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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Global shares gain as global economic outlook improves

LONDON (Reuters) - World share markets extended a week-long rally on Thursday as manufacturing surveys in China and the United States boosted confidence in global growth and euro zone data at least did not worsen the already weak outlook for that region.


The euro hit a three high against the dollar on optimism that a funding deal for debt-crippled Greece will ultimately be agreed - and despite data indicating the region's economy is on course for its deepest recession since early 2009.


"The driving factors behind euro/dollar are that the global macroeconomic backdrop seems to be improving and people are pricing out the tail risk on Greece," said Arne Lohmann Rasmussen, head of currency research at Danske Bank.


The euro rose 0.4 percent to $1.2880, its highest since November 2.


The view there will be a deal to help Athens was bolstered on Wednesday when German Chancellor Angela Merkel said after the failure of the latest talks, that an agreement was possible when euro zone ministers meet again on Monday.


The hopes for a Greek deal, combined with the better economic data and a growing view that a solution can be found to the U.S. fiscal crisis, lifted the MSCI world equity index 0.4 percent to 326 points, putting it on track for its best week since mid-September.


Europe's FTSE Eurofirst 300 index rose 0.4 percent to a two-week high of 1,101.70 points, with London's FTSE 100, Paris's CAC-40 and Frankfurt's DAX between 0.3 and 0.7 percent higher.


However, trading was subdued, with U.S. markets closed for the Thanksgiving holiday.


CHINA BOOST


Confidence in the global economic outlook got its biggest boost from the HSBC flash Manufacturing Purchasing Managers Index (PMI) for China, which pointed to an expansion in activity after seven consecutive quarters of slowdown.


The Chinese data followed a report on Wednesday showing U.S. manufacturing grew in November at its quickest pace in five months, indicating strong economic growth in the fourth quarter.


"There are questions over whether the Chinese economy is really that bad or if the U.S. will take a long time to recover, but we are getting signs that the situation is not as bad as assumed," said Peter Braendle, head of European equities at Zurich-based Swisscanto Asset Management.


PMI data on the manufacturing and services sectors in Europe's two biggest economies, Germany and France, added to the better tone, revealing that conditions had not worsened in November, though both economies are still contracting.


However, the PMI numbers for the wider euro zone remain extremely weak, pointing to the recession-hit region shrinking by about 0.5 percent in the current quarter - its sharpest contraction since the first quarter of 2009.


"The weak PMI outturn for November is a major disappointment in light of the increases in the German and French PMI surveys, and suggest the recession on the euro zone's periphery is gathering further pace," said ING economist Martin van Vliet.


BOND DEMAND


In the fixed-income markets, the improving tone enabled Spain to sell 3.88 billion euros ($4.97 billion) of new government bonds on Thursday, even though it has already raised enough funds for this year's needs.


The average yield on the three-year bonds in the auction was 3.617 percent, compared with 3.66 percent at a sale earlier in November and a 2012 average of 3.79 percent.


Ten-year Spanish yields were 6 basis points lower on the day at 5.67 percent, having traded above 6 percent at the start of the week.


"It's a clear reflection that sentiment in Spain has improved markedly," RIA Capital Markets bond strategist Nick Stamenkovic said, adding that the market was expecting Madrid to ask for an international bailout early next year.


Expectations Greece will soon get more cash set Greek yields on course for their 10th consecutive daily fall. The February 2023 bond yield dropped to 16.16 percent, its lowest since it was issued during a debt restructuring in March.


COMMODITIES STEADY


Commodity prices had some support from the improving outlook for world demand, but the prospect of only modest global growth in 2013 kept the gains in check.


Three-month copper on the London Metal Exchange rose 0.6 percent to $7,735.25 a metric tonne, and spot gold inched up to $1,730.30 an ounce.


Oil prices were more mixed as the ceasefire between Israel and Gaza's Hamas rulers on Thursday eased concerns over the impact the unrest might have had on supply from the region, offsetting support from the prospect of more Chinese oil demand.


Brent slipped 7 cents to $110.90 a barrel, while U.S. crude was up 2 cents at $87.40.


($1 = 0.7801 euros)


(Additional reporting by Jessica Mortimer and Marius Zaharia; Editing by Will Waterman and Alastair Macdonald)


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Egypt announces Hamas-Israel ceasefire

CAIRO/GAZA (Reuters) - Israel and the Islamist Hamas movement agreed on Wednesday to an Egyptian-sponsored ceasefire to halt an eight-day conflict around the Gaza Strip that has killed more than 140 Palestinians and five Israelis.


Announcing the ceasefire in Cairo, Egyptian Foreign Minister Mohamed Kamel Amr said it would come into force at 9 p.m. (15:00 EDT) - which would give 1.7 million Palestinians respite from days of ferocious air strikes and halt rocket attacks from Gaza that for the first time reached Tel Aviv and Jerusalem.


A flurry of explosions shook the city of Gaza as the truce deadline approached and several rockets landed in the southern Israeli city of Beersheba.


Amr said mediation efforts had "resulted in understandings to cease fire, restore calm and halt the bloodshed".


U.S. Secretary of State Hillary Clinton, standing alongside him, thanked Egypt's new Islamist President Mohamed Mursi for his peace efforts, saying his government was assuming "responsibility, leadership" in the region.


Israeli Prime Minister Benjamin Netanyahu told U.S. President Barack Obama he was ready to give the ceasefire a chance, but that "more forceful action" might be needed if it failed, according to a statement from his office.


Obama in turn reiterated his country's commitment to Israel's security and pledged to seek funds for a joint missile defense program, the White House said.


Senior Hamas lawmaker Ahmed Bahar said Israel had "submitted to the conditions and demands set by the resistance" and he hailed the outcome as a triumph.


"Resistance achieved a historical victory against the occupation and laid the foundation for the battle of liberation of the full land and sacred sites," Bahar, deputy speaker of the Palestinian parliament, said in a statement from his office.


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 rejects the Jewish state's right to exist, won a Palestinian election in 2006.


BUS BLAST


The ceasefire was forged despite a bus bomb explosion that wounded 15 Israelis in Tel Aviv earlier in the day and despite more Israeli air strikes that killed 10 Gazans.


The Tel Aviv blast, near the Israeli Defence Ministry, touched off celebratory gunfire from militants in Gaza and had threatened to complicate truce efforts. It was the first serious bombing in Israel's commercial capital since 2006.


In Gaza, Israel struck more than 100 targets, including a cluster of Hamas government buildings. Medical officials said a two-year-old boy was among the dead.


Israel has carried out more than 1,500 strikes since the offensive began with the killing of a top Hamas commander and with the declared aim of deterring Hamas from launching rocket attacks that have long disrupted life in southern Israeli towns.


Medical officials in Gaza said 146 Palestinians, more than half of them civilians, including 36 children, have been killed in Israel's offensive. Nearly 1,400 rockets have been fired into Israel, killing four civilians and a soldier, the military said.


Egypt, a longstanding U.S. ally now under Islamist leadership after last year's overthrow of Hosni Mubarak, took center stage in diplomatic efforts to halt the carnage, using its privileged ability to speak directly to both sides.


"This is a critical moment for the region," Clinton said. "Egypt's new government is assuming the responsibility and leadership that has long made this country a cornerstone for regional stability and peace."


She also pledged to work with partners in the region "to consolidate this progress, improve conditions for the people of Gaza, provide security for the people of Israel".


Egypt has walked a fine line between its sympathies for Hamas, an offshoot of the Muslim Brotherhood to which Mursi belongs, and its need to preserve its 1979 peace treaty with Israel and its ties with Washington, its main aid donor.


"Egypt calls on all to monitor the implementation of what has been agreed under Egypt's sponsorship and to guarantee the commitment of all the parties to what has been agreed," its foreign minister said at the news conference in Cairo.


Israel, the top recipient of U.S. assistance, agreed to stop fighting after having gathered troops and armor on the border with Gaza in preparation for a high-risk ground assault.


Netanyahu, in his conversation with Obama, "agreed to his recommendation to give the Egyptian ceasefire proposal a chance, and in this way provide an opportunity to stabilize the situation and calm it before any more forceful action would be necessary", an Israeli statement said.


(Additional reporting by Ori Lewis and Crispian Balmer in Jerusalem, Yasmine Saleh and Shaimaa Fayed in Cairo and Margaret Chadbourn in Washington; Editing by Alastair Macdonald)


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Harley Pasternak: 5 Ways to Avoid Blowing Your Diet on Thanksgiving






Only on People.com








11/21/2012 at 01:10 PM EST







Harley Pasternak and Jessica Simpson


John Sciulli/BEImages


Celebrity trainer and PEOPLE.com blogger Harley Pasternak give his top 5 tips for a healthy, happy Thanksgiving. Plus, he shares some holiday recipes from some of his star clients like Jessica Simpson and Megan Fox.

Turkey, stuffing, corn bread, cranberry sauce, apple pie, sweet potatoes with marshmallow topping: Thanksgiving has gone from being a day when we give thanks for everything we have, to a day when we EAT everything we have!

Studies show that people can eat between 3,000 to 4,500 calories on Thanksgiving alone, which is, of course, a lot more than necessary on a generally sedentary day.

While I completely support treating yourself on Thanksgiving, I encourage you to be at least somewhat mindful about what you consume. Studies show that people tend to gain 5 to 7 lbs. between Thanksgiving and Christmas. And I don't want your health and fitness goals to be set back because of what's supposed to be a joyous holiday.

Let this Thanksgiving be the first one in which the turkey – and not you – is the thing getting stuffed!

5 Tips for Making Thanksgiving Healthier

1. Walk it out!
The morning of Thanksgiving, go for a brisk walk. If you're traveling to Thanksgiving dinner, park your car a few blocks away and walk the extra distance. After dinner, get some fresh air and walk around the block. Before you know it, you will have taken a few extra thousand steps, burned off your dessert and helped your digestion!

2. Eat a healthy breakfast and lunch
Filling up on "good calories" on Thanksgiving is key in controlling your appetite come dinnertime. Showing up ravenous to Thanksgiving dinner is never a good idea.

3. Exercise portion control
I know some think this is Thanksgiving sacrilege, but honestly portion control is the name of the game. First, start with a smaller plate. Smaller plates equal smaller portions. Next, follow the 3:2:1 rule: 3 parts veggies, 2 parts protein, 1 part whole grains.

4. Lose the booze!
Not only is alcohol almost twice as calorically dense as carbohydrates and protein, but your body stops burning fat as efficiently when you drink!

5. Take your time
I always say, life's too short not to enjoy yourself on special days, and Thanksgiving dinner is definitely one of them! So go ahead and cut yourself a piece of mom's pecan pie – but instead of shoveling it in your mouth, slow down and enjoy each bite.

Try Some of My Clients' Thanksgiving Recipes

Jessica Simpson's Broccoli Rice Casserole
The truth is that my client Jessica Simpson – who is looking amazing these days! – loves using Cheese Whiz. But I modified her recipe and substituted real light cheddar cheese to make this holiday casserole more healthy.

Ingredients
• 2 (10 ounce) boxes frozen chopped broccoli, thawed
• 2 cups cooked rice
• 8 ounces shredded lite cheddar cheese
• 2 (10¾ ounce) cans cream of chicken soup. Or you use 1 can each of cream of chicken and cream of mushroom soup
• 1 small onion, chopped
• 2 tablespoons of olive oil

Directions
• Cook onion in oil in a large skillet until soft.
• Add remaining ingredients and cook just until cheese is melted.
• Put in 2 quart casserole dish.
• Bake at 350 (uncovered) for 1 hour.

To make ahead and freeze: Mix all ingredients together (start with your rice cooked, not raw) and spoon into two or even three smaller casserole dishes, cover, label and freeze. If you thaw overnight, just cook for one hour. If cooking from frozen state, add 10 minutes or so, check for doneness.
Serves 6

Megan Fox's 'Healthy' Pumpkin Pie
Ingredients
• 1 (15 ounce) can of pumpkin
• 8 ounces of skim milk or 8 ounces low-fat soymilk
• 3 egg whites
• ½ reduced fat graham cracker crust (Take off the sides of the crust and discard)
• 1 cup agave
• pumpkin pie spice
• 2 egg whites, for the crust

Directions
• Preheat oven to 425°F.
• Mix pumpkin, milk and egg whites until smooth.
• Gradually stir in agave.
• Add the pumpkin pie spice; taste and add more if needed.
• Pour into crust and spread evenly.
• Bake in the oven for 15 minutes then reduce the temperature to 350°F and bake for another 45 minutes (may vary depending on ovens).
• Let cool and serve
Makes 8 servings

Jordana Brewster's Healthy Stuffing
Ingredients
• 1 tablespoon of olive oil
• 14 ounces of stuffing bread (such as Pepperidge Farm
or Mrs. Cubbisons)
• ½ cup chopped onion
• ½ cup diced celery
• ½ cup diced carrots
• ½ cup diced mushroom
• 2-3 cloves of garlic
• 2- 2½ cup chicken broth
• Poultry seasoning to taste (I usually use 1-2 tsp)
• Pepper to taste around 1 tsp

Directions
• Preheat oven to 350 degrees.
• Heat a large sauté pan. Once heated, add oil and spray with cooking spray.
• Add carrots and saute. Add celery, onion, garlic and mushroom add additional cooking spray. If needed, continue cooking until veggies are tender.
• Remove from heat, transfer to bowl and allow to cool slightly.
• In a large bowl add bread stuffing and veggies. Toss together and season with pepper and poultry seasoning.
• Add chicken broth and mix until moist, but not soaking. Taste and adjust seasoning as necessary.
• Spray casserole dish with cooking spray and add stuffing mix.
• Cover with foil and bake 20-25 minutes. Uncover and cook additional 10 minutes or until slightly crispy on top.
Makes around 16 servings

Have a healthy Thanksgiving recipe? Tweet me at @harleypasternak or leave a comment below!

Check back every Wednesday for more insider tips from celebrity trainer Harley Pasternak on Hollywood's hottest bodies – and learn how to get one yourself! Plus: follow Harley on Twitter at @harleypasternak

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US abortions fall 5 pct, biggest drop in a decade

NEW YORK (AP) — U.S. abortions fell 5 percent during the recession and its aftermath in the biggest one-year decrease in at least a decade, perhaps because women are more careful to use birth control when times are tough, researchers say.

The decline, detailed on Wednesday by the Centers for Disease Control and Prevention, came in 2009, the most recent year for which statistics are available. Both the number of abortions and the abortion rate dropped by the same percentage.

Some experts theorize that some women believed they couldn't afford to get pregnant.

"They stick to straight and narrow ... and they are more careful about birth control," said Elizabeth Ananat, a Duke University assistant professor of public policy and economics who has researched abortions.

While many states have aggressively restricted access to abortion, most of those laws were adopted in the past two years and are not believed to have played a role in the decline.

Abortions have been dropping slightly over much of the past decade. But before this latest report, they seemed to have pretty much leveled off.

Nearly all states report abortion numbers to the federal government, but it's voluntary. A few states — including California, which has the largest population and largest number of abortion providers — don't send in data. While experts estimate there are more than 1 million abortions nationwide each year, the CDC counted about 785,000 in 2009 because of incomplete reporting.

To come up with reliable year-to-year comparisons, the CDC used the numbers from 43 states and two cities — those that have been sending in data consistently for at least 10 years. The researchers found that abortions per 1,000 women of child-bearing age fell from about 16 in 2008 to roughly 15 in 2009. That translates to nearly 38,000 fewer abortions in one year.

Mississippi had the lowest abortion rate, at 4 per 1,000 women of child-bearing age. The state also had only a couple of abortion providers and has the nation's highest teen birth rate. New York, second to California in number of abortion providers, had the highest abortion rate, roughly eight times Mississippi's.

Nationally since 2000, the number of reported abortions has dropped overall by about 6 percent and the abortion rate has fallen 7 percent.

By all accounts, contraception is playing a role in lowering the numbers.

Some experts cite a government study released earlier this year suggesting that about 60 percent of teenage girls who have sex use the most effective kinds of contraception, including the pill and patch. That's up from the mid-1990s, when fewer than half were using the best kinds.

Experts also pointed to the growing use of IUDs, or intrauterine devices, T-shaped plastic sperm-killers that a doctor inserts into the uterus. A study released earlier this year by the Guttmacher Institute, a nonprofit organization that does research on reproductive health, showed that IUD use among sexually active women on birth control rose from less than 3 percent in 2002 to more than 8 percent in 2009.

IUDs essentially prevent "user error," said Rachel Jones, a Guttmacher researcher.

Ananat said another factor may be the growing use of the morning-after pill, a form of emergency contraception that has been increasingly easier to get. It came onto the market in 1999 and in 2006 was approved for non-prescription sale to women 18 and older. In 2009 that was lowered to 17.

Underlying all this may be the economy, which was in recession from December 2007 until June 2009. Even well afterward, polls showed most Americans remained worried about anemic hiring, a depressed housing market and other problems.

You might think a bad economy would lead to more abortions by women who are struggling. However, John Santelli, a Columbia University professor of population and family health, said: "The economy seems to be having a fundamental effect on pregnancies, not abortions."

More findings from the CDC:

— The majority of abortions are performed by the eighth week of pregnancy, when the fetus is about the size of a lima bean.

— White women had the lowest abortion rate, at about 8.5 per 1,000 women of child-bearing age; the rate for black women was about four times that. The rate for Hispanic women was about 19 per 1,000.

— About 85 percent of those who got abortions were unmarried.

— The CDC identified 12 abortion-related deaths in 2009.

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Wall Street rises after Gaza truce in thin holiday trade

NEW YORK (Reuters) - Stocks advanced on Wednesday after a ceasefire was declared to end the flare-up in violence between Israel and the Palestinians, though the lack of a deal to release aid to Greece kept a lid on gains.


Investors also remained anxious about the tax increases and spending cuts that are poised to come into effect in the new year - known as the "fiscal cliff" - though policymakers are not expected to get back to negotiations until after Thursday's Thanksgiving holiday.


Trading volume was light ahead of Thursday's market holiday. The stock market also will close early at 1 p.m. (1800 GMT) on Friday.


Greece's international lenders failed again to reach a deal to release emergency aid to the debt-saddled country. Lenders will try again next Monday, but Germany signaled that significant divisions remain.


A truce between Israel and Hamas gave stocks some support around midday after Egypt announced a ceasefire will come into effect later in the day.


Fears that the fiscal cliff discussions in Washington could be drawn out or yield no resolution have been at the forefront of investors' minds in recent weeks. Combined with concerns over the euro zone's continued debt problems, the worries had taken more than 5 percent off the S&P 500 since Election Day in early November.


Positive comments from U.S. politicians that they will work to find common ground have helped the S&P 500 recoup some of that loss in recent sessions.


"I think the focus is heavy on what are we doing about fiscal cliff," said Kurt Brunner, portfolio manager at Swarthmore Group in Philadelphia.


"Are these guys talking? Are there going to be substantive decisions made?"


St Jude Medical shares tumbled 13.3 percent to $30.96 after an inspection report from health regulators raised new safety concerns about one of the company's leads that are used with implantable defibrillators, analysts said.


A small gain in International Business Machines helped the Dow outperform the other indexes. IBM was up 0.7 percent at $190.47.


The Dow Jones industrial average <.dji> added 49.35 points, or 0.39 percent, to 12,837.86. The Standard & Poor's 500 Index <.spx> edged up 2.62 points, or 0.19 percent, to 1,390.43. The Nasdaq Composite Index <.ixic> gained 8.28 points, or 0.28 percent, to 2,924.96.


Salesforce.com Inc jumped 7.6 percent to $157.03 after the business software provider beat Wall Street's expectations for the third quarter and maintained its outlook for the rest of the year.


But Deere & Co dragged on the S&P 500 after the world's largest farm equipment maker reported a weaker-than-expected quarterly profit. Its stock lost 4 percent to $82.52.


The market did not derive much direction from the day's economic data, with initial jobless claims falling last week, as expected.


Other data showed manufacturing picked up at its quickest pace in five months in November, while consumer sentiment improved only slightly.


The focus will likely turn to retailers on Friday as analysts try to assess how strong the holiday shopping season will be this year, Brunner said. Holiday shopping traditionally kicks off the day after Thanksgiving, known as Black Friday, as stores offer deals and discounts to lure consumers.


(Editing by Jan Paschal)


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Hamas says Gaza truce agreed; Israel, Egypt say no deal yet

GAZA/JERUSALEM (Reuters) - A Hamas official said Egyptian mediators had clinched a truce with Israel on Tuesday that would go into effect within hours, but Egypt and Israel said a Gaza ceasefire deal was still up in the air after a week of fighting.


"The talks are still continuing," an Egyptian official, who declined to be identified, told Reuters. He said Cairo was hopeful of an agreement later in the day.


Israel pressed on with its strikes in Gaza on the seventh day of its offensive and Palestinian rockets still flashed across the border as U.S. Secretary of State Hillary Clinton headed to the region after attending an Asian summit.


The Jewish state launched the campaign last week with the declared aim of halting the rocketing of its towns from the Palestinian enclave, ruled by the Hamas militant group that does not recognize Israel's right to exist.


Medical officials in Gaza said 21 Palestinians were killed on Tuesday. An Israeli soldier and a civilian died when rockets exploded near the Gaza frontier, police and the army said.


Gaza medical officials say 130 people have died in Israeli strikes, mostly civilians, including 31 children. In all, five Israelis have died, including three civilians killed last week.


Clinton was due to meet Prime Minister Benjamin Netanyahu late on Tuesday in Jerusalem. Earlier, he said that Israel was open to a long-term deal aimed at ending Palestinian rocket attacks that have plagued its southern region for years.


Khaled Meshaal, exile leader of Hamas, said on Monday that Israel must halt its military action and lift its blockade of the Palestinian coastal enclave in exchange for a truce.


Both Netanyahu, favored to win a January national election, and U.S. President Barack Obama have said they want a diplomatic solution, rather than a possible Israeli ground operation in the densely populated territory, home to 1.7 million Palestinians.


Speaking to Reuters from Cairo, where intensive efforts have been under way to end the violence, Hamas official Ayman Taha said "an agreement for calm has been reached".


He said it would be declared at 9 p.m. (15:00 EDT) - though no deal was announced as the clock ticked past that hour - and take effect at midnight (18:00 EDT).


Netanyahu spokesman Mark Regev told Reuters that Taha's announcement was premature and Israeli military operations in Gaza would continue in parallel with diplomacy: "We're not there yet," Regev said on CNN. "The ball's still in play."


Hamas spokesman Sami Abu Zuhri, speaking after Taha made his remarks, said the group was still waiting to hear whether Israel would accept the terms of a deal: "Cairo informed us they expect the response to be positive," Abu Zuhri said.


Israel's military on Tuesday targeted about 100 sites in Gaza, including ammunition stores and the Gaza headquarters of the National Islamic Bank.


Israeli police said more than 150 rockets were fired from Gaza by the evening.


"No country would tolerate rocket attacks against its cities and against its civilians. Israel cannot tolerate such attacks," Netanyahu said with U.N. Secretary-General Ban Ki-moon, who arrived in Jerusalem from talks in Cairo, at his side.


"If a long-term solution can be put in place through diplomatic means, then Israel would be a willing partner to such a solution," he said. "But if stronger military action proves necessary to stop the constant barrage of rockets, Israel will do what is necessary to defend our people."


HAMAS TARGETS JERUSALEM AGAIN


After nightfall, Israel stepped up its Gaza bombardment. Artillery shells and missiles fired from naval gunboats slammed into the territory and air strikes came at a frequency of about one every 10 minutes.


In an attack claimed in Gaza by Hamas's armed wing, a longer-range rocket targeted Jerusalem on Tuesday for the second time since Israel launched the air offensive.


The rocket, which fell harmlessly in the occupied West Bank, triggered warning sirens in the holy city about the time Ban arrived for truce discussions. Another rocket damaged an apartment building in Rishon Lezion, near Tel Aviv.


Rockets fired at the two big cities over the past week were the first to reach them in decades, a sign of what Israel says is an increasing threat from Gaza militants.


In the Gaza Strip on Tuesday, Hamas executed six alleged collaborators, whom a security source quoted by the Hamas Aqsa radio said "were caught red-handed" with "filming equipment to take footage of positions". The radio said they were shot.


Militants on a motorcycle dragged the body of one of the men through the streets.


Along Israel's sandy, fenced-off border with the Gaza Strip, tanks, artillery and infantry massed in field encampments awaiting any orders to go in. Some 45,000 reserve troops have been called up since the offensive was launched.


A delegation of nine Arab ministers, led by the Egyptian foreign minister, visited Gaza in a further signal of heightened Arab solidarity with the Palestinians.


Egypt has been a key player in efforts to end the most serious fighting between Israel and Palestinian militants since a three-week Israeli invasion of the enclave in the winter of 2008-9. Egypt has a 1979 peace treaty with Israel seen by the West as the cornerstone of Middle East peace, but that has been tested as never before by the removal of U.S. ally Hosni Mubarak as president last year in the Arab Spring uprisings.


Mohamed Mursi, elected Egyptian president this year, is a veteran of the Muslim Brotherhood, spiritual mentors of Hamas, but says he is committed to Egypt's treaty with Israel.


Mursi has warned Netanyahu of serious consequences from an invasion of the kind that killed more than 1,400 people in Gaza four years ago. But he has been careful so far not to alienate Israel, or Washington, a major aid donor to Egypt.


(Additional reporting by Cairo bureau; Writing by Jeffrey Heller; Editing by Alastair Macdonald)


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Alicia Keys 'Definitely' Having 'At Least' One More Child















11/20/2012 at 02:45 PM EST







Swizz Beatz, Alicia Keys and Egypt Daoud Dean


James Devaney/FilmMagic


When Alicia Keys gave birth to son Egypt two years ago everything changed.

"To have this type of love in my life at this time in my life, it means so much. Perspectives change, priorities change," she tells Lara Logan on CBS' Person to Person, airing Friday, Nov. 23 (10:00 p.m. ET).

But motherhood has been a welcomed change for Keys, 31, who tied the knot with rapper-producer Swizz Beatz, 34, in July 2010.

"I was such a different person seven years ago. Nothing would stop me from traipsing from here to London to L.A. back to London to L.A. in three days and not sleep. ... It was just that I thought that that was everything," she says. "But to have time to spend with my family and my son, it's like perspectives change a bit, it's like, 'Hold up! Let's not kill ourselves here.' "

Although balancing a family with her musical career has been an adjustment for the "Girl on Fire" singer, she excitedly speaks about the possibility of having more children.

When asked if she'd like to have "a lot more" children, Keys answered, "Definitely at least one more."

Watch more of the interview below:

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New push for most in US to get at least 1 HIV test

WASHINGTON (AP) — There's a new push to make testing for the AIDS virus as common as cholesterol checks.

Americans ages 15 to 64 should get an HIV test at least once — not just people considered at high risk for the virus, an independent panel that sets screening guidelines proposed Monday.

The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a check-up, something a doctor can order with as little fuss as a cholesterol test or a mammogram. Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening.

Yet not nearly enough people have heeded that call: Of the more than 1.1 million Americans living with HIV, nearly 1 in 5 — almost 240,000 people — don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.

The updated guidelines will bring this long-simmering issue before doctors and their patients again — emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.

"It allows you to say, 'This is a recommended test that we believe everybody should have. We're not singling you out in any way,'" said task force member Dr. Douglas Owens of Stanford University and the Veterans Affairs Palo Alto Health Care System.

And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV — which includes gay and bisexual men and injecting drug users — were eligible for that no-copay screening.

There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.

Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.

Monday's proposal also recommends:

—Testing people older and younger than 15-64 if they are at increased risk of HIV infection,

—People at very high risk for HIV infection should be tested at least annually.

—It's not clear how often to retest people at somewhat increased risk, but perhaps every three to five years.

—Women should be tested during each pregnancy, something the task force has long recommended.

The draft guidelines are open for public comment through Dec. 17.

Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.

"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.

The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.

"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said — the reason that making it routine during any health care encounter could help.

But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 percent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 percent of ER patients known to be at increased risk were tested while there.

Mermin calls that "a tragedy. It's a missed opportunity."

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Wall Street falls as Bernanke's comments weigh

NEW YORK (Reuters) - Stocks slid as Federal Reserve Chairman Ben Bernanke's comments added to worries about the economic impact of the U.S. "fiscal cliff" and Hewlett-Packard's stock sank on news of an $8.8 billion accounting charge.


Bernanke, in comments before the Economic Club of New York, said the Fed does not have the tools to offset the damage that would result if politicians fail to strike a deal to prevent going off the fiscal cliff. If a solution isn't approved in time, then mandatory tax increases and spending cuts will go into effect early next year. Bernanke said he does not believe the possible benefits of cutting the interest it pays on bank reserves are sufficient to outweigh the risk of trouble in money markets.


"In the short run, we're hostage to the fiscal cliff. I think (Bernanke's) got to be really, really fearful that Washington doesn't get its act together and that creates stresses on the financial system," said Dan Veru, chief investment officer of Palisade Capital Management in Fort Lee, New Jersey.


Stocks rallied for the last two sessions on optimism that Washington politicians could agree on a deal to avoid the U.S. fiscal cliff. But the gains followed two weeks of sharp losses.


Hewlett-Packard Co shares sank 12 percent to a 10-year low at $11.70 as the computer and printer maker swung to a fourth-quarter loss. The company said it took an $8.8 billion charge related to its acquisition of software firm Autonomy, citing "serious accounting improprieties.


The Dow Jones industrial average <.dji> was down 63.43 points, or 0.50 percent, at 12,732.53. The Standard & Poor's 500 Index <.spx> was down 5.78 points, or 0.42 percent, at 1,381.11. The Nasdaq Composite Index <.ixic> was down 15.01 points, or 0.51 percent, at 2,901.06.


Another factor weighing on stocks was Moody's Investors Service's reduction of France's sovereign rating by one notch to Aa1 after the market's close on Monday. Moody's cited an uncertain fiscal outlook as a result of the weakening economy.


(Additional reporting by Chuck Mikolajczak Editing by Jan Paschal)


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