fire in Gaza.


For Mr. Morsi, who seemed to be saying to the nation that it needed to surrender the last checks on his power in order to save democracy from Mubarak-era judges, the challenge was to convince Egyptians that the ends justified his means.


But even as he tried, thousands of protesters marched to condemn his decision. Clashes broke out between the president’s supporters and his critics, and near Tahrir Square, the riot police fired tear gas and bird shot as protesters hurled stones and set fires.


Since Thursday, when Mr. Morsi issued the decree, the president and his supporters have argued that he acted precisely to gain the power to address the complaints of his critics, including the families of protesters killed during the uprising and its aftermath.


By placing his decisions above judicial review, the decree enabled him to replace a public prosecutor who had failed to win convictions against senior officers implicated in the killings of protesters.


The president and his supporters also argued that the decree insulated the Constituent Assembly, which is drafting the constitution, from meddling by Mubarak-era judges.


Since Mr. Mubarak’s ouster, courts have dissolved Parliament, kept a Mubarak loyalist as top prosecutor and disbanded the first Assembly.


But by ending legal appeals, the decree also removed a safety valve for critics who say the Islamist majority is dominating the drafting of the constitution.


Mayy El Sheikh contributed reporting from Cairo, and Helene Cooper from Washington.



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Jessica Simpson Made You Say 'Wow' - And You're Laughing at the President















11/24/2012 at 09:15 AM EST







McKayla Maroney and President Barack Obama


Pete Souza/The White House/Getty


From baby news, to post baby-bodies and a scowl on President Obama, it's been an eclectic week on PEOPLE.com

As always, you've been reacting in droves, telling us what you love, what makes you mad, and what's making you LOL.

Check out the stories with top reactions on the site this week, and keep clicking on the emoticons at the bottom of each story to tell us what you think!

Love Nothing like a newborn baby to make you smile! Readers loved meeting Tamera Mowry-Housley's brand new baby boy, Aden.

Wow Jaws likely dropped over Jessica Simpson's dramatic 60-pound weight loss, which she showed off at an event for her fashion line, the Jessica Simpson Collection. The hot mama worked her post-baby body in jeans and a hot pink blazer, drawing raves from fans.

Angry Guess Taylor Swift fans aren't too fond of One Direction … or vice versa. Amid speculation that Swift is dating Harry Styles, readers clicked their displeasure.

Sad Three teenagers at the same high school who committed suicide in the last two months saddened readers this week. Few details about the students have been released, but school superintendant Dr. Michael Murphy said, "Each incident seems to be in isolation of each other."

LOL On a lighter note, Fab Five gymnast McKayla Maroney perfected her "not impressed" expression at the Olympic Games … and she's brought it all the way to the White House. President Obama mimicked the vault silver medalist's scowl, and regardless of where you stand on the political spectrum, everyone agreed the pic was laugh-out-loud funny.

Check back next week for another must-read roundup, and see what readers are reacting to every day here.

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Program opens door to citizenship for immigrants









Ricardo Sepida gets emotional when he sees his son-in-law in a Navy uniform. Even aircraft carriers make him misty-eyed. There is no better country than the United States, says Sepida, an immigrant from the Philippines.


Yet despite possessing a green card for 40 years, Sepida has never become an American citizen. Life got in the way, as he raised two children, worked a full-time job as a biomedical technician and ran side businesses on the weekends.


"I was so busy at work, I had so many things to do and I'd forget about it," said Sepida, 61, of Sylmar. "I regret it now. I should have done it a long time ago."





Sepida is among the millions of immigrants who are eligible for citizenship but have postponed the milestone, whether because of the $680 fee, a busy schedule or fear of the English and civics exams. In 2011, about 750,000 immigrants applied for naturalization out of the 8.5 million who were eligible.


A $20-million effort is now under way to get more permanent residents to become citizens so they can vote, have access to a wider range of jobs and become fully American. The money for the New Americans Campaign comes from major foundations and is going mainly to nonprofits that have already been doing citizenship work. Two former commissioners of the Immigration and Naturalization Service have signed on as advisors.


"We're going to just grow the number of people who aren't really completely part of the American fabric, who aren't pitching their tent, unless we get them off the sideline and into the game," said Eric Cohen, executive director of the Immigrant Legal Resource Center, which is the campaign's main coordinator.


The campaign is being touted as bipartisan — Doris Meissner and James Ziglar, the two former INS leaders, served under Presidents Clinton and George W. Bush, respectively. Organizers chose to launch the effort after the November presidential election to avoid any association with partisan voter registration drives, Meissner said.


With the growing clout of Latinos and Asian Americans, who voted for Democrat Barack Obama over Republican Mitt Romney by a ratio of nearly three to one, an increase in naturalization rates could have an effect on local and national politics.


Los Angeles is among eight cities targeted by the New Americans drive, which will last three to five years. The cities, which also include Charlotte, Dallas, Detroit, Houston, Miami, New York and San Jose, are home to about 40% of those who qualify for citizenship.


The money will pay for more workshops to help immigrants fill out the 10-page application and prepare for the exams. The New Americans project will also fund outreach efforts like the CitzenshipWorks website, which provides application guidance in English, Spanish, Chinese and Vietnamese.


Separately, U.S. Citizenship and Immigration Services, which processes applications and is a successor agency to INS, has worked with Los Angeles officials to install a "citizenship corner" in each of the city's 73 public libraries.


"It's one of those things where you don't know how good it is unless you experience it," said Phyllis Coven, director of U.S. Citizenship and Immigration Services' Los Angeles office. "It's a great gift, an honor and a privilege to hold a U.S. passport and become a full member of this society."


At the Chinatown library, the most pressing issue is English fluency, said Shan Liang, the branch manager. Elderly Chinese immigrants flock to the library's free English and civics classes, but some have a long way to go before they can answer such questions as, "Why did the colonists fight the British?" The cost can also be an issue for retirees living on a fixed income, Liang said.


"It is an intimidating process. It is quite a lot of questions," said Joyce Noche, head of the citizenship and immigration project at the Asian Pacific American Legal Center, one of the groups conducting workshops under the program. "Our attorneys can't actually answer all the questions themselves. It is not a walk in the park."


Typically, the naturalization process takes about five months from submitting the initial application to reciting an oath of allegiance at a group swearing-in ceremony.


On a recent Saturday morning, Sepida attended a New Americans workshop in North Hills with his wife, Sally, who has been a citizen for decades. Among a group of procrastinators, Sepida stood out.


Tony Lu, who coordinates the CitizenshipWorks project for the Immigration Advocates Network, examined Sepida's permanent resident card. The pale blue document, dating from 1972, was so old that Lu had never seen that version of it. (Most versions are beige or pink; the agency returned to its original green hue in 2010).


Sepida sat down at a computer to work on his application. Others got one-on-one help with pen and paper, leaving with a completed application and free flashcards to practice English vocabulary and civics.


Elizabeth Lopez Perez, 45, who was brought across the Mexican border when she was 2, got her green card more than 25 years ago. As a single mother raising three children, she hardly had a spare moment.


Now, the impediment is the $680 application fee. The former nursing assistant, who has been unemployed for the last six years, hoped to qualify for a fee waiver for low-income applicants.


"Before, I didn't have the time, and I had the money," said Lopez Perez, of North Hills. "Now I have the time, and I don't have the money."


cindy.chang@latimes.com





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Military Analysis: For Israel, Gaza Conflict Is Test for an Iran Confrontation


Menahem Kahana/Agence France-Presse — Getty Images


An Israeli missile is launched from a battery. Officials said their antimissile system shot down 88 percent of all assigned targets.







WASHINGTON — The conflict that ended, for now, in a cease-fire between Hamas and Israel seemed like the latest episode in a periodic showdown. But there was a second, strategic agenda unfolding, according to American and Israeli officials: The exchange was something of a practice run for any future armed confrontation with Iran, featuring improved rockets that can reach Jerusalem and new antimissile systems to counter them.




It is Iran, of course, that most preoccupies Prime Minister Benjamin Netanyahu and President Obama. While disagreeing on tactics, both have made it clear that time is short, probably measured in months, to resolve the standoff over Iran’s nuclear program.


And one key to their war-gaming has been cutting off Iran’s ability to slip next-generation missiles into the Gaza Strip or Lebanon, where they could be launched by Iran’s surrogates, Hamas, Hezbollah and Islamic Jihad, during any crisis over sanctions or an Israeli strike on Iran’s nuclear facilities.


Michael B. Oren, the Israeli ambassador to the United States and a military historian, likened the insertion of Iranian missiles into Gaza to the Cuban missile crisis.


“In the Cuban missile crisis, the U.S. was not confronting Cuba, but rather the Soviet Union,” Mr. Oren said Wednesday, as the cease-fire was declared. “In Operation Pillar of Defense,” the name the Israel Defense Force gave the Gaza operation, “Israel was not confronting Gaza, but Iran.”


It is an imprecise analogy. What the Soviet Union was slipping into Cuba 50 years ago was a nuclear arsenal. In Gaza, the rockets and parts that came from Iran were conventional, and, as the Israelis learned, still have significant accuracy problems. But from one point of view, Israel was using the Gaza battle to learn the capabilities of Hamas and Islamic Jihad — the group that has the closest ties to Iran — as well as to disrupt those links.


Indeed, the first strike in the eight-day conflict between Hamas and Israel arguably took place nearly a month before the fighting began — in Khartoum, the capital of Sudan, as another mysterious explosion in the shadow war with Iran.


A factory said to be producing light arms blew up in spectacular fashion on Oct. 22, and within two days the Sudanese charged that it had been hit by four Israeli warplanes that easily penetrated the country’s airspace. Israelis will not talk about it. But Israeli and American officials maintain that Sudan has long been a prime transit point for smuggling Iranian Fajr rockets, the kind that Hamas launched against Tel Aviv and Jerusalem over recent days.


The missile defense campaign that ensued over Israeli territory is being described as the most intense yet in real combat anywhere — and as having the potential to change warfare in the same way that novel applications of air power in the Spanish Civil War shaped combat in the skies ever since.


Of course, a conflict with Iran, if a last-ditch effort to restart negotiations fails, would look different than what has just occurred. Just weeks before the outbreak in Gaza, the United States and European and Persian Gulf Arab allies were practicing at sea, working on clearing mines that might be dropped in shipping lanes in the Strait of Hormuz.


But in the Israeli and American contingency planning, Israel would face three tiers of threat in a conflict with Iran: the short-range missiles that have been lobbed in this campaign, medium-range rockets fielded by Hezbollah in Lebanon and long-range missiles from Iran.


The last of those three could include the Shahab-3, the missile Israeli and American intelligence believe could someday be fitted with a nuclear weapon if Iran ever succeeded in developing one and — the harder task — shrinking it to fit a warhead.


A United States Army air defense officer said that the American and Israeli militaries were “absolutely learning a lot” from this campaign that may contribute to a more effective “integration of all those tiered systems into a layered approach.”


The goal, and the challenge, is to link short-, medium- and long-range missile defense radar systems and interceptors against the different types of threats that may emerge in the next conflict.


Even so, a historic battle of missile versus missile defense has played out in the skies over Israel, with Israeli officials saying their Iron Dome system shot down 350 incoming rockets — 88 percent of all targets assigned to the missile defense interceptors. Israeli officials declined to specify the number of interceptors on hand to reload their missile-defense batteries.


Before the conflict began, Hamas was estimated to have amassed an arsenal of 10,000 to 12,000 rockets. Israeli officials say their pre-emptive strikes on Hamas rocket depots severely reduced the arsenal of missiles, both those provided by Iran and some built in Gaza on a Syrian design.


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Jake Owen Welcomes a Daughter




Celebrity Baby Blog





11/22/2012 at 08:30 PM ET



Jake Owen Welcomes Daughter Olive Pearl Courtesy Jake Owen


It’s a Thanksgiving baby!


Jake Owen and his wife Lacey welcomed their first child, daughter Olive Pearl Owen, on Thursday, Nov. 22 in Nashville, Tenn., his rep confirms to PEOPLE.


Pearl, as she will be called after Owen’s late godmother, weighed in at 6 lbs., 3 oz. and is 19½ inches long.


“Lacey and I are so excited to start our own family,” Owen, 31, tells PEOPLE. “We are looking forward to teaching Pearl everything we learned from our parents and also learning from her.”


Sharing a photo of his newborn daughter on Twitter, the musician wrote, “Today is the greatest day of my life. Turkey baby!!! Happy Thanksgiving.”

It’s been a whirlwind year for Owen and his wife, 22. After getting engaged on stage in April, the couple wed on the beach in May and announced the pregnancy in July.


– Sarah Michaud with reporting by Julie Dam


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AP PHOTOS: Simple surgery heals blind Indonesians

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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Westside Assembly race is a nail-biter









One contestant in a still-undecided Assembly race has already begun hiring staff "just in case."


His opponent, on the other hand, kept a commitment to go to Hawaii with her mother, on the advice of her political consultant who told her there was "nothing you can do here but wait" until the ballots are counted.


That's how Santa Monica Mayor Richard Bloom and Assemblywoman Betsy Butler, both Democrats, are coping with the uncertainty of not knowing which has won their contest in California's changed political landscape. Political observers say the state may now have more such close races because of redrawn political maps and a new system that allows members of the same party to compete against each other in fall general election races.





The Butler-Bloom race is among a handful of contests the secretary of state's office considers too close to call more than two weeks after the election, so they must sweat it out until county elections officials can finish counting the hundreds of thousands of eligible ballots that couldn't be tallied on election night.


Counties have until Dec. 4 to finish their work and report to the state the final tallies for 53 congressional, 80 Assembly and 20 state Senate races.


"This is the third time I've been in a close race, so I've got more experience than I'd like to have," Bloom, 59, quipped recently, as he continued to hold a thread-like lead over Butler. He lost his first race for the City Council, in 1998, by around 100 votes and squeaked onto this year's fall ballot in a tight four-way primary.


He's been raising money for election consultants to monitor the post-election day ballot processing and has spent time in Sacramento attending orientation sessions for new lawmakers. Bloom also has been — tentatively — hiring staff for what he hopes will be his Capitol and local offices for the 50th Assembly District.


"The timeline is very short, and if everything holds to expectations," Bloom said, "I need to be prepared to assume office" Dec. 3.


Butler, 49, spent the first couple of weeks after the election tending to business in her old district, in Marina del Rey and the South Bay, before deciding to join her mother this week on their annual trip to Hawaii.


"I advised her to go because there is really nothing she can do here but wait," Parke Skelton, Butler's campaign consultant, said this week.


The Butler campaign, the California Democratic Party and Assembly Speaker John A. PĂ©rez (D-Los Angeles), who backed the incumbent, also are sending representatives to keep tabs on the canvassing at the registrar-recorder/county clerk's offices in Norwalk.


But there's little either side can do except watch and wait as scores of county workers painstakingly slog every day — including Thanksgiving and weekends — through the roughly 792,000 ballots left countywide after election night. (No one can say how many remained in the Assembly race; estimates by the campaigns put the number at 15,000 to 40,000.)


Batches of newly processed ballots are tallied every few days and updated results posted on the registrar's website, lavote.net.


By Tuesday a total of about 476,000 ballots had been processed. The latest batch, consisting of about 130,000 ballots, showed Bloom's lead had slipped to just 79 votes, the smallest since he finished election night 212 votes ahead. The current tally is 85,508 for Bloom, 85,429 for Butler. The next update is scheduled for Friday.


Visitors can watch the tallies through a window from the hallway but aren't allowed inside.


Two floors above the computer room, workers sort through the uncounted ballots, which include mail-in votes that arrived before the 8 p.m. election day deadline but not soon enough to be processed for counting that night.


Also being counted are provisional ballots, which were given, for example, to voters who had requested mail ballots but showed up at the polls without them, or whose registration could not be immediately verified or who dropped off their ballots at other precincts. Those must be checked against registration rolls and precinct rosters to be sure no one voted twice.


Other ballots are too damaged or too lightly marked to go through a tabulating machine; each of those is examined and, if valid, "remade" so it can be counted. (The ballots are designed to hide how someone voted to avoid tampering.)


When the counting is done, the losing side can seek a recount but would have to pay for it, with the money refunded only if the outcome changes.


jean.merl@latimes.com





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Israel and Hamas Maintain Cease-Fire, After Push by the U.S. and Egypt





CAIRO — A cease-fire agreed to under intense Egyptian and American pressure between Israel and the Palestinian militant group Hamas to halt eight days of bloody conflict seemed to be holding on Thursday, averting a full-scale Israeli ground invasion of the Gaza Strip without resolving the underlying disputes.




With Israeli forces still massed on the Gaza border, a tentative calm in the fighting descended after the agreement was announced on Wednesday night. Some of the tens of thousands of Israeli reservists called up during the conflagration appeared to be making preparations on Thursday to redeploy away from staging areas along the Gaza border where the Israeli military had mounted a buildup of armor and troops.


The success of the truce will be an early test of how Egypt’s new Islamist government might influence the most intractable conflict in the Middle East.


In southern Israel, the target of more than 1,500 rockets fired from Gaza over the past week, wary residents began to return to routine. But schools within a 25-mile radius of the Palestinian enclave remained closed and thousands of soldiers, mobilized for a possible ground invasion, remained along the Gaza border. The military said that a decision regarding the troop deployment would be made after an assessment of the situation later Thursday.


A rocket alert sounded at the small village of Nativ Haasara near the border with Gaza on Thursday morning, sending residents skeptical from the start about the cease-fire running for shelter. The military said the alert had been a false alarm.


In Gaza, traffic returned to streets that had been deserted, stores and markets opened and workers began the huge task of cleaning up the debris left by days of aerial and naval bombardment. Thousands of Palestinians demonstrated in Gaza in support of the cease-fire as the Hamas leadership emerged from the fighting claiming victory.


Israel Radio said a dozen rockets were fired from Gaza in the first few hours of the cease-fire, but Israeli forces did not respond. In the rival Twitter feeds that offered a cyberspace counterpoint to the exchanges of airstrikes and rockets, the Israel Defense Forces said they had achieved their objectives while the armed Al Qassam Brigades in Gaza said Israeli forces had “raised the white flag.”


After more than a week of nights punctuated by the crash of bombardment and the sound of outgoing missiles, reporters in Gaza said the night had been quiet.


At the same time, Israeli security forces said on Thursday that they detained 55 Palestinian militants in the West Bank after earlier confrontations. The army said the detentions were designed to “continue to maintain order” and to “prevent the infiltration of terrorists into Israeli communities.”


The United States, Israel and Hamas all praised Egypt’s role in brokering the cease-fire as the antagonists pulled back from violence that had killed more than 150 Palestinians and five Israelis over the past week. The deal called for a 24-hour cooling-off period to be followed by talks aimed at resolving at least some of the longstanding grievances between the two sides.


Gazans poured into the streets declaring victory against the far more powerful Israeli military. In Israel, the public reaction was far more subdued. Many residents in the south expressed doubt that the agreement would hold, partly because at least five Palestinian rockets thudded into southern Israel after the cease-fire began.


The one-page memorandum of understanding left the issues that have most inflamed the tensions between the Israelis and the Gazans up for further negotiation. Israel demands long-term border security, including an end to Palestinian missile launching over the border. Hamas wants an end to the Israeli embargo.


The deal demonstrated the pragmatism of Egypt’s new Islamist president, Mohamed Morsi, who balanced public support for Hamas with a determination to preserve the peace with Israel. But it was unclear whether the agreement would be a turning point or merely a lull in the conflict.


The cease-fire deal was reached only through a final American diplomatic push: Secretary of State Hillary Rodham Clinton conferred for hours with Mr. Morsi and the United Nations secretary general, Ban Ki-moon, at the presidential palace here. Hanging over the talks was the Israeli shock at a Tel Aviv bus bombing on Wednesday — praised by Hamas — that recalled past Palestinian uprisings and raised fears of heavy Israeli retaliation. After false hopes the day before, Western and Egyptian diplomats said they had all but given up hope for a quick end to the violence.


David D. Kirkpatrick reported from Cairo, and Jodi Rudoren from Gaza. Reporting was contributed by Fares Akram from Gaza, Isabel Kershner and Ethan Bronner from Jerusalem, Mayy El Sheikh from Cairo, Rick Gladstone from New York, and Alan Cowell from Paris.



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Miranda Lambert Channels Katniss on a Thanksgiving Hunting Spree















11/22/2012 at 09:00 AM EST



The couple who hunts together stays together?

This might just be the holiday philosophy embraced by country lovebirds Blake Shelton and Miranda Lambert who have Tweeted words of praise for one another as they take to the Oklahoma woods for some pre-Thanksgiving sportsmanship.

Tagging her Twitter photos #katnissforever, Lambert posted a photo of herself in camouflage, a bow and binoculars while toting a pink cup. She lyrically Tweeted to her husband, quoting a Waylon Jennings song: "Baby it's time we got back to the basics of love ... first time in the woods this season. & with BS."

Shelton also told PEOPLE Tuesday night at The Voice that his country star wife can more than rock the outdoors-man vibe.

"I'll tell you, we went huntin' a few nights ago and she actually caught a wild hog with a bow and arrow," Shelton praised. "Miranda is the real deal. She doesn't just sing about guns and things like that. She does it. She's a big bow hunter. People don't know that about her."

Her mad skills, Shelton adds, are also sexy.

"It's so impressive to see this hot girl walking out of the house with this bow and arrow and shooting things with it," he said. "I love it. I hope that's what we do again on Thanksgiving."


In addition to her hunting, Lambert also is ready to get her Black Friday on. She's set to open her own store, The Pink Pistol, in Tishomingo, Okla., on Friday.

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Study finds mammograms lead to unneeded treatment

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

___

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

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