WHO: Slight cancer risk after Japan nuke accident


LONDON (AP) — Two years after Japan's nuclear plant disaster, an international team of experts said Thursday that residents of areas hit by the highest doses of radiation face an increased cancer risk so small it probably won't be detectable.


In fact, experts calculated that increase at about 1 extra percentage point added to a Japanese infant's lifetime cancer risk.


"The additional risk is quite small and will probably be hidden by the noise of other (cancer) risks like people's lifestyle choices and statistical fluctuations," said Richard Wakeford of the University of Manchester, one of the authors of the report. "It's more important not to start smoking than having been in Fukushima."


The report was issued by the World Health Organization, which asked scientists to study the health effects of the disaster in Fukushima, a rural farming region.


On March 11, 2011, an earthquake and tsunami knocked out the Fukushima plant's power and cooling systems, causing meltdowns in three reactors and spewing radiation into the surrounding air, soil and water. The most exposed populations were directly under the plumes of radiation in the most affected communities in Fukushima, which is about 150 miles (240 kilometers) north of Tokyo.


In the report, the highest increases in risk are for people exposed as babies to radiation in the most heavily affected areas. Normally in Japan, the lifetime risk of developing cancer of an organ is about 41 percent for men and 29 percent for women. The new report said that for infants in the most heavily exposed areas, the radiation from Fukushima would add about 1 percentage point to those numbers.


Experts had been particularly worried about a spike in thyroid cancer, since radioactive iodine released in nuclear accidents is absorbed by the thyroid, especially in children. After the Chernobyl disaster, about 6,000 children exposed to radiation later developed thyroid cancer because many drank contaminated milk after the accident.


In Japan, dairy radiation levels were closely monitored, but children are not big milk drinkers there.


The WHO report estimated that women exposed as infants to the most radiation after the Fukushima accident would have a 70 percent higher chance of getting thyroid cancer in their lifetimes. But thyroid cancer is extremely rare and one of the most treatable cancers when caught early. A woman's normal lifetime risk of developing it is about 0.75 percent. That number would rise by 0.5 under the calculated increase for women who got the highest radiation doses as infants.


Wakeford said the increase may be so small it will probably not be observable.


For people beyond the most directly affected areas of Fukushima, Wakeford said the projected cancer risk from the radiation dropped dramatically. "The risks to everyone else were just infinitesimal."


David Brenner of Columbia University in New York, an expert on radiation-induced cancers, said that although the risk to individuals is tiny outside the most contaminated areas, some cancers might still result, at least in theory. But they'd be too rare to be detectable in overall cancer rates, he said.


Brenner said the numerical risk estimates in the WHO report were not surprising. He also said they should be considered imprecise because of the difficulty in determining risk from low doses of radiation. He was not connected with the WHO report.


Some experts said it was surprising that any increase in cancer was even predicted.


"On the basis of the radiation doses people have received, there is no reason to think there would be an increase in cancer in the next 50 years," said Wade Allison, an emeritus professor of physics at Oxford University, who also had no role in developing the new report. "The very small increase in cancers means that it's even less than the risk of crossing the road," he said.


WHO acknowledged in its report that it relied on some assumptions that may have resulted in an overestimate of the radiation dose in the general population.


Gerry Thomas, a professor of molecular pathology at Imperial College London, accused the United Nations health agency of hyping the cancer risk.


"It's understandable that WHO wants to err on the side of caution, but telling the Japanese about a barely significant personal risk may not be helpful," she said.


Thomas said the WHO report used inflated estimates of radiation doses and didn't properly take into account Japan's quick evacuation of people from Fukushima.


"This will fuel fears in Japan that could be more dangerous than the physical effects of radiation," she said, noting that people living under stress have higher rates of heart problems, suicide and mental illness.


In Japan, Norio Kanno, the chief of Iitate village, in one of the regions hardest hit by the disaster, harshly criticized the WHO report on Japanese public television channel NHK, describing it as "totally hypothetical."


Many people who remain in Fukushima still fear long-term health risks from the radiation, and some refuse to let their children play outside or eat locally grown food.


Some restrictions have been lifted on a 12-mile (20-kilometer) zone around the nuclear plant. But large sections of land in the area remain off-limits. Many residents aren't expected to be able to return to their homes for years.


Kanno accused the report's authors of exaggerating the cancer risk and stoking fear among residents.


"I'm enraged," he said.


___


Mari Yamaguchi in Tokyo and AP Science Writer Malcolm Ritter in New York contributed to this report.


__


Online:


WHO report: http://bit.ly/YDCXcb


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Sequestration: Surrender Is in the Air












The budget ax is about to fall, and there's little lawmakers in Washington are doing to stop it.


Despite a parade of dire warnings from the White House, an $85 billion package of deep automatic spending cuts appears poised to take effect at the stroke of midnight on Friday.


The cuts – known in Washington-speak as the sequester – will hit every federal budget, from defense to education, and even the president's own staff.


On Capitol Hill, Senate Democrats and Republicans each staged votes Thursday aimed at substituting the indiscriminate across-the-board cuts with more sensible ones. Democrats also called for including new tax revenue in the mix. Both measures failed.


Lleaders on both sides publicly conceded that the effort was largely for show, with little chance the opposing chamber would embrace the other's plan. They will discuss their differences with President Obama at the White House on Friday.


"It isn't a plan at all, it's a gimmick," Senate Minority Leader Mitch McConnell, R-Ky., said today of the Democrats' legislation.


"Republicans call the plan flexibility" in how the cuts are made, said Senate Majority Leader Harry Reid. "Let's call it what it is. It is a punt."


The budget crisis is the product of a longstanding failure of Congress and the White House to compromise on plans for deficit reduction. The sequester itself, enacted in late 2011, was intended to be so unpalatable as to help force a deal.








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Republicans and Democrats, however, remain gridlocked over the issue of taxes.


Obama has mandated that any steps to offset the automatic cuts must include new tax revenue through the elimination of loopholes and deductions. House Speaker John Boehner and the GOP insist the approach should be spending cuts-only, modifying the package to make it more reasonable.


"Do we want to close loopholes? We sure do. But if we are going to do tax reform, it should focus on creating jobs, not funding more government," House Speaker John Boehner said, explaining his opposition to Obama's plan.


Boehner, McConnell, Reid and House Minority Leader Nancy Pelosi will huddle with Obama at the White House on Friday for the first face-to-face meeting of the group this year.


"There are no preconditions to a meeting like this," White House spokesman Jay Carney said today. "The immediate purpose of the meeting is to discuss the imminent sequester deadline and to avert it."


Even if the leaders reach a deal, there's almost no chance a compromise could be enacted before the deadline. Lawmakers are expected to recess later today for a long weekend in their districts.


What will be the short-term impact of the automatic cuts?


Officials say it will be a gradual, "rolling impact" with limited visible impact across the country in the first few weeks that the cuts are allowed to stand.


Over the long term, however, the Congressional Budget Office and independent economic analysts have warned sequester could lead to economic contraction and possibly a recession.


"This is going to be a big hit on the economy," Obama said Wednesday night.


"It means that you have fewer customers with money in their pockets ready to buy your goods and services. It means that the global economy will be weaker," he said. "And the worst part of it is, it's entirely unnecessary."


Both sides say that if the cuts take effect, the next best chance for a resolution could come next month when the parties need to enact a new federal budget. Government funding runs out on March 27, raising the specter of a federal shutdown if they still can't reach a deal.


"As we anticipate an across-the-board budget cuts across our land, we still expect to see your goodness prevail, O God, " Senate Chaplain Barry Black prayed on the Senate floor this morning, "and save us from ourselves."



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Basketball: Knicks withstand Curry's 54 points to beat Warriors






NEW YORK: The New York Knicks withstood a dazzling 54-point display from Golden State's Stephen Curry on Wednesday to post a 109-105 NBA victory over the Warriors at Madison Square Garden.

Curry's points total was the highest in the league this season, surpassing the 52 of Oklahoma City's Kevin Durant against Dallas last month.

But his individual effort was not enough against a Knicks team that received 35 points from Carmelo Anthony and 26 off the bench from JR Smith.

Tyson Chandler contributed 16 points for New York and grabbed a career-best 28 rebounds.

Curry and the Warriors nearly claimed the victory despite the absence of David Lee, serving a one-game suspension for his role in an altercation with the Pacers' Roy Hibbert at Indiana on Tuesday that included several players and saw the shoving match spill into the spectator area behind the basket.

Curry made 11 of his 13 attempts from three-point range, one short of the league single-game record. He added seven assists and six rebounds.

Carl Landry scored 15 points and Jarrett Jack chipped in 14 for the Warriors.

Curry became the first player to score at least 50 points at Madison Square Garden since LeBron James did it with the Cavaliers in 2009.

He scored or assisted on Golden State's last 20 points. By then the New York crowd was cheering him, but the Knicks held the Warriors scoreless for the last two minutes of the contest.

After Raymond Felton denied Curry's jump shot with 1:28 remaining and the score knotted at 105-105, New York's Smith made a jump shot that gave the Knicks the lead for good.

"We closed out," Knicks coach Mike Woodson said. "We made the defensive stops we had to make coming down the stretch.

"We made plays, but boy, you've got to tip your hat to Curry. He played great."

- AFP/fa



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Assembly polls: Left Front heads for landslide victory in Tripura

AGARTALA: In a virtual status quo, the ruling formations were ahead and appeared to be romping back to power in the assembly elections in Tripura, Nagaland and Meghalaya where counting of votes was taken up on Thursday.

Tripura's ruling Communist Party of India-Marxist (CPI-M) led Left Front was Thursday heading for a landslide victory and seemed set to retain power for a fifth straight term.

TRIPURA

PARTY LEADS WINS
CONGRESS 6 1
CPM 36 10
CPI 0 0
Revolutionary Socialist Party 2 0
Others 1 0

MEGHALAYA

PARTY LEADS WINS
CONGRESS 24 1
UDP 4 0
NCP 2 0
National People's Party 2 0
Hill state People's
Democratic party
4
0
Others 11 0

NAGALAND

PARTY LEADS WINS
CONGRESS 4 1
Janata Dal(United) 1 0
NPF 14 13
NCP 5 0
Rashtriya Janata Dal 1 0
Others 6 0

The Left Front government is set to come back to power for the fifth consecutive term in Tripura with leader of the coalition CPM leading in 32 of the 60 seats while its ally CPI was ahead in one.

Congress was a poor second leading only in four seats and others in one in the trends available so far.

In Meghalaya, the ruling Congress-UDP coalition is ahead in 14 of the 60 seats. Congress was ahead in 9 and its alliance partner UDP in 5.

Nagaland also continued with the same trend of favouring the ruling combination.

The Naga Peoples Front (NPF) was ahead in 15 seats while the Congress was ahead in 4, JD(U) 1 and others 2 in the 60-member assembly.

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Medicare paid $5.1B for poor nursing home care


SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.


The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.


One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.


By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.


Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.


"These findings raise concerns about what Medicare is paying for," the report said.


Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.


In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.


In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.


The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.


That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.


Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.


In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.


"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."


CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.


Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.


"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.


Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.


"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."


Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.


Investigators found the homes didn't always do what was needed to ensure a smooth transition.


In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.


___


On the Web:


The OIG report: http://1.usa.gov/VaztQm


The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1


___


Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.


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Arias Prosecutor Too Combative, Experts Say












He has barked, yelled, been sarcastic and demanded answers from accused murderer Jodi Arias this week.


And in doing so, prosecutor Juan Martinez and his aggressive antics may be turning off the jury he is hoping to convince that Arias killed her ex-boyfriend Travis Alexander in June 2008, experts told ABCNews.com today.


"Martinez is his own worst enemy," Mel McDonald, a prominent Phoenix defense attorney and former judge, told ABC News. "He takes it to the point where it's ad nauseam. You have difficulty recognizing when he's driving the point home because he's always angry and pushy and pacing around the courtroom. He loses the effectiveness, rather than build it up."


"He's like a rabid dog and believes you've got to go to everybody's throat," he said.


"If they convict her and give her death, they do it in spite of Juan, not because of him," McDonald added.


Martinez's needling style was on display again today as he pestered Arias to admit that she willingly participated in kinky sex with Alexander, though she previously testified that she only succumbed to his erotic fantasies to please him.


Arias, now 32, and Alexander, who was 27 at the time of his death, dated for a year and continued to sleep together for another year following their break-up.


Arias drove to his house in Mesa, Ariz., in June 2008, had sex with him, they took nude photos together and she killed him in his shower. She claims it was in self-defense. If convicted, Arias could face the death penalty.








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Martinez also attempted to point out inconsistencies in her story of the killing, bickering with her over details about her journey from Yreka, Calif., to Mesa, Ariz., including why she borrowed gas cans from an ex-boyfriend, when she allegedly took naps and got lost while driving, and why she spontaneously decided to visit Alexander at his home in Mesa for a sexual liaison.


"I want to know what you're talking about," Arias said to Martinez at one point.


"No, I'm asking you," he yelled.


Later, he bellowed, "Am I asking you if you're telling the truth?"


"I don't know," Arias said, firing back at him. "Are you?"


During three days of cross examining Arias this week, Martinez has spent hours going back and forth with the defendant over word choice, her memory, and her answers to his questions.


"Everyone who takes witness stand for defense is an enemy," McDonald said. "He prides himself on being able to work by rarely referring to his notes, but what he's giving up in that is that there's so much time he wastes on stupid comments. A lot of what I've heard is utterly objectionable."


Martinez's behavior has spurred frequent objections of "witness badgering" from Arias' attorney Kirk Nurmi, who at one point Tuesday stood up in court and appealed to the judge to have a conference with all of the attorneys before questioning continued. Judge Sherry Stephens at one point admonished Martinez and Arias for speaking over one another.


Andy Hill, a former spokesperson for the Phoenix police department, and Steven Pitt, a forensic psychiatrist who has testified as an expert witness at many trials in the Phoenix area, both said that despite his aggressive style, Martinez would likely succeed in obtaining a guilty verdict.


"When it comes to cross examination, one size does not fit all," said Pitt. "But if you set aside the incessant sparring, what the prosecutor I believe is effectively doing is pointing out the various inconsistencies in the defendant's version of events."






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Iran upbeat on nuclear talks, West still wary


ALMATY (Reuters) - Iran was upbeat on Wednesday after talks with world powers about its nuclear work ended with an agreement to meet again, but Western officials said it had yet to take concrete steps to ease their fears about its atomic ambitions.


Rapid progress was unlikely with Iran's presidential election, due in June, raising domestic political tensions, diplomats and analysts had said ahead of the February 26-27 meeting in the Kazakh city of Almaty, the first in eight months.


The United States, China, France, Russia, Britain and Germany offered modest sanctions relief in return for Iran curbing its most sensitive nuclear work but made clear that they expected no immediate breakthrough.


In an attempt to make their proposals more palatable to Iran, the six powers appeared to have softened previous demands somewhat, for example regarding their requirement that the Islamic state ship out its stockpile of higher-grade uranium.


Iran's chief nuclear negotiator Saeed Jalili said the powers had tried to "get closer to our viewpoint", which he said was positive.


In Paris, U.S. Secretary of State John Kerry commented that the talks had been "useful" and that a serious engagement by Iran could lead to a comprehensive deal in a decade-old dispute that has threatened to trigger a new Middle East war.


Iran's foreign minister said in Vienna he was "very confident" an agreement could be reached and Jalili, the chief negotiator, said he believed the Almaty meeting could be a "turning point".


However, one diplomat said Iranian officials at the negotiations appeared to be suggesting that they were opening new avenues, but it was not clear if this was really the case.


Iran expert Dina Esfandiary of the International Institute for Strategic Studies said: "Everyone is saying Iran was more positive and portrayed the talks as a win."


"I reckon the reason for that is that they are saving face internally while buying time with the West until after the elections," she said.


The two sides agreed to hold expert-level talks in Istanbul on March 18 to discuss the powers' proposals, and return to Almaty for political discussions on April 5-6, when Western diplomats made clear they wanted to see a substantive response from Iran.


"Iran knows what it needs to do, the president has made clear his determination to implement his policy that Iran will not have a nuclear weapon," Kerry said.


A senior U.S. official in Almaty said, "What we care about at the end is concrete results."


ISRAELI WARNING


Israel, assumed to be the Middle East's only nuclear-armed power, was watching the talks closely. It has strongly hinted it might attack Iran if diplomacy and sanctions fail to ensure that it cannot build a nuclear weapon. Iran denies any such aim.


Israeli Prime Minister Benjamin Netanyahu said economic sanctions were failing and urged the international community to threaten Iran with military action.


Western officials said the offer presented by the six powers included an easing of a ban on trade in gold and other precious metals, and a relaxation of an import embargo on Iranian petrochemical products. They gave no further details.


In exchange, a senior U.S. official said, Iran would among other things have to suspend uranium enrichment to a fissile concentration of 20 percent at its Fordow underground facility and "constrain the ability to quickly resume operations there".


The official did not describe what was being asked of Iran as a "shutdown" of the plant as Western diplomats had said in previous meetings with Iran last year.


Iran says it has a sovereign right to enrich uranium for peaceful purposes, and wants to fuel nuclear power plants so that it can export more oil.


But 20-percent purity is far higher than that needed for nuclear power, and rings alarm bells abroad because it is only a short technical step away from weapons-grade uranium. Iran says it produces higher-grade uranium to fuel a research reactor.


Iran's growing stockpile of 20-percent-enriched uranium is already more than half-way to a "red line" that Israel has made clear it would consider sufficient for a bomb.


In Vienna on Wednesday, a senior U.N. nuclear agency official told diplomats in a closed-door briefing that Iran was technically ready to sharply increase this higher-grade enrichment, two Western diplomats said.


"Iran can triple 20 percent production in the blink of an eye," one of the diplomats said.


The U.S. official in Almaty said the powers' latest proposal would "significantly restrict the accumulation of near-20-percent enriched uranium in Iran, while enabling the Iranians to produce sufficient fuel" for their Tehran medical reactor.


This appeared to be a softening of a previous demand that Iran ship out its stockpile of higher-grade enriched uranium, which it says it needs to produce medical isotopes.


Iran has often indicated that 20-percent enrichment could be up for negotiation if it received the fuel from abroad instead.


Jalili suggested Iran could discuss the issue, although he appeared to rule out shutting down Fordow. He said the powers had not made that specific demand.


The Iranian rial, which has lost more than half its foreign exchange value in the last year as sanctions bite, rose some 2 percent on Wednesday, currency tracking websites reported.


(Additional reporting by Fredrik Dahl and Yeganeh Torbati in Almaty, Georgina Prodhan in Vienna, Zahra Hosseinian in Zurich, Gabriela Baczynska in Moscow, Dan Williams in Jerusalem and Marcus George in Dubai; Writing by Timothy Heritage and Fredrik Dahl; Editing by Louise Ireland)



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Ferrari goes up in flames at Teban Gardens






SINGAPORE: A red Ferrari went up in flames near Teban Gardens Road on Wednesday.

A Channel NewsAsia viewer was having his lunch at a coffee shop in the vicinity when he heard an explosion.

According to the viewer, the red Ferrari had stopped in front of block 54 Teban Gardens Road, along Penjuru Road.

The Chinese male driver had gotten out of the car before the explosion.

The driver did not appear to have been injured.

The Singapore Civil Defence Force (SCDF) arrived five minutes later and put out the fire.

SCDF confirmed that there were no reported injuries and that no other vehicle was involved in the incident.

The cause of the fire is being investigated.

- CNA/ck



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Chuck Hagel's remarks against India 'bizarre': BJP

NEW DELHI: Terming as "outlandish and bizarre" the statement of Chuck Hagel, the new US defence secretary, that India has financed problems for Pakistan in Afghanistan, BJP on Wednesday asked the government to exert diplomatic pressure on Washington for unconditional withdrawal of his statement.

The statement given by Hagel that India has financed problems in Pakistan is "outlandish, bizarre and baseless," BJP spokesperson Rajiv Pratap Rudy said.

He also expressed surprise over Hagel giving a clean to Pakistan, which has harboured in the backyard of its military base al-Qaida chief Osama Bin Laden, who was responsible for killing of more than 5000 Americans in the World Trade Centre attack.

"BJP is concerned at the indifference of the Indian government by not reacting to Hagel. BJP demands that government of India uses its diplomatic pressure to see that Mr Chuck Hagel retracts his statement unconditionally," Rudy said.

Hagel had made the remarks during a speech at Oklahoma's Cameron University in 2011, which has surfaced now.

"India for some time has always used Afghanistan as a second front, and India has over the years financed problems for Pakistan on that side of the border," the former Republican Senator had said.

His remarks are considered in sharp contrast to viewpoint of Obama Administration that has always been in praise of India's developmental role in Afghanistan and in fact has been pressing New Delhi to do more in Afghanistan.

Reacting to this, the Indian Embassy in Washington had said, "Such comments attributed to Senator Hagel, who has been a long-standing friend of India and a prominent votary of close India-US relations, are contrary to the reality of India's unbounded dedication to the welfare of Afghan people".

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Advanced breast cancer edges up in younger women


CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.


The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.


Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.


It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.


"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.


Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.


Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.


Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.


There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.


Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.


Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.


"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."


The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.


The study was published Tuesday in the Journal of the American Medical Association.


About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.


Routine screening with mammograms is recommended for older women but not those younger than 40.


Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.


He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."


Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.


The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.


Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.


"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."


Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.


Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.


"It changed the complete course of my life," she said. "But it's still a good life."


____


Online:


JAMA: http://jama.ama-assn.org


CDC: http://www.cdc.gov/cancer/breast/index.htm


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