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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Gaza ceasefire holds but mistrust runs deep

GAZA/JERUSALEM (Reuters) - A ceasefire between Israel and Hamas held firm on Thursday with scenes of joy among the ruins in Gaza over what Palestinians hailed as a victory, and both sides saying their fingers were still on the trigger.


In the sudden calm, Palestinians who had been under Israeli bombs for eight days poured into Gaza streets for a celebratory rally, walking past wrecked houses and government buildings.


But as a precaution, schools stayed closed in southern Israel, where nerves were jangled by warning sirens - a false alarm, the army said - after a constant rain of rockets during the most serious Israeli-Palestinian fighting in four years.


Israel had launched its strikes last week with a declared aim of ending rocket attacks on its territory from Gaza, ruled by the Islamist militant group Hamas, which denies Israel's right to exist. Hamas had responded with more rockets.


The truce brokered by Egypt's new Islamist leaders, working with the United States, headed off an Israeli invasion of Gaza.


It was the fruit of intensive diplomacy spurred by U.S. President Barack Obama, who sent his secretary of state to Cairo and backed her up with phone calls to Israeli Prime Minister Benjamin Netanyahu and Egyptian President Mohamed Mursi.


Mursi's role in cajoling his Islamist soulmates in Gaza into the U.S.-backed deal with Israel suggested that Washington can find ways to cooperate with the Muslim Brotherhood leader whom Egyptians elected after toppling former U.S. ally Hosni Mubarak, a bulwark of American policy in the Middle East for 30 years.


Mursi, preoccupied with Egypt's economic crisis, cannot afford to tamper with a 1979 peace treaty with Israel, despite its unpopularity with Egyptians, and needs U.S. financial aid.


MORE DEATHS


Despite the quiet on the battlefield, the death toll from the Gaza conflict crept up on both sides.


The body of Mohammed al-Dalu, 25, was recovered from the rubble of a house where nine of his relatives - four children and five women - were killed by an Israeli bomb this week.


That raised to 163 the number of Palestinians killed, more than half of them civilians, including 37 children, during the Israeli onslaught, according to Gaza medical officials.


Nearly 1,400 rockets struck Israel, killing four civilians and two soldiers, including an officer who died on Thursday of wounds sustained the day before, the Israeli army said.


Israel dropped 1,000 times as much explosive on the Gaza Strip as landed on its soil, Defense Minister Ehud Barak said.


Municipal workers in Gaza began cleaning streets and removing the rubble of bombed buildings. Stores opened and people flocked to markets to buy food.


Jubilant crowds celebrated, with most people waving green Hamas flags but some carrying the yellow emblems of the rival Fatah group, led by Western-backed President Mahmoud Abbas.


That marked a rare show of unity five years after Hamas, which won a Palestinian poll in 2006, forcibly wrested Gaza from Fatah, still dominant in the Israeli-occupied West Bank.


Israel began ferrying tanks northwards, away from the border, on transporters. It plans to discharge gradually tens of thousands of reservists called up for a possible Gaza invasion.


But trust between Israel and Hamas remains in short supply and both said they might well have to fight again.


"The battle with the enemy has not ended yet," Abu Ubaida, spokesman of Hamas's armed wing Izz el-Deen Al-Qassam Brigades, said at an event to mourn its acting military chief Ahmed al-Jaabari, whose killing by Israel on November 14 set off this round.


"HANDS ON TRIGGER"


The exiled leader of Hamas, Khaled Meshaal, said in Cairo his Islamist movement would respect the truce, but warned that if Israel violated it "our hands are on the trigger".


Netanyahu said he had agreed to "exhaust this opportunity for an extended truce", but told Israelis a tougher approach might be required in the future.


Facing a national election in two months, he swiftly came under fire from opposition politicians who had rallied to his side during the fighting but now contend he emerged from the conflict with no real gains for Israel.


"You don't settle with terrorism, you defeat it. And unfortunately, a decisive victory has not been achieved and we did not recharge our deterrence," Shaul Mofaz, leader of the main opposition Kadima party, wrote on his Facebook page.


In a speech, Ismail Haniyeh, Hamas's prime minister in Gaza, urged all Palestinian factions to respect the ceasefire and said his government and security services would monitor compliance.


According to a text of the agreement seen by Reuters, both sides should halt all hostilities, with Israel desisting from incursions and targeting of individuals, while all Palestinian factions should cease rocket fire and cross-border attacks.


The deal also provides for easing Israeli curbs on Gaza's residents, but the two sides disagreed on what this meant.


Israeli sources said Israel would not lift a blockade of the enclave it enforced after Hamas won a Palestinian election in 2006, but Meshaal said the deal covered the opening of all of the territory's border crossings with Israel and Egypt.


Israel let dozens of trucks carry supplies into the Palestinian enclave during the fighting. Residents there have long complained that Israeli restrictions blight their economy.


Barak said Hamas, which declared November 22 a national holiday to mark its "victory", had suffered heavy military blows.


"A large part of the mid-range rockets were destroyed. Hamas managed to hit Israel's built-up areas with around a metric tone of explosives, and Gaza targets got around 1,000 metric tonnes," he said.


He dismissed a ceasefire text published by Hamas, saying: "The right to self-defense trumps any piece of paper."


He appeared to confirm, however, a Hamas claim that the Israelis would no longer enforce a no-go zone on the Gaza side of the frontier that the army says has prevented Hamas raids.


(Additional reporting by Noah Browning in Gaza, Ori Lewis, Crispian Balmer and Dan Williams in Jerusalem; Writing by Jeffrey Heller and Alistair Lyon; Editing by Giles Elgood)


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Football: Arsenal agree US$239m Emirates sponsorship deal






LONDON: Arsenal have agreed a 150 million pounds (US$239 million, 185 million euros) extension of their shirt sponsorship agreement with Emirates Airlines, the club announced on Friday.

The lucrative new contract, which runs until the end of the 2018-19 season, will be worth 30 million pounds a year to Arsenal.

"This agreement is a testimony to Arsenal's approach and to the capabilities we have developed in recent years, as well as the strength of our partnership with Emirates," said chief executive Ivan Gazidis.

"The original deal with Emirates was a key facilitator of our move from Highbury (Arsenal's former stadium) and this next phase of our relationship will be just as critical to keep us at the top of the game in England and Europe."

Under the terms of the deal, the Emirati company will continue to hold naming rights for Arsenal's north London stadium until 2028.

Sheikh Ahmed bin Saeed Al Maktoum, the chairman and chief executive of Emirates Airline and Group, said: "Arsenal's strong appeal around the globe and ambitious approach to the game parallel our own approach to business, making them a valuable partner for our brand."

- AFP/de



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Map row: India calls China's action 'unacceptable', hits back

NEW DELHI/BEIJING: India on Friday termed as "unacceptable" China depicting Arunachal Pradesh and Aksai Chin as its territory in maps of the country on their new e-passports, a step that led to retaliatory action by New Delhi.

China sprung the surprise on India when it showed these territories as part of its own in the maps on their new e-passports.

The Indian embassy in Beijing responded by issuing visas to Chinese nationals with a map of India including Arunachal and Aksai Chin as part of its territory.

In India's first official reaction, external affairs minister Salman Khurshid said, "We are not prepared to accept it."

"We, therefore, ensure that our flags of disagreement are put out immediately when something happens. We can do it in an agreeable way or you can do it in a disagreeable way," he told NDTV.

China, on its part, sort of fudged the issue with its foreign ministry spokesperson saying that the matter should be dealt with in a "level headed and rational manner" to avoid "unnecessary disruptions" to people to people exchanges.

"Hope the countries regard it in a cool-headed manner. China would like to maintain communication with other counties to ensure convenience of travel for both Chinese and foreigners", she said in Beijing.

After the Chinese government started issuing new e-passports, carrying pages with watermark Chinese maps including Arunachal and Aksai Chin as its parts, India hit back by issuing visas to Chinese nationals with a map of India including these places as part of its territory.

Earlier also, China had triggered a diplomatic row by issuing stapled visas to residents of Jammu and Kashmir, terming it as a "disputed territory" and denied visas to those hailing from Arunachal Pradesh.

Peeved over this action, India lodged a strong protest with China which subsequently reverted to issuing normal visas to residents of Jammu and Kashmir but without officially admitting that they were doing so.

China's claim to Aksai Chin and Arunachal Pradesh, which shares a 1,030km unfenced border with it, is not new.

In 1962, China and India fought a brief war over Aksai Chin and Arunachal Pradesh, but in 1993 and 1996 the two countries signed agreements to respect the Line of Actual Control (LAC) to maintain peace and tranquility.

Significantly, these developments occur even as a high- level team of Chinese diplomats, for the first time, visited Sikkim in connection with consular issues, which was seen as reconfirmation of Beijing's stance of accepting the state as part of India.

The development comes even as Prime Minister Manmohan Singh met his Chinese counterpart Wen Jiabao on the sidelines of the Asean summit in Cambodia where the two leaders discussed ways to move forward on the vexed boundary issue.

National security adviser Shivshankar Menon is expected to visit Beijing soon for the next round of boundary talks at the level of special representatives with his Chinese counterpart Dai Bingguo.

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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:

Read More..

Shoppers Descend on Black Friday Deals













HERE for Full Coverage of Black Friday


"I'm here because my mom is making me, because she said I couldn't eat any of the Thanksgiving food if I didn't hold her place in line," Alex Horton told ABC News station WLS-TV in Chicago Thursday.


Many critics panned the early start this year, saying it cuts into quality time that should be spent with family and friends.


Chicago resident Claudia Fonseca got creative and took Thanksgiving to go.


"We brought a plate, but that's about it, we've been here since 11 a.m. And that's it," Fonseca told WLS Thursday.


Black Friday makes headlines every year, but not always for the right reason as violence has become linked to the day after Thanksgiving tradition.






Bloomberg via Getty Images













4 Steps to Get the Best Holiday Shopping Deals Watch Video







In Los Angeles, police aren't taking any chances with the LAPD deploying dozens of extra officers around the city to make sure things don't get out of hand.


Ontario Mills shopping mall in Los Angeles opened at midnight last year, but decided to give excited shoppers a two-hour head start to get their hands on the cut-rate deals, especially for electronics.


"This is my first year," Gabriela Mendoza told ABC News station KABC-TV Thursday. "I tried to stay away from this but I've heard it's really exciting so, I'm looking forward to it."


Things have been relatively calmer compared to the incident last year when a woman was accused of unleashing pepper spray on other shoppers in a dash for electronics at Walmart in Los Angeles.


The Black Friday madness kicked off Thursday when a south Sacramento, Calif., Kmart opened its doors at 6 a.m. Thursday. A shopper in a line of people that had formed nearly two hours earlier reportedly threatened to stab the people around him.


At two Kmarts in Indianapolis, police officers were called in after fights broke out among shoppers trying to score vouchers for a 32-inch plasma TV going for less than $200, police told ABC News affiliate RTV6. No injuries or arrest were made.


Stores have taken preventive measures in hopes of shoppers and tempers at ease, where safety is the main concern for everyone involved.


Mall of America has tightened its Black Friday policies and will bar unaccompanied minors from the megamall all day today. After a chair-throwing melee last year after Christmas, which was captured on smartphones and posted online, the mall is taking steps to prevent any repeat.


At the Arden Fair Mall in Sacramento, Calif., security planned to place barricades at the mall entrance to control the crowds and officials planned to double the number of security officers.


ABC News' John Schriffen and Sarah Netter contributed to this report.



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Gaza ceasefire takes hold but mistrust runs deep

GAZA/JERUSALEM (Reuters) - A ceasefire between Israel and Gaza's Hamas rulers took hold on Thursday after eight days of conflict, although deep mistrust on both sides cast doubt on how long the Egyptian-sponsored deal can last.


Quiet reigned on both sides of the frontier overnight and during the morning after a dozen rockets landed in Israel in the initial hours after the truce came into force late on Wednesday. Israeli police said there had been no casualties or damage.


The deal brokered by Egypt's new Islamist government, working with the United States, prevented - at least for the moment - an Israeli invasion of the Palestinian enclave.


Gaza medical officials said 162 Palestinians, more than half of them civilians, including 37 children and 11 women, were killed. Nearly 1,400 rockets were fired into Israel, killing four civilians and a soldier, the Israeli military said.


Israel's defense minister said Israel dropped 1,000 times as much explosive on the Gaza Strip as had landed in Israel.


Municipal workers in Gaza began cleaning streets and removing the rubble of buildings bombed in Israel's air strikes. Stores opened and people flocked to markets to buy food.


"Israel learnt a lesson it will never forget," said 51-year-old Khalil al-Rass from Beach refugee camp in the city of Gaza.


In rocket-hit towns in southern Israel, schools remained closed as a precaution. Nerves were jangled when warning sirens sounded, in what the military quickly said was a false alarm.


Trust was in short supply. The exile leader of Hamas, Khaled Meshaal, said his Islamist movement would respect the truce if Israel did, but would respond to any violations. "If Israel complies, we are compliant. If it does not comply, our hands are on the trigger," he told a news conference in Cairo.


Israeli Prime Minister Benjamin Netanyahu said he had agreed to "exhaust this opportunity for an extended truce", but told his people a tougher approach might be required in the future.


Facing a national election in two months, he swiftly came under fire from opposition politicians who rallied to his side during the fighting but now contend he emerged from the conflict with no real gains for Israel.


"You don't settle with terrorism, you defeat it. And unfortunately, a decisive victory has not been achieved and we did not recharge our deterrence," Shaul Mofaz, leader of the main opposition Kadima party, wrote on his Facebook page.


BLOCKADE


If the truce holds, it will give the 1.7 million Gazans respite from days of air strikes and halt rocket salvoes from militants that have unnerved a million people in southern Israel and reached Tel Aviv and Jerusalem for the first time.


Both sides quickly began offering differing interpretations of the ceasefire, which highlighted the many actual or potential areas of discord.


According to a text of the agreement seen by Reuters, both sides should halt all hostilities, with Israel desisting from incursions and targeting of individuals, while all Palestinian factions should cease rocket fire and cross-border attacks.


The deal also provides for easing Israeli restrictions on Gaza's residents, who live in what British Prime Minister David Cameron has called an "open prison".


The text said procedures for implementing this would be "dealt with after 24 hours from the start of the ceasefire".


Israeli sources said Israel would not lift a blockade of the enclave it enforced after Hamas, which preaches the Jewish state's destruction, won a Palestinian election in 2006.


However, Meshaal said the deal covered the opening of all of the territory's border crossings. "The document stipulates the opening of the crossings, all the crossings, and not just Rafah," he said. Israel, trying to stop Hamas arming itself, controls all entry to Gaza apart from one crossing with Egypt.


Israel let dozens of trucks carry supplies into the Palestinian enclave during the fighting. Residents there have long complained that Israeli restrictions blight their economy.


HAMAS HOLIDAY


Meshaal thanked Egypt for mediating and praised Iran for providing Gazans with financing and arms. "We have come out of this battle with our heads up high," he said, adding that Israel had been defeated and failed in its "adventure".


Israeli Defense Minister Ehud Barak said Hamas had suffered a heavy military blow, including the death of its top commander, killed in an air strike at the start of the operation on November 14 and the deal merely let Hamas surrender while saving face.


"A large part of the mid-range rockets were destroyed. Hamas managed to hit Israel's built-up areas with around a metric tonne of explosives, and Gaza targets got around 1,000 metric tonnes," Barak told Israel Radio.


"So whoever misses what is happening in Gaza does not understand that this entire agreement is a paper bridge for the defeated so that they can explain to their public how they can even show their faces after what they were hit with for a week."


Hamas declared November 22 a national holiday marking "the victory of the resistance". Its spokesman, Sami Abu Zuhri, said: "Resistance has achieved and has imposed a new formula - if you hit Gaza, we will hit Tel Aviv and beyond Tel Aviv.


Some Israelis staged protests against the deal, notably in the southern town of Kiryat Malachi, where three civilians were killed by a rocket from Gaza last week, army radio said.


Interviewed on Israel's Army Radio, Barak dismissed a ceasefire text published by Hamas as "a piece of paper which I don't remember anyone going around with - there's no signature on it".


He appeared to confirm, however, a key Hamas claim that the Israelis would no longer enforce a no-go zone on the Gaza side of the frontier that the army says has prevented Hamas raids:


"If there are no attacks along the border ... then I tell you that there is no problem with them working the farmland on the perimeter up to the fence," Barak said.


But should the Palestinians exploit such measures to breach the truce, Israel would be "free to act," he said, adding: "The right to self-defense trumps any piece of paper."


CAIRO


Egypt, an important U.S. ally now under Islamist leadership, took centre stage in diplomacy to halt the bloodshed. Cairo has walked a fine line between sympathies for Hamas, an offshoot of the Muslim Brotherhood that produced President Mohamed Mursi and much of his government, and preserving its 1979 peace treaty with Israel and its ties with Washington, its main aid donor.


Announcing the agreement in Cairo, Egyptian Foreign Minister Mohamed Kamel Amr said mediation had "resulted in understandings to cease fire, restore calm and halt the bloodshed".


U.S. Secretary of State Hillary Clinton, standing beside Amr, thanked Mursi for peace efforts that showed "responsibility, leadership" in the region.


Gaza erupted in a Middle East already shaken by last year's Arab revolts that toppled several veteran U.S.-backed leaders, including Egypt's Hosni Mubarak, and by a civil war in Syria, where President Bashar al-Assad is fighting for survival.


Israel, the United States and the European Union all classify Hamas as a terrorist organization over its refusal to recognize Israel, renounce violence and accept existing interim Palestinian-Israeli peace deal.


But its stance is popular with many Palestinians and has kept the movement competitive with the secular Fatah movement of President Mahmoud Abbas, who remains in the occupied West Bank after losing Gaza to Hamas in a civil war five years ago.


The ceasefire was forged despite a bus-bomb explosion that wounded 15 Israelis in Tel Aviv on Wednesday and Israeli air strikes that killed 10 people in Gaza. It was the first serious bombing in Israel's commercial capital since 2006. There was no claim of responsibility, though Hamas praised the attack.


Israeli forces detained 55 suspected militants in the West Bank on Thursday, the military said, citing a need to prevent "the infiltration of terrorists into Israeli communities".


(Additional reporting by Noah Browning in Gaza, Ori Lewis, Allyn Fisher-Ilan, Crispian Balmer and Dan Williams in Jerusalem and Marwa Awad, Yasmine Saleh, Shaimaa Fayed and Tom Perry in Cairo; Writing by Jeffrey Heller, Alistair Lyon and David Stamp; Editing by Alastair Macdonald)


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India probes Cadbury for alleged tax evasion






NEW DELHI: India on Thursday accused the local unit of candy giant Cadbury of evading millions of dollars in taxes as the nation seeks to boost revenues and narrow a yawning fiscal gap.

The Directorate General of Central Excise Investigation (DGCEI) has found two cases of alleged tax evasion involving Cadbury India, junior finance minister S.S. Palanimanickam told parliament.

"Two cases of tax evasion by Cadbury India Ltd have been detected by DGCEI during the years 2009-10 to 2012-13," Palanimanickam said in a written statement to parliament.

The government has stepped up its tax collection drive in a bid to raise revenue and reduce a ballooning fiscal deficit.

The minister said one case involved the alleged non-payment by Cadbury of two billion rupees ($36 million) in excise duties - taxes on manufacture of goods - at a plant in the northern state of Himachal Pradesh.

Another case involved a tax demand for 117 million rupees in service taxes and an equal sum as penalty.

Cadbury has already paid 121 million rupees in taxes and another 5.3 million rupees in interest, he said.

Cadbury India, controlled by international snacks maker Mondelez International, said in a statement it was "fully cooperating with the authorities on this enquiry" and had no further comment.

- AFP/de



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Chhath stampede: Two cases filed against Bihar CM

PATNA: Two cases have been filed in separate courts here against Bihar chief minister Nitish Kumar in connection with the stampede on Chhath festival that claimed 17 lives.

While the court of Chief Judicial Magistrate, Patna, has fixed hearing in a case on November 26, the court of First Class Judicial Magistrate, Patna City has posted the hearing for November 30.

A local social worker Kishori Das filed a complaint under various sections of IPC in the court of CJM Patna, Ramakant Yadav naming the CM, his deputy Sushil Kumar Modi and five others in the incident at Adalatghat on November 19 in which 17 people, including 10 women and children lost their lives.

The CJM admitted it and fixed November 26 for the hearing.

The complainant claimed that his wife was among those injured in the incident.

Another social worker Ramji Yogesh filed a case on the stampede in Patna city court against nine persons, including the CM and his deputy.

First Class Judicial Magistrate of Patna city court Prabhakar Jha posted the matter for hearing on November 30.

The complainant had filed the writ under various sections of the IPC in the court of Additional Chief Judicial Magistrate Priti Verma, who transferred the case to the court of first class judicial magistrate.

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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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