Protests Erupt After Egypt’s Leader Seizes New Power


Tara Todras-Whitehill for The New York Times


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







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




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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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



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Michelle Obama and Daughters Welcome Christmas Tree at White House















11/24/2012 at 10:15 AM EST



'Tis the season!

Michelle Obama and daughters Malia, 14, and Sasha, 11 – assisted by their not-so-little helper Bo Obama – welcomed a Christmas tree to the White House on Friday.

The 19-ft. Fraser fir from Peak Farms in Jefferson, N.C., arrived on a red and green wagon drawn by two Clydesdale horses while the Marine Band played the classic carol "Oh Christmas Tree."

How festive!

According to tradition, the tree will be displayed in the White House's Blue Room and the First Lady will select and supervise the decorating.

After sampling the scent of the tree's needles, Ms. Obama reportedly gave a thumbs-up and told onlookers, "It's a go."

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AP PHOTOS: Simple surgery heals blind Indonesians

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

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

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

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

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

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

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

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

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

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Wall Street Week Ahead: Political wrangling to pinch market's nerves

NEW YORK (Reuters) - Volatility is the name of this game.


With the S&P 500 above 1,400 following five days of gains, traders will be hard pressed not to cash in on the advance at the first sign of trouble during negotiations over tax hikes and spending cuts that resume next week in Washington.


President Barack Obama and U.S. congressional leaders are expected to discuss ways to reduce the budget deficit and avoid the "fiscal cliff" of automatic tax increases and spending cuts in 2013 that could tip the economy into recession.


As politicians make their case, markets could react with wild swings.


The CBOE Volatility Index <.vix>, known as the VIX, Wall Street's favorite barometer of market anxiety that usually moves in an inverse relationship with the S&P 500, is in a long-term decline with its 200-day moving average at its lowest in five years. The VIX could spike if dealings in Washington begin to stall.


"If the fiscal cliff happens, a lot of major assets will be down on a short-term basis because of the fear factor and the chaos factor," said Yu-Dee Chang, chief trader and sole principal of ACE Investments in Virginia.


"So whatever you are in, you're going to lose some money unless you go long the VIX and short the market. The 'upside risk' there is some kind of grand bargain, and then the market goes crazy."


He set the chances of the economy going over the cliff at only about 5 percent.


Many in the market agree there will be some sort of agreement that will fuel a rally, but the road there will be full of political landmines as Democrats and Republicans dig in on positions defended during the recent election.


Liberals want tax increases on the wealthiest Americans while protecting progressive advances in healthcare, while conservatives make a case for deep cuts in programs for the poor and a widening of the tax base to raise revenues without lifting tax rates.


"Both parties will raise the stakes and the pressure on the opposing side, so the market is going to feel much more concerned," said Tim Leach, chief investment officer of U.S. Bank Wealth Management in San Francisco.


"The administration feels really confident at this point, or a little more than the Republican side of Congress may feel," he said. "But it's still a balanced-power Congress so neither side can feel that they can act with impunity."


THE MIDDLE EAST AND EUROPE


Tension in the Middle East and unresolved talks in Europe over aid for Greece could add to the uncertainty and volatility on Wall Street could surge, analysts say.


An Egypt-brokered ceasefire between Israel and Hamas came into force late on Wednesday after a week of conflict, but it was broken with the shooting of a Palestinian man by Israeli soldiers, according to Palestine's foreign minister.


Buoyed by accolades from around the world for mediating the truce, Egyptian President Mohamed Mursi assumed sweeping powers, angering his opponents and prompting violent clashes in central Cairo and other cities on Friday.


"Those kinds of potential large-scale conflicts can certainly overwhelm some of the fundamental data here at home," said U.S. Bank's Leach.


"We are trying to keep in mind the idea that there are a lot of factors that are probably going to contribute to higher volatility."


On a brighter note for markets, Greece's finance minister said the International Monetary Fund has relaxed its debt-cutting target for Greece and a gap of only $13 billion remains to be filled for a vital aid installment to be paid.


Still, a deal has not been struck, and Greece is increasingly frustrated at its lenders, still squabbling over a deal to unlock fresh aid even though Athens has pushed through unpopular austerity cuts.


HOUSING DATA COULD CONFIRM RECOVERY


Next week is heavy on economic data, especially on the housing front. Some of the numbers have been affected by Superstorm Sandy, which hit the U.S. East Coast more than three weeks ago, killing more than 100 people in the United States alone and leaving billions of dollars in damages.


The housing data, though, could continue to confirm a rebound in the sector that is seen as a necessary step to unlock spending and lower the stubbornly high unemployment rate.


Tuesday's S&P/Case-Shiller home price index for September is expected to show the eighth straight month of increases, extending the longest continuous string of gains since prices were boosted by a homebuyer tax credit in 2009 and 2010.


New home sales for October, due on Wednesday, and October pending home sales data, due on Thursday, are also expected to show a stronger housing market.


Other data highlights next week include durable goods orders for October and consumer confidence for November on Tuesday and the Chicago Purchasing Managers Index on Friday.


At Friday's close, the S&P 500 wrapped up its second-best week of the year with a 3.6 percent gain. Encouraging economic data next week could confirm that regardless of the ups and downs that the fiscal cliff could bring, the market's fundamentals are solid.


Jeff Morris, head of U.S. equities at Standard Life Investments in Boston, said that "it's kind of noise here" in terms of whether the market has spent "a few days up or down. It has made some solid gains over the course of the year as the housing recovery has come into view, and that's what's underpinning the market at these levels.


"I would caution against reading too much into the next few days."


(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: rodrigo.campos(at)thomsonreuters.com)


(Reporting by Rodrigo Campos; Editing by Tim Dobbyn and Jan Paschal)


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


Menahem Kahana/Agence France-Presse — Getty Images


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







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




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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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Tom Cruise Reunites with Suri for Thanksgiving















11/23/2012 at 10:00 AM EST







Suri and Tom Cruise in January 2012


Sharpshooter Images/Splash News Online


Tom Cruise has a very special reason to be thankful this holiday.

After more than three months apart from his 6-year-old daughter Suri – the pair were last together on Aug. 5 after a week-long vacation – the actor, 50, welcomed his little girl to London earlier this week.

"He's super excited" about the visit, a source tells PEOPLE.

Mom Katie Holmes spent Thanksgiving in Toledo, Ohio, with the rest of the tight-knit Holmes clan. The actress, 33, had the day off from her Broadway comedy Dead Accounts.

For Cruise, the long-awaited reunion was especially sweet. Based in London since mid-August, where he is deep in pre-production for the sci-fi action film All You Need Is Kill, the actor has been struggling to cope with the distance between them since Holmes filed for divorce in June and was awarded primary custody of the couple's only child.

Although Cruise has been "heartbroken" by the situation, as his friend Christopher McQuarrie recently told PEOPLE, he and Suri have been speaking by phone daily. And sources on both sides have said that both Cruise and Holmes are continuing to try to work things out amicably. "They are all about co-parenting," a Holmes pal said in September.

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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..

Wall Street rises on Greece deal hopes, retailers gain

NEW YORK (Reuters) - Wall Street rose on Friday on signs of progress in talks about releasing aid to Greece and as investors bid up retail shares on hopes consumers will scoop up bargains on Black Friday, which heralds the start of the holiday shopping season.


U.S. equity market trading will end early at 1:00 pm ET (1800 GMT) after closing Thursday for the Thanksgiving holiday. With many investors on holiday, trade volume got off to a slow start.


Greece said the International Monetary Fund had relaxed its debt-cutting target for the country, suggesting lenders were closer to a deal for a vital aid tranche to be paid. But other sources involved in the talks cautioned the funding gap was far bigger than Greece has suggested.


Euro zone finance ministers, the IMF and European Central Bank (ECB) failed earlier this week to agree on how to get the country's debt down to a sustainable level and will have a third attempt at resolving the issue on Monday.


"Anything positive out of Europe related to the sovereign debt ... that can act as a catalyst," said Todd Salamone, director of research at Schaeffer's Investment Research in Cincinnati, Ohio.


The S&P 500 looked likely to break a two-week losing streak, having gained more than 3 percent this week so far. Stocks had tumbled earlier in the month on worries about the impact of tax and spending changes to take effect from January, but hopes that politicians will reach a deal to avert the so-called fiscal cliff helped the market recoup some of those declines this week.


The index also broke back above the 1,400 level, which could provide support.


The Dow Jones industrial average <.dji> gained 112.71 points, or 0.88 percent, to 12,949.60. The Standard & Poor's 500 Index <.spx> rose 12.34 points, or 0.89 percent, to 1,403.37. The Nasdaq Composite Index <.ixic> climbed 30.32 points, or 1.04 percent, to 2,956.88.


The retail sector rose as investors looked for signs of how much consumers are spending as stores lured them with Black Friday deals and discounts.


Black Friday, the day after Thanksgiving, kicks off the U.S. Christmas shopping season for retailers and is often the busiest shopping day of the year. The National Retail Federation expects sales during the holiday season to grow 4.1 percent this year.


Shares of electronics retailer Best Buy Co were up 1.6 percent at $11.76, while J C Penney gained 1.6 percent to $17.53.


Big-name technology companies also climbed as investors added to positions on a day of thin trading.


Microsoft helped lift the Nasdaq, gaining 1.7 percent to $27.41, while Oracle rose 1.2 percent to $30.76.


"Anyone that was on the sidelines waiting for a pullback like the one we just had in some of the tech names, they're looking for any glimpse of strong price action for permission to enter into those (stocks)," said Salamone.


Research in Motion surged on optimism about its soon-to-be-launched BlackBerry 10 devices that will vie against Apple's iPhone and Android-based smartphones. RIM was up 12 percent at $11.49.


(Editing by Bernadette Baum)


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





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




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


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


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


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


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


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


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


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


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


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


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


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


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


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



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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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