Morsi Urged to Retract Edict to Bypass Judges in Egypt

Tara Todras-Whitehill for The New York Times

Protesters lit flares and denounced the edict of President Mohamed Morsi during clashes with riot police officers in front of the high court building in Cairo on Saturday. More Photos »

CAIRO — Egyptian judges rebelled Saturday against an edict by President Mohamed Morsi exempting his decrees from judicial review, denouncing it as an attack on judicial independence and calling for a judges’ strike.

The condemnation came from an array of organizations. The Supreme Council of the Judiciary, a top judicial body, called the decree “an unprecedented attack on judicial independence” and urged the president to rescind it. A major association of judges, the Judges Club, called for a strike by courts across Egypt. The leader of the national lawyers’ association endorsed the strike call.

A judicial strike would be the steepest escalation yet in a political struggle between the country’s new Islamist leaders and the institutions of the old authoritarian government over the drafting of a new constitution. Those tensions have flared since Mr. Morsi announced his decree on Thursday, saying he acted to prevent the courts from dissolving the Constitutional Assembly, as they had dissolved an earlier assembly and the Parliament.

He said his expanded powers, which he announced a day after he won international praise for brokering a cease-fire in Gaza, would last only until the new constitution was ratified.

The judges, all of whom were appointed by Egypt’s ousted strongman, Hosni Mubarak, joined political leaders in opposing the decree. Because the court dissolved the Parliament, the judiciary was the last check on his power, and critics called the decree a step toward autocracy.

State news media reported that judges and prosecutors had already declared a strike in Alexandria, and there were other news reports of planned walkouts in Qulubiya and Beheira, but those could not be confirmed.

There were small street protests outside the court building where the judges met. And a coalition of disparate opposition leaders, including the former United Nations diplomat Mohamed ElBaradei and three other former Egyptian presidential candidates, demanded the cancellation of the decree.

The strike call by the Judges Club, which has been led in recent years by a clique loyal to Mr. Mubarak and opposed to the Islamists, followed a vote at a more representative assembly of about 1,000 of the club’s members. They urged courts to suspend all activities except those vital to citizens, and it was unclear how individual courts might respond.

As the Judges Club met in the High Court building, the small crowd of protesters outside chanted that Egypt’s judges were “a red line.” When another group armed with the flares favored by hard-core soccer fans tried to force their way into the building, the police fired tear gas.

Inside, the Mubarak-appointed chief prosecutor, Abdel Meguid Mahmoud, declared to a crowd of cheering judges that he rejected Mr. Morsi’s attempt to fire him. He called the presidential decree “null and void” and warned of a “systematic campaign against the country’s institutions in general and the judiciary in particular.” Judges in the meeting chanted for the “fall of the regime,” reprising the signature rallying cry of the revolt last year against Mr. Mubarak, but this time against Mr. Morsi.

Khaled Ali, a human rights lawyer, said he had filed one of several lawsuits asking the courts to attempt to overturn Mr. Morsi’s decree.

The coalition of opposition leaders, calling their group the National Salvation Front, declared that it would not negotiate with Mr. Morsi about resolving the crisis until he withdrew his decree. “We will not enter into a dialogue about anything while this constitutional declaration remains intact and in force,” said Amr Moussa, one of the leaders and Mr. Mubarak’s former foreign minister. “We demand that it be withdrawn, and then we can talk.”

What set off the battle was the year-end deadline for the Constitutional Assembly chosen last spring to draft a new constitution. There have been rumors that the Supreme Constitutional Court was poised to dissolve the assembly in a ruling next Sunday. Top courts had already dissolved both an earlier Constitutional Assembly and the Parliament. All three bodies were dominated by Islamists, who have prevailed in elections, and many of the top judges harbor deep fears of an Islamist takeover.

Kareem Fahim, Nevine Ramzy and Mai Ayyad contributed reporting.

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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..

L.A.'s revamped teacher evaluation system getting mixed grades

Third-grade teacher Kelly Vallianos wanted to find an engaging way for her students to learn about measuring perimeters. One idea — to have students design a restaurant floor plan — was too difficult, she feared.

But with the help of colleagues, she found a way to tailor that fifth-grade idea to her younger students at Dominguez Elementary School, who excitedly sketched out an imaginary pizzeria.

Vallianos credits the Los Angeles Unified School District's new teacher evaluation system for sparking deeper and more collaborative conversations with administrators, who she said gave her ideas to make the lesson work.

The district's new performance reviews have come under fire by United Teachers Los Angeles, which opposes the controversial element of using student test scores as one factor in measuring teacher effectiveness.

But largely lost in the debate is the fact that the system's centerpiece is a new classroom observation process that, despite some drawbacks, is being praised by many as a better way to help teachers improve.

"It's a more reflective, much more well-rounded process," said Vallianos, who has been teaching for 19 years.

Teachers are ranked on a scale on instruction, lesson plans, classroom environment and dozens of other criteria. A highly effective teacher, for instance, will be able to intellectually engage all students and prompt them to lead their own discussion topics. An ineffective teacher will generate all questions and most answers, involving just a handful of students.

During observations, administrators type notes into their laptops and later rate each of 61 skills. Principals and other administrators conducting the observations must pass a test to ensure they are fairly and accurately scoring instructors. Conferences with teachers before and after the classroom visits are required.

The method is meant to make observations more useful, uniform and objective, using evidence rather than opinions. But it's an elaborate process and has provoked widespread criticism that it takes too long for principals who are already overwhelmed with increasing workloads. And those who can't type well take even longer, administrators say.

"The technology is creating great difficulty and frustration," said Judith Perez, president of the Associated Administrators of Los Angeles. "It feels like an immense amount of pressure on people without alleviating their workload."

Teachers union President Warren Fletcher agrees that a better system is needed; UTLA has designed its own. He said "the jury is still out" on the district's observation process but added that it shares some common elements with the union's proposal.

The new system also includes evidence of student achievement — which could be in the form of test scores — feedback from students and parents, and the teacher's contributions to the school community.

The new observations were tested last year on a voluntary basis with about 450 teachers and 320 administrators; this year, every principal and one volunteer teacher at each of the district's 1,200 schools are expected to be trained.

Officials have not yet announced when the system will be used for every teacher — or when the ratings will begin to count for decisions on layoffs, tenure or pay. But in a video shown at the training sessions, L.A. Supt. John Deasy made the stakes clear.

"We have perhaps no greater responsibility than assuring that every student in this district is taught by an effective teacher in a school led by an effective leader," he said.

Many educators agree that the current evaluation system — known as Stull for the state law that created it — doesn't promote that goal of top-notch teachers for every student. Criticized as a perfunctory checklist of expectations that doesn't help teachers improve, the system awarded 99.3% of L.A. Unified teachers the highest rating in 2009-10 — even though only 45% of district students that year performed at grade level for reading and 56% were proficient in math.

The new system has given teachers like Lisa Thorne a boost. Thorne, a math teacher at Hamilton High School, said the new process is "unwieldy" but far more helpful in homing in on her strengths and weaknesses.

After the self-evaluation part of the process, Thorne chose to focus on improving her work with small groups of students, prompting her to try such techniques as using a three-dimensional pegboard to teach geometry. And she started a new computer-based class to help struggling ninth-graders master algebra. Administrators had seen her use the techniques with older students during a class visit and were impressed enough to give her the green light, she said.

"I would definitely say the new system is an improvement, because it's more specific about what they're looking for," Thorne said. "It helps to get the conversation going with administrators."

Eduardo Solorzano, principal of San Fernando Middle School, agrees. In particular, he said, the focus on careful note-taking has given him specific examples to use in helping teachers improve.

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Protests Erupt After Egypt’s Leader Seizes New Power

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.  

Maya Alleruzzo/Associated Press

Egyptian protesters chanted antigovernment slogans and waved a national flag in Tahrir Square on Friday.

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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What Made Jessica Biel Want to Steal a Girdle?

Stylewatch
Style News Now

11/21/2012 at 11:00 AM ET

Suzanne Tenner

Her wedding gown was dreamy, pink and modern, but while filming Hitchcock, Jessica Biel found herself taken with her character’s muted — and binding — mid-century costumes.

“I would have stolen that girdle, and pretty much everything that I could have,” the actress joked to PEOPLE at the film’s Los Angeles premiere on Tuesday. “But I literally think that they would have hunted me down.”

In fact, while many actors are free to keep a memento from the project that they have worked on, Biel quickly got the sense that playing Vera Miles would be a labor of love steeped in authenticity — without the benefit of a fashion souvenir.

“Those costumes came from an amazing old costume house, and I really don’t know how many women wore the same costumes [on prior films],” Biel explained. “They have so much history, and they were not allowed to be taken away, so I didn’t actually take anything.”

That’s not to say that the stunning newlywed walked away completely empty-handed; Biel admitted that the experience, while sometimes uncomfortable, altered the way in which she views both fashion and femininity.

“I think every time that I step back into that period and really explore those beautiful, feminine shapes, especially where it’s all about the waist, I try to take that and bring that into my personal fashion and life,” she shared. “I try to do a little bit more of the feminine thing.” Tell us: Do you plan to see Hitchcock?

–Reagan Alexander

PHOTOS: SEE STARS ON SET IN ‘LIGHTS! CAMERA! FASHION!’

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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..

Low-income students get crash course in college preparation

For Sylmar High School senior Thalia Linares, college feels like a long shot.

It's not a lack of motivation that worries her. It's the money and her immigration status.

Linares emigrated from Michoacán, Mexico, when she was 3. Now she's concerned not only that colleges won't accept her because she's undocumented, but that she won't be able to afford the tuition if they do.

So on a recent Friday evening, she skipped going to Venice High School to watch her school's football team in the first round of playoffs and instead attended a five-hour crash course in college preparation.

She and dozens of other Sylmar students, graduates and volunteers packed a classroom for the event hosted by College Summit, a national nonprofit dedicated to increasing the number of low-income students who go to college.

Linares' dark eyes darted frantically between a printed copy of her transcript and the partially completed Cal State Northridge application open on a laptop. It was due in exactly three weeks.

Linares let out a long sigh and caught the eye of 20-year-old Maria Gonzalez, a former College Summit peer mentor who now studies liberal arts at Los Angeles Mission College and helps out with these events.

The senior nodded politely as the friendly stranger talked about application due dates and class requirements. Then Gonzalez said something that grabbed Linares' attention: She, too, had moved from Mexico as a child and was undocumented.

Linares asked Gonzalez if she ever feared she couldn't afford school without access to funding reserved for citizens. "Of course," Gonzalez responded. "But there are so many scholarships out there. If you give me your email address, I'll email you every scholarship I ever applied to."

A smile spread across Linares' face.

For former College Summit peer leaders like Gonzalez and UC Santa Barbara student Alberto Perez, who got his shift covered at work and made the trek down to his alma mater for the event, giving back to this program is a no-brainer.

Each summer a handful of students from Sylmar and 11 other L.A. Unified schools who are considered "better than their numbers" — a reference to their test scores and grades — attend a weekend-long College Summit boot camp at a nearby university. They then return to their campuses as peer mentors and share what they learned with fellow students.

Perez said the days he spent at the University of Redlands in 2010 didn't just hone his focus on college, they changed his life.

During the process of writing his personal statement — each student gets assigned a writing coach at camp — he shared something he'd kept bottled up since childhood: the anger and confusion tied to losing four family members to cancer.

"Once I opened up on this, I figured I could open up about anything," Perez said.

He also credits much of his success to his former College Summit advisor, Laurie Kornblau, who hosted the recent event in her classroom.

Ms. K., as she is known, clad in blue camouflage shorts and a College Summit T-shirt, greeted her former student with a hug and a laugh at how much he'd changed. The once cripplingly shy junior had shown up wearing a sweater adorned with his fraternity's Greek letters.

Kornblau, who calls the peer mentors "dudes" or gives them such nicknames as Bristol, Shenaynay and Loco, teaches both English and courses related to college acceptance.

She said her students have the ability and the desire to become good college students.

"They're all bright and beautiful and should be doing something," she said. "The system's told them they don't deserve it, and the system is wrong."

Between 70% and 80% of the students who take her College Summit class go on to a post-secondary school, Kornblau said, adding proudly that her students fare better than the average Los Angeles Unified School District student. In the 2008-09 school year — the one for which the most up-to-date data are available on the state's Department of Education website — 63% of L.A. Unified graduates enrolled at a post-secondary institution.

Back in Classroom 33, decorated with college pennants and a sign that reads, "I'm going to college," Gonzalez pulled on her coat.

Before she headed out, she rested her hand on Linares' shoulder.

"Email me if you need anything," Gonzalez said.

Linares nodded.

"Promise?" Gonzalez asked.

Linares smiled and said yes.

marisa.gerber@latimes.com

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With Cease-Fire Joy in Gaza, Palestinian Factions Revive Unity Pledges

GAZA — Palestinians erupted in triumphant celebrations here on Thursday, vowing new unity among rival factions and a renewed commitment to the tactic of resistance, while Israel’s leaders sought to soberly sell the achievements of their latest military operation to a domestic audience long skeptical of cease-fire deals like the one announced the night before.

After eight days of intense Israeli shelling from air and sea that killed 162 Gazans, including at least 30 militant commanders, and flattened many government buildings and private homes, people poured onto the bomb-blasted streets, beaming as they shopped and strolled under the shield of the cease-fire agreement reached Wednesday in Cairo. The place was awash in flags, not only the signature green of the ruling Hamas party but also the yellow, black and red of rivals Fatah, Islamic Jihad and the Popular Front for the Liberation of Palestine, a rainbow not visible here in years.

Despite the death and destruction, Hamas emerged emboldened, analysts said, not only because it had landed rockets near Tel Aviv and Jerusalem, but also from the unprecedented visits and support by Arab and Muslim leaders, potentially resetting the balance of power and tone in Palestinian politics, as leaders from various factions declared the peace process dead.

“The blood of Jabari united the people of the nation on the choice of jihad and resistance,” Ismail Haniya, the Hamas prime minister, declared in a televised speech, referring to the commander Ahmed al-Jabari, killed in an Israeli airstrike at the beginning of the operation last week. “Resistance is the shortest way to liberate Palestine.”

There were neither celebrations nor significant protests across the border in Israel, where people in southern cities passed the first day in more than a week without constant sirens signaling incoming rockets sending them to safe rooms. Instead, an uneasy, even grim calm set in. The military announced that an officer, Lt. Boris Yarmulnik, 28, had died from wounds sustained in a rocket attack the day before, bringing the death toll on the Israeli side to six, four of them civilians. The Israeli authorities announced several arrests, including of an Arab Israeli citizen, in a bus bombing in Tel Aviv on Wednesday that revived memories of the violence from the last Palestinian uprising.

But there was collective relief in Israel as thousands of army reservists, sent to the Gaza border ahead of a possible ground invasion, gradually began returning home. With national elections eight weeks away, Israeli politicians tried to showcase accomplishments without raising expectations.

“It could last nine months or it could last nine weeks,” Defense Minister Ehud Barak said of the cease-fire. “When it does not last, we will know what to do. We see clearheadedly the possibility that we will have to do this again.”

And so it went on the day after the latest round in the decades-old Israeli-Palestinian conflict. What was widely heralded as a game changer by Palestinian politicians and independent analysts alike was viewed by Israeli officials and commentators as a maintenance mission that had succeeded in its stated goals: restoring quiet after months of intensifying rocket fire, and culling the weapons cache of Gaza’s armed groups.

Details of the cease-fire agreement announced Wednesday by Secretary of State Hillary Rodham Clinton and the Egyptian foreign minister remained unclear. Both sides pledged to stop the violence, and Palestinians say Israel will loosen its restrictions on fishing off Gaza’s Mediterranean coastline and farming along its northern and eastern borders. But the critical question of whether the border crossings would be open wide for people and commerce was not fully addressed, with only a vague promise that discussions would ensue after 24 hours. The exact agenda, time, location and even participants in these discussions have not been announced.

At the same time, Mustafa Barghouti, a West Bank leader who has spent the past several days in Gaza, said the Palestinian factions had agreed to meet in Cairo for another round of unity talks in the next few days, as President Mahmoud Abbas of the Palestinian Authority prepares to take his case for observer-state status to the United Nations next week. Though Hamas and Fatah, the party Mr. Abbas leads, have signed four reconciliation agreements in the five years since Hamas took control of Gaza after winning elections here, Mr. Barghouti said this time was different.

“Hamas is stronger, of course, and Abbas is having to change his line because negotiations failed,” he said after appearing with Mr. Haniya at a rally. “This time Israel felt the heat of the Arab Spring, and Gaza was not isolated; the whole Arab world was here. The road is open for unity.”

First, though, Hamas faces an enormous rebuilding effort, with at least 10 of its government buildings — including the ministries of culture, education and interior; the prime minister’s headquarters; and police stations — now reduced to rubble littered with payroll sheets and property tax rolls. A spokesman said that the government kept most records on laptops, but the Abu Khadra, a huge complex of constituent services, is gone.

Dr. Hassan Khalaf, director of Al Shifa Hospital, which was not attacked, dismissed the worry. “We can gather under the sky under a tent,” he said. “They can come to my house.”

In Jerusalem, Dan Meridor, a senior minister of intelligence and atomic energy, told reporters that Israel had “used force in a very moderate and measured way.” He said the military had struck 10 times the number of targets compared with the previous government’s invasion of Gaza four years ago but killed far fewer people than during that invasion: slightly over 10 percent. One of the main military achievements, he said, was the destruction of most of the long-range Iranian Fajr-5 missiles in Gaza.

Jodi Rudoren reported from Gaza, and Isabel Kershner from Jerusalem. Fares Akram contributed reporting from Gaza, and Tamir Elterman from Sderot, Israel.

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Jake Owen Welcomes a Daughter

Mom & Babies
Celebrity Baby Blog

11/22/2012 at 08:30 PM ET

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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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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