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

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Global shares rally on brighter global economic outlook

LONDON (Reuters) - World share markets extended a week-long rally on Thursday as manufacturing surveys in China and the United States boosted confidence over the growth outlook and euro zone data was not as weak as some had feared.


The single currency also touched a two-week high against the dollar, despite data indicating the euro zone's economy is on course for its deepest downturn since early 2009, on renewed optimism of a deal emerging to provide aid payments to Greece.


"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 0.3 percent to $1.2869, its highest level since November 7.


The prospects of a deal to help Athens were boosted when German Chancellor Angela Merkel said on Wednesday after the failure of overnight talks that an agreement was possible when euro zone ministers meet again on Monday.


The likelihood of a deal, combined with better economic data and a growing view that a resolution can be found to the U.S. fiscal crisis lifted the MSCI's world equity index 0.3 percent to 325.75 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 1,101.90 points, with London's FTSE 100, Paris's CAC-40 and Frankfurt's DAX between 0.3 and 0.7 percent higher.


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


CHINA BOOST


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


"There have been a lot of concerns regarding the outlook for global growth. In this context, any improvement in Chinese data is welcome, given that investors are still risk averse," said Robert Parkes, equity strategist at HSBC Securities.


The Chinese data followed an 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.


PMI data on the manufacturing and services sectors in Europe's two biggest economies of 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.


BOND DEMAND


Amid the improving appetite for riskier assets, Spain sold 3.88 billion euros ($4.97 billion) of new government bonds on Thursday, 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.


German 10-year bonds yields, which tend to rise as investors' anxiety over the euro zone outlook ease, were up slightly at 1.439 percent.


COMMODITIES STEADY


Commodity prices gained some support form the improving outlook for world demand from all the PMI data, but prospects of only modest global growth in 2013 kept gains in check.


London copper rose 0.6 percent to $7,740 a metric tonne, and spot gold inched up to $1,730 an ounce.


Brent crude oil dipped under $111 per barrel as a ceasefire between Israel and Gaza's Hamas rulers eased concerns over the impact the unrest may have on supply from the region.


Brent slipped 34 cents to $110.52 a barrel, while U.S. crude was steady at $87.38.


(Reporting by Richard Hubbard; Editing by Will Waterman)


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Gaza shakes as Clinton seeks truce

GAZA/JERUSALEM (Reuters) - U.S. Secretary of State Hillary Clinton on Wednesday pursued a Gaza truce, with Israel and Hamas still at odds over key terms, as Israeli air strikes shook the enclave and Palestinian rockets hit across the border.


After talks in Ramallah with Palestinian President Mahmoud Abbas and a possible second meeting with Israeli Prime Minister Benjamin Netanyahu, whom she saw late on Tuesday, Clinton planned to fly to Egypt, the main broker in efforts to end eight days of fighting and avert a possible Israeli ground offensive.


In Tel Aviv, at least 10 people were wounded when a bus was blown up in what the government called a terrorist attack. The incident, which touched off celebratory gunfire from militants in Gaza, threatened to complicate efforts to reach a ceasefire.


Israel's best-selling Yedioth Ahronoth newspaper said an emerging outline of a ceasefire agreement called for Egypt to announce a 72-hour ceasefire followed by further talks on long-term understandings.


Under the proposed document, which the newspaper said neither party would be required to sign, Israel would hold its fire, end attacks against top militants and promise to examine ways to ease its blockade of the enclave.


Hamas, the report said, would pledge not to strike any Israeli target and ensure other Palestinian factions in the Gaza Strip also stop their attacks.


An Israeli political source said differences holding up a deal centered on a Hamas demand to lift the Gaza blockade completely and the kind of activity that would be allowed along the frontier, where Israeli troops often fire into the enclave to keep Palestinians away from an area near a border fence.


Hamas official Ezzat al-Rishq said the main stumbling block was "the temporary timeframe for a ceasefire that the Israelis want us to agree to".


The London-based Al Hayat newspaper, citing sources in Hamas and Islamic Jihad, said Israel wanted a 90-day period to determine "good intentions" before discussing Palestinian demands, a position the report said the groups have rejected.


Rishq said a short-term truce, whose proposed duration he did not disclose, "would only buy (Israel) time" until a general election in January and "we would have accomplished nothing in the way of a long-term truce".


Hamas sources said the group was also demanding control over Gaza's Rafah borders with Egypt, so that Palestinians could cross easily and Israeli guarantees to stop assassinating Hamas leaders.


Israel, one of the Hamas sources said, wanted a commitment from the group to stop smuggling through tunnels that run into Gaza under the Egyptian border. The tunnel network is a conduit for weapons and commercial goods.


Clinton, who flew to the region on Tuesday from an Asian summit, said in her public remarks with Netanyahu that it was "essential to de-escalate the situation".


"The rocket attacks from terrorist organizations inside Gaza on Israeli cities and towns must end and a broader calm restored," she said


Netanyahu told Clinton he wanted a "long-term" solution. Failing that, Netanyahu made clear, that he stood ready to step up the military campaign to silence Hamas' rockets.


"A band-aid solution will only cause another round of violence," said Ofir Gendelman, a Netanyahu spokesman.


While diplomatic efforts continued, Israel struck more than 100 targets in Gaza overnight, killing a Hamas gunman and destroying a cluster of Hamas government buildings.


Palestinians militants fired 31 rockets at Israel, causing no casualties, and Israel's Iron Dome interceptor system shot down 14 of them, police said.


Israel has carried out more than 1,500 strikes since the offensive began. Medical officials in Gaza said 139 Palestinians, most of them civilians, including 34 children, have been killed. Nearly 1,400 rockets have been fired into Israel, killing four civilians and a soldier, the Israeli military said.


CLINTON MEETS PALESTINIAN PRESIDENT


In the West Bank city of Ramallah, Clinton held talks with Palestinian President Abbas, whose bid to upgrade the Palestinians' status at the United Nations, in the absence of peace negotiations with Israel, is opposed by Washington.


"Secretary Clinton informed the president that the U.S. administration is exerting every possible effort to reach an immediate ceasefire and the president expressed his full support for this endeavor," said Palestinian chief negotiator Saeb Erekat.


"Once the Israelis accept to stop their bombardments, their assassinations, there will be a comprehensive ceasefire sustained from all parties," Erekat said.


A Palestinian official with knowledge of Cairo's mediation told Reuters that Egyptian intelligence officials would hold further discussions on Wednesday with leaders of Hamas and the Islamic Jihad group.


"There may be a response from Israel that Egyptian mediators want to present to Hamas and Islamic Jihad leaders," the official said. "Let's be hopeful it would be something Palestinian factions can accept."


Like most Western powers, Washington shuns Hamas as an obstacle to peace and has blamed it for the Gaza conflagration. A U.N. Security Council statement condemning the conflict was blocked on Tuesday by the United States, which complained that it "failed to address the root cause," the Palestinian rockets.


Hamas for its part is exploring the opportunities that last year's Arab Spring has given it to enjoy favor from new Islamist governments, and from Sunni Gulf powers keen to woo it away from Shi'ite Iran.


It may count on some sympathy from Egypt's president, Mohamed Mursi, though that country's first freely elected leader, whose Muslim Brotherhood inspired Hamas' founders, has been careful to stick by the 1979 peace deal with Israel struck by Cairo's former military rulers.


In Jerusalem, Clinton assured Netanyahu of "rock-solid" U.S. support for Israel's security, and praised Mursi's "personal leadership and Egypt's efforts thus far" to end the Gaza conflict and promote regional stability.


"As a regional leader and neighbor, Egypt has the opportunity and responsibility to continue playing a crucial and constructive role in this process. I will carry this message to Cairo tomorrow (Wednesday)," she said.


Along the Gaza border, Israeli tanks, artillery and infantry remained poised for a possible ground offensive in the densely populated enclave of 1.7 million Palestinians.


But an invasion, likely to entail heavy casualties, would be a major political risk for Netanyahu, who is currently favored to win the upcoming Israeli election. More than 1,400 Palestinians were killed in Israel's three-week war in the Gaza Strip in the winter of 2008-9, prompting international criticism of Israel.


(Additional reporting by Cairo bureau; Writing by Jeffrey Heller; Editing by Giles Elgood)


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The Voice: Top Eight Contestants Revealed















11/20/2012 at 10:05 PM EST







From left: Adam Levine, Cee Lo Green, Christina Aguilera, Blake Shelton and host Carson Daly


Mark Seliger/NBC


Following what Blake Shelton called the "best episode of The Voice we've ever had", spirited group performances on Tuesday night's show kept the energy up and distracted viewers just long enough from the business at hand – impending eliminations.

Christina Aguilera brought the heat with her song "Let There Be Love." Rascal Flatts shared their hit "Changed." Later, Adam Levine performed a rendition of Queen's "Crazy Little Thing Called Love," followed by the contestants taking on Pat Benatar's "Hit Me with Your Best Shot."

But once again, the decisions about who would stay and who would go were completely up to the viewers. No input from the coaches could save contestants this time. Keep reading to find out which contestants will sing again next week ...

The first round of results turned out to be good news for Nicholas David and Cassadee, later joined by Dez Duron and Cody Belew in the top eight.

America also gave Terry McDermott, Melanie Martinez, Trevin Hunte and Amanda Brown another shot at superstardom.

That means Bryan Keith and Sylvia Yacoub won't be singing again on Monday night's episode.

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OB/GYNs back over-the-counter birth control pills

WASHINGTON (AP) — No prescription or doctor's exam needed: The nation's largest group of obstetricians and gynecologists says birth control pills should be sold over the counter, like condoms.

Tuesday's surprise opinion from these gatekeepers of contraception could boost longtime efforts by women's advocates to make the pill more accessible.

But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance.

Still, momentum may be building.

Already, anyone 17 or older doesn't need to see a doctor before buying the morning-after pill — a higher-dose version of regular birth control that can prevent pregnancy if taken shortly after unprotected sex. Earlier this year, the Food and Drug Administration held a meeting to gather ideas about how to sell regular oral contraceptives without a prescription, too.

Now the influential American College of Obstetricians and Gynecologists is declaring it's safe to sell the pill that way.

Wait, why would doctors who make money from women's yearly visits for a birth-control prescription advocate giving that up?

Half of the nation's pregnancies every year are unintended, a rate that hasn't changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor's visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn't require a prescription, women could "pick it up in the middle of the night if they run out," she said. "It removes those types of barriers."

Tuesday, the FDA said it was willing to meet with any company interested in making the pill nonprescription, to discuss what if any studies would be needed.

Then there's the price question. The Obama administration's new health care law requires FDA-approved contraceptives to be available without copays for women enrolled in most workplace health plans.

If the pill were sold without a prescription, it wouldn't be covered under that provision, just as condoms aren't, said Health and Human Services spokesman Tait Sye.

ACOG's opinion, published in the journal Obstetrics & Gynecology, says any move toward making the pill nonprescription should address that cost issue. Not all women are eligible for the free birth control provision, it noted, citing a recent survey that found young women and the uninsured pay an average of $16 per month's supply.

The doctors group made clear that:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there's no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they'd like to discuss other forms of birth control such as implantable contraceptives that do require a physician's involvement.

The group didn't address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires girls younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers' ages. Presumably regular birth control pills would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don't require a prescription.

Switching isn't a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor's involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country's health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

"Being able to easily get the pill when you need it makes a difference," he said.

___

Online:

OB/GYN group: http://www.acog.org

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Global shares, euro fall as Greek deal proves elusive

LONDON (Reuters) - European shares and the euro fell on Wednesday after Greece's international lenders failed to reached an agreement needed to provide it with emergency aid, though some of the losses were recouped on talk that a deal was close.


Euro zone finance ministers, the International Monetary Fund and the European Central Bank will gather again on Monday after nearly 12 hours of talks through the night failed to reach a consensus on how to bring Greece's debt down.


Since the meeting ended, French Finance Minister Pierre Moscovici said a deal was just "a whisker away", while European paymaster Germany said a plan to provide Greece with funding until 2016 was being developed.


The euro, which initially fell 0.5 percent after the meeting on Greece broke up, recovered slightly to be down 0.3 percent at $1.2775.


"The old worries about the euro zone show investor sentiment remains on a knife edge", said Richard Hunter, head of UK equities at Hargreaves Lansdown.


The euro area's blue chip stock index, the Euro STOXX 50 <.stoxx50e>, fell 0.3 percent at the start of trading, but recovered some of the losses to stand down 0.2 percent at 2,504.57 points. <.eu/>


In the main European centres the German DAX <.gdaxi> was down 0.1 percent, while France's CAC-40 <.fchi> and London's FTSE 100 <.ftse> were down 0.2 percent. <.l/>


Efforts by politicians to convince markets a deal was possible on Monday also led to a reversal in demand for safe-haven German bonds, and the main Bund futures contract erased all its gains to be down 3 ticks at 142.35.


FED WARNING


World equity markets had already been rocked before the Greek delay by a warning from Federal Reserve Chairman Ben Bernanke on Tuesday that the central bank lacked the tools to cushion the impact of a potential U.S. fiscal crisis.


The Fed chief said worries over how the current budget negotiations, aimed at preventing a series of mandatory tax increases and spending cuts early next year, had already damaged growth in the world's largest economy.


Bernanke's comments snapped a two-day rally on Wall Street, but gains in Asian markets and the recovery in European shares left MSCI world equity index <.miwd00000pus> unchanged at around 324 points.


U.S. stock futures were down 0.2 percent, pointing to another weak day on Wall Street when it opens for its last session before the Thanksgiving holiday.


Asian shares had initially fallen in reaction to the Greek news but recovered to close with small gains due to a rise in mainland Chinese markets and in Tokyo.


MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> gained 0.3 percent, while Japan's Nikkei stock average <.n225> closed up 0.9 percent at a two month-high.


YEN WEAKNESS


The Nikkei's gains came as shares in exporters rose after the yen hit a seven-month low against the dollar on expectations that a new government will aggressively push the Bank of Japan to expand monetary stimulus.


The yen hit a low of 82.12 to the dollar, its weakest level since early April.


The euro's decline and the weaker Japanese yen lifted the dollar by 0.3 percent against a basket of key currencies <.dxy>, which weighed on commodities such as gold, which fell 0.25 percent to $1,723.40 an ounce.


In the oil market Brent crude was steady near $110 per barrel as any concerns about the lack of aid to Greece were offset by fears of supply disruption from the Middle East, where Palestinians and Israelis continued to trade rockets and air strikes despite overnight truce talks.


"There are opposing forces where the uncertainty in Europe and the United States meets with the bullish uncertainty in the Middle East ... so I think we're going to see a volatile market," said Jeremy Friesen, commodity strategist at Societe Generale in Hong Kong.


Brent crude futures were up 15 cents at $109.98 a barrel, off an earlier session-high of $110.55. U.S. crude rose 19 cents to $86.94.


(Additional reporting by Jessica Jaganathan; Editing by Will Waterman)


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World pressure for Gaza truce intensifies

GAZA/JERUSALEM (Reuters) - The U.N. chief called for an immediate ceasefire in the Gaza Strip on Tuesday and U.S. Secretary of State Hillary Clinton headed to the region with a message that escalation of the week-long conflict was in nobody's interest.


Nevertheless, Palestinian rocket fire and Israeli air strikes continued for a seventh day.


Hamas militants said they fired 16 missiles at the southern Israeli city of Beersheba after Israel's military targeted roughly 100 sites in Gaza overnight, including ammunition stores and the Gaza headquarters of the National Islamic Bank.


Some 110 Palestinians have died in a week of fighting, the majority of them civilians, including 27 children. Three Israelis died last week when a Gaza missile struck their house.


In Cairo, U.N. Secretary-General Ban Ki-moon called for an immediate ceasefire and said an Israeli ground operation in Gaza would be a "dangerous escalation" that must be avoided.


He had held talks in the Egyptian capital with Arab League chief Nabil Elaraby and was due to meet Egypt's Islamist President Mohamed Mursi before travelling to Israel for talks with Israeli Prime Minister Benjamin Netanyahu.


Israel's leaders weighed the benefits and risks of sending tanks and infantry into the densely populated coastal enclave two months before an Israeli election, and indicated they would prefer a diplomatic path backed by world powers, including U.S. President Barack Obama, the European Union and Russia.


The White House said Clinton was going to the Middle East for talks in Jerusalem, Ramallah and Cairo to try to calm the conflict. An Israeli sources said she was expected to meet Netanyahu on Wednesday.


Netanyahu and his top ministers debated their next moves in a meeting that lasted into the early hours of Tuesday.


"Before deciding on a ground invasion, the prime minister intends to exhaust the diplomatic move in order to see if a long-term ceasefire can be achieved," a senior Israeli official, speaking on condition of anonymity, said after the meeting.


A delegation of nine Arab ministers, led by the Egyptian foreign minister, were due in Gaza later on Tuesday in a further signal of heightened Arab solidarity with the Palestinians.


Any diplomatic solution may pass through Egypt, Gaza's other neighbor and the biggest Arab nation, where the ousting of U.S. ally Hosni Mubarak and the election of Mursi is part of a dramatic reshaping of the Middle East wrought by Arab uprisings and now affecting the Israeli-Palestinian conflict.


Mursi, whose Muslim Brotherhood was mentor to the founders of Hamas, took a call from Obama on Monday telling him the group must stop rocket fire into Israel - effectively endorsing Israel's stated aim in launching the offensive last week. Obama, as quoted by the White House, also said he regretted civilian deaths - which have been predominantly among the Palestinians.


"The two leaders discussed ways to de-escalate the situation in Gaza, and President Obama underscored the necessity of Hamas ending rocket fire into Israel," the White House said, adding that the U.S. leader had also called Netanyahu.


"In both calls, President Obama expressed regret for the loss of Israeli and Palestinian civilian lives."


EGYPT SEES DEAL


Mursi has warned Netanyahu of serious consequences from a ground invasion of the kind that killed more than 1,400 people in Gaza four years ago. But he has been careful not to alienate Israel, with whom Egypt's former military rulers signed a peace treaty in 1979, or Washington, a major aid donor to Egypt.


Egyptian Prime Minister Hisham Kandil told Reuters a ceasefire was possible: "I think we are close, but the nature of this kind of negotiation, (means) it is very difficult to predict."


After Hamas leader Khaled Meshaal laid out demands in Cairo that Israel take the first step in restoring calm, and warned Netanyahu that a ground war in Gaza could wreck his re-election prospects in January, a senior Israeli official denied a Hamas assertion that the prime minister had asked for a truce.


"Whoever started the war must end it," Meshaal said, referring to Israel's assassination from the air on Wednesday of Hamas's Gaza military chief, a move that followed a scaling up of rocket fire onto Israeli towns over several weeks.


An official close to Netanyahu told Reuters: "We would prefer to see a diplomatic solution that would guarantee the peace for Israel's population in the south. If that is possible, then a ground operation would no longer be required."


Fortified by the ascendancy of fellow Islamists in Egypt and elsewhere, and courted by fellow Sunni Arab leaders in the Gulf keen to draw the Palestinian group away from old ties to Shi'ite Iran, Hamas has tested its room for maneuver, as well as longer-range rockets that have reached the Tel Aviv metropolis.


LOWER INTENSITY


Israeli statistics showed some easing in the ferocity of the exchanges on Monday. Israeli police counted 110 rockets, causing no casualties, of which 42 were shot down by anti-missile batteries. Tuesday's salvo also caused no injuries.


There has been no attack on Tel Aviv since Sunday.


Hamas said four-year-old twin boys had died with their parents when their house in the town of Beit Lahiya was struck from the air during the night. Neighbors said the occupants were not involved with militant groups.


Israel had no immediate comment on that attack. It says it takes extreme care to avoid civilians and accuses Hamas and other militant groups of deliberately placing Gaza's 1.7 million people in harm's way by placing rocket launchers among them.


Nonetheless, fighting Israel, whose right to exist Hamas refuses to recognize, is popular with many Palestinians and has kept the movement competitive with the secular Fatah movement of Palestinian President Mahmoud Abbas, who remains in the West Bank after losing Gaza to Hamas in a civil war five years ago.


"Hamas and the others, they're our sons and our brothers, we're fingers on the same hand," said 55-year-old Faraj al-Sawafir, whose home was blasted by Israeli forces. "They fight for us and are martyred, they take losses and we sacrifice too."


In scenes recalling Israel's 2008-2009 winter invasion of the coastal enclave, tanks, artillery and infantry have massed in field encampments along the sandy, fenced-off border.


Israel has also authorized the call-up of 75,000 military reservists, so far mobilizing around half that number.


Although 84 percent of Israelis support the current Gaza assault, according to a poll by Israel's Haaretz newspaper, only 30 percent want an invasion.


In an echo of frictions over the civil war in Syria, Russia accused the United States on Monday of blocking a bid by the U.N. Security Council to condemn the escalating conflict in the Gaza Strip. Washington has generally stopped the U.N. body from putting what it sees as undue pressure on its Israeli ally.


(Writing by Alastair Macdonald; and Crispian Balmer)


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Dancing with the Stars: Couples Perform Crazy Combinations in Semi-Finals






Dancing With the Stars










11/19/2012 at 11:05 PM EST







Shawn Johnson and Derek Hough


Craig Sjodin/ABC


It's the semi-finals!

The remaining five couples on Dancing with the Stars faced two rounds of competition on Monday. First, the pairs performed mixed-up routines, blending uncommon styles with unusual themes. Then, they celebrated the 25th anniversary of Michael Jackson's hit album Bad with more traditional ballroom numbers.

Keep reading for all the details and scores ...

Melissa Rycroft & Tony Dovolani
Last week's top scorers kicked off the night with a caveman hustle. "Fred and Wilma have never danced so well," Len Goodman said, while Bruno Tonioli said they lost footing during the turns. They scored a 27.5. But their red-hot Argentine tango to "Dirty Diana" was a perfect 30. "That was beyond anything I could have imagined for you," a thrilled Carrie Ann Inaba said. "I would be really disappointed if you're not here next week," Len added.

Shawn Johnson & Derek Hough
Hough said he would rather put mustard on ice cream than combine their Knight Rider theme with the Bhangra style. But the judges ate up the routine – and awarded the pair a perfect 30. In round two, their Argentine tango sparked disagreement on the panel. Bruno and Len held up 10s but Carrie Ann knocked off a point. "Every line was perfect, but dance is sometimes more than just movement and I thought that you lacked the real passion of the Argentine tango," she said.

Apolo Ohno & Karina Smirnoff
Their big top jazz routine was another sticking point for Carrie Ann and Bruno. She found the mime-themed dance "very disjointed," "out of sync" and "quite sloppy." He found it "edgy, surreal" and a "great mixture of jazz movement." They earned 27 points. But there was no arguing over their rumba to "Man in the Mirror," which earned a perfect 30. "It was like the sea," Len said. "There was wave after wave of effortless motion. There was a subtlety to it, there was a calmness. It captivated. It was fabulous."

Emmitt Smith & Cheryl Burke
The goal of their espionage lindy hop was to be cartoonish. Though that was tough for the former Dallas Cowboy, the judges were pleased and awarded the pair 27 points. "It was like a Looney Tunes version of James Bond," Bruno said. "It was the most fun performance I've seen you do." Their tango to "Leave Me Alone" was more of a challenge, but Len still gave Smith credit: "You've coped marvelously well with two dances that didn't really suit you," he said.

Kelly Monaco & Val Chmerkovskiy
Their surfer flamenco was super sexy – Val ended up in nothing but Speedo! – but the judges had issues with their technique, and handed out only 25.5 points. "It had a lot of aggression and a lot of fire. But the flamenco has very, very exact placement and it wasn't there," Bruno said. Carrie Ann called it "robotic." But they added 28.5 points with a romantic rumba to "I Just Can't Stop Loving You." "That was smoldering, driven by desire, consumed by lust," Bruno said. "The chemistry between you two is literally singeing."

Two couples are heading home Tuesday night, leaving just three to compete in next week's finale. Who deserves a chance at the mirror-ball trophy? Discuss in the comments 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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Stock index futures signal lower start

LONDON (Reuters) - Stock index futures pointed to a lower open on Wall Street on Tuesday, with futures for the S&P 500 and Nasdaq 100 down 0.2 percent, and Dow Jones contracts down 0.1 percent at 0905 GMT.


Japan's Nikkei <.n225> ended a four-day winning run on Tuesday as investors took profits in exporters, which had rallied on hopes Japan's main opposition party would win next month's election and pressure the central bank for more stimulus steps.


European shares edged lower early on, with the French CAC 40 <.fchi> a core euro zone laggard after ratings agency Moody's issued a long-awaited downgrade of France's credit rating.


The U.S. Commerce Department releases housing starts and permits data for October at 1330 GMT, expected to show a pull-back after hefty gains in recent months. But a severe storm in late October could exaggerate the magnitude of the decline.


The Federal Reserve's Chairman Ben Bernanke speaks before the Economic Club of New York at 1715 GMT, a speech that may offer a fresh chance to gauge the Fed's appetite for more monetary stimulus. Market participants currently expect the Fed to step up asset purchases in 2013 after Operation Twist expires.


JPMorgan Chase & Co named little-known executive Marianne Lake as its chief financial officer on Monday, making her one of the most powerful women on Wall Street and the top ambassador to investors for the largest U.S. bank.


The U.S. International Trade Commission will review a judge's decision which found did not violate patents owned by Samsung Electronics in making the iPod touch, iPhone and iPad.


Tiger Global Management, a technology focused hedge fund run by Chase Coleman and Feroz Dewan, disclosed a big stake in Groupon Inc on Monday, a vote of confidence for the struggling daily deal website.


Best Buy reports quarterly results, expected to show a fall in earnings per shares to $0.12 from $0.47, as the world's largest consumer electronics chain struggles to fend off online and discount rivals. Investors are awaiting word on whether founder and top shareholder Richard Schulze comes through with a formal bid to take the company private.


Hewlett Packard, H.J. Heinz Company and salesforce.com are also among companies due to report results on Tuesday.


Archstone Inc, the apartment building owner and developer owned by Lehman Brothers Holdings Inc, said on Monday it plans to raise up to $3.45 billion in its initial public offering, making it the biggest U.S. commercial real estate IPO ever.


Stocks rose for a second consecutive session on Monday as investors were encouraged by the early atmosphere surrounding talks to tackle the nation's fiscal crunch.


President Barack Obama and the U.S. Congress hope to start serious negotiations after this week's Thanksgiving holiday on Thursday on how to avoid the "fiscal cliff," which has politicians and economists worried about the direction of the world's largest economy.


The Dow Jones industrial average <.dji> rose 207.65 points, or 1.65 percent, on Monday to 12,795.96 points. The Standard & Poor's 500 Index <.spx> was up 27.01 points, or 1.99 percent, at 1,386.89. The Nasdaq Composite Index <.ixic> was up 62.94 points, or 2.21 percent, at 2,916.07.


(Reporting By Francesco Canepa/editing by Chris Pizzey, London MPG Desk, +44 (0)207 542-4441)


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