Italy's lefti-wing leader suggests loose alliance to end deadlock

ROME: Italian left-wing leader Pier Luigi Bersani on Friday held out the prospect of forming a minority government based on a loose alliance in parliament following inconclusive elections, as Europe puts on pressure for a quick solution.

"I am calling it a government of change, which I would take the responsibility of leading," the Democratic Party leader said in an interview with La Repubblica daily, warning that Italy's "governability (is) at risk".

"Like all governments, it will ask for the confidence of parliament," he said.

But Bersani rejected out of hand the possibility of a grand coalition arrangement with Silvio Berlusconi's centre-right forces, after a new anti-establishment party upset the traditional balance of power between Italy's right and left by winning big in the polls early this week.

Bersani said the government he is proposing would have key objectives, including easing austerity measures, creating jobs, helping the poorest and cutting government costs -- echoing at least some of the demands made by the anti-establishment Five Star Movement.

But since a Democratic Party-led coalition did not manage majorities in both houses of parliament, the new government would depend on the support of other parties in the upper house -- an arrangement that analysts have warned would prove "highly unstable" at a time when Italy is facing an acute economic crisis.

Stefano Folli, editorialist for Il Sole 24 Ore business daily, said it would "hand over the government" to the whims of the populist Five Star Movement.

Most analysts say there will have to be new elections within months to resolve the impasse.

It is unclear whether the Five Star Movement would support Bersani after its leader, former comedian Beppe Grillo, said his movement "is not going to give a vote of confidence to the Democratic Party or to anyone else".

Not everyone in his movement agrees with this rejection, however.

The party captured a quarter of the vote with a campaign that mixed advocacy on environmental causes and grassroots local issues with a crusade against political sleaze, drawing many austerity-weary Italians to its ranks.

The party has spooked Europe with its promise to hold a referendum on the euro and cancel Italy's debts, prompting European leaders to urge Italy to stick to its fiscal commitments and form a government as soon as possible.

A deputy from German Chancellor Angela Merkel's Christian Democratic Union (CDU) called on Friday for Italy to leave the euro if it could not stick to EU rules after its inconclusive election.

"If one can't succeed in persuading the people of a country that they have to stick to the commitments they have themselves signed up to in terms of how the common currency works, then you can't demand new elections from outside, but the country must return to its own currency," said Klaus-Peter Willsch.

Markets were jittery in trading on Friday, with the Milan index plunging 1.58 percent -- the worst performer among major European stock markets.

The technocratic cabinet of outgoing premier Mario Monti, who won praise abroad for his budget discipline and economic reforms but became increasingly unpopular at home, will stay in place until a new government is formed.

A centrist coalition led by Monti came in fourth place, garnering far too little support to be able to cobble a majority in alliance with the left.

Bersani meanwhile ruled out another possibility -- the formation of an emergency coalition with his long-time arch-rival Berlusconi -- saying: "The hypothesis of a grand understanding does not exist and will never exist".

The scandal-tainted Berlusconi on Friday made an appearance at his appeal trial in Milan against a tax fraud conviction linked to his business empire.

A verdict in the case is expected later this month, along with a ruling in another trial in which Berlusconi is a defendant on charges of having sex with an underage prostitute and abuse of office while he was still prime minister.

Italy's new parliament must convene by March 15 at the latest under the rules of the constitution. After parliament meets, formal negotiations can begin with Italian President Giorgio Napolitano on a new government.

Guglielmo Meardi, a professor at Warwick Business School in Britain, said Italy was "used to parliamentary instability... and should stay on the rails until the autumn, when fresh elections could be held."

- AFP/al

Read More..

Prepared for arrest on return: Yasin Malik

ISLAMABAD: JKLF chief YasinMalik, who created flutters in India by sharing dais with 26/11 mastermind HafizSaeed in Pakistan, said on Friday he is prepared for confiscation of his passport or his arrest on returning home next week.

"I will be flying back to Delhi from Lahore on the regular PIA flight on March 9," Malik said.

Asked about calls for the revocation of his passport after Saeed joined him at a protest in Islamabad against the hanging of Afzal Guru, Malik said: "It is their wish if they wish to confiscate my passport or to arrest me. Jail is my second home".

Saeed, blamed by India for masterminding the 2008 Mumbai attacks, had briefly participated in the protest organised by the Jammu and Kashmir Liberation Front (JKLF) in Islamabad on February 10.

After photographs appeared in the media of Saeed and Malik, demands were made by political parties for the cancellation of Malik's passport.

"The government needs to come out clean with an action plan. They must arrest, forfeit his passport and take action against Malik and tell the nation. This is a monumental mistake on the part of the home ministry and we will raise at all forums available," BJP had said.

Reports in the Indian media said Malik's activities in Pakistan could cost him the freedom to travel abroad.

Authorities could also decide not to reissue a passport to him.

Malik visits Pakistan several times a year to meet his wife and his young daughter.

Read More..

Sequester Set to Trigger Billions in Cuts

Nobody likes the sequester.

Even the word is enough to send shivers of fiscal panic, or sheer political malaise, down the spines of seasoned politicians and news reporters. And today, the sequester will almost certainly happen, a year and a half after its inception as an intentionally unpalatable event amid the stalemate of the debt-limit crisis in 2011.

Automatic budget cuts will be triggered across federal agencies, as President Obama will be required to order sequestration into effect before midnight Friday night. The federal bureaucracy will implement its various plans to save the money it's required to save.

Now that the sequester will probably happen, here are some questions and answers about it:

1. HOW BIG IS IT?

The cuts were originally slated for $109 billion this year, but after the fiscal-cliff deal postponed the sequester for two months by finding alternate savings, the sequester will amount to $85 billion over the remainder of the year. Over the rest of the year, nondefense programs will be cut by nine percent, and defense programs will be cut by 13 percent.

If carried out over 10 years (as designed), the sequester will amount to $1.2 trillion in total.

2. WHAT WILL BE CUT, SPARED?

Most government programs will be cut, including both defense and nondefense spending, with the cuts distributed evenly (by dollar amount) over those two categories.

Some vital domestic entitlements, however, will be spared. Social Security checks won't shrink; nor will Veterans Administration programs. Medicare benefits won't get cut, but payments to providers will shrink by two percent. The Children's Health Insurance Program (CHIP), food stamps, Pell grants, and Medicaid will all be shielded from the sequester.

But lots of things will get cut. The Obama administration has warned that a host of calamities will befall vulnerable segments of the population.

3. WHY DOES IT HAVE TO BE SO BAD?

Questions persist over whether or not it really does.

The sequester will mean such awful things because it forces agencies to cut things indiscriminately, instead of simply stripping money from their overall budgets.

But some Republicans, including Oklahoma Sen. Tom Coburn, have suggested that federal agencies have plenty of flexibility to implement these cuts while avoiding the worst of the purported consequences. Louisiana Gov. Bobby Jindal accused President Obama of trying to "distort" the severity of the sequester. The federal government will still spend more money than it did last year, GOP critics of sequester alarmism have pointed out.

The White House tells a different story.

According to the Office of Management and Budget, the sequestration law forces agency heads to cut the same percentage from each program. If that program is for TSA agents checking people in at airports, the sequester law doesn't care, and Homeland Security Secretary Janet Napolitano can't do anything about it.

Agency heads do have some authority to "reprogram" funds, rearranging their money to circumvent the bad effects. But an OMB official told ABC News that "these flexibilities are limited and do not provide significant relief due to the rigid nature of the way in which sequestration is required by law to be implemented."

4. WHEN WILL THE WORST OF IT START?

Not until April -- but some of the cuts could be felt before then.

Read More..

SingPost sets up S$10m fund to help low-wage employees

SINGAPORE: SingPost is setting up a $10 million "Inclusivity Fund", which will benefit its low-wage workers.

Over 70 per cent of the fund will go to helping the workers cope with the rising cost of living. This will include retention awards and enhancements to their wages.

Part of the fund will also go into training to help them upgrade their skills.

Staff with school-going children can also stand to benefit from bursaries and scholarships.

The fund will be disbursed over five years and benefit some 3,400 workers.

The company will also be investing about S$30 million to enhance its delivery and improve processes.

- CNA/xq

Read More..

Left pulls off emphatic win in Tripura sweeping 50 of 60 seats

AGARTALA: The Left Front on Thursday retained power in Tripura for the fifth consecutive time, sweeping 50 of the 60 seats and leaving the Congress badly bruised with just 10 seats.

Hundreds of Left activists, mainly from the Communist Party of India-Marxist CPI(M), celebrated across the state as election results left the Congress in gloom.

The CPI(M) bagged 49 seats while the Communist Party of India (CPI) won one seat.

It was the best result for the Left since 1978, when it won a record 56 seats. It increased its 2008 tally by one seat.

"This is a verdict in favour of development, peace and stability besides good governance," a beaming chief minister Manik Sarkar said.

"People voted and supported the Left Front for taking up development work and for curbing militancy," Sarkar added.

Sarkar, 64, who retained his Dhanpur seat in west Tripura, is the only political leader to be chief minister for a record fourth term in Tripura, a Marxist bastion. It was Sarkar's sixth electoral win.

While the Congress managed to retain its 2008 tally of 10 seats, its ally the Indigenous Nationalist Party of Tripura (INPT) drew blank. It had won one seat five years ago.

The Trinamool Congress, which fielded 22 candidates in 2008, did not contest this time to prevent a split in non-Left votes. But even that did not help the Congress.

The Left Front wrested four seats from the Congress-INPT-NCT (Nationalist Conference of Tripura) coalition. The Congress snatched three seats from the Left.

"Left Front candidates have increased their winning margin in most seats," an Election Commission official said.

The 49 seats of CPI(M) is three more than what it got in 2008. The CPI won one seat and lost another.

The Revolutionary Socialist Party (RSP) and Forward Bloc lost the two and one seats they contested.

Finance minister Badal Chowdhury posted the highest winning margin of 12,450 votes.

Assembly speaker Ramendra Chandra Debnath, commerce minister Jitendra Chowdhury, school education minister Tapan Chakraborty, information minister Anil Sarkar and tribal welfare minister Aghore Debbarma won by huge margins.

Teacher-turned-politician Anil Sarkar, 75, who is also a poet and writer, was re-elected on CPI(M) ticket from Pratapgarh in western Tripura for a record ninth time.

Congress leader Ratan Lal Nath won from Mohanpur for the fifth time while state Congress president Sudip Roy Barman retained his Agartala seat for the fourth time.

Former Tripura assembly speaker Jitendra Sarkar, who this time contested on Congress ticket, wrested Barjala seat from the CPI(M). He won by 254 votes.

CPI(M) candidate Ratan Das wrested Ramnagar after a gap of 25 years. He defeated former state Congress chief Surajit Datta by just 15 votes.

"This is a great victory for the Left Front. Good governance is one of the key factors," CPI-M spokesperson Gautam Das told IANS.

Notable Congress losers included former chief minister Samir Ranjan Barma, party leader Subal Bhowmik and INPT president and former militant leader Bijoy Kumar Hrangkhawl.

Tripura made history when a record 93.57 percent of the 2.3 million voters exercised their franchise February 14. There were 249 candidates.

The Left has ruled Tripura since 1978 barring one term (1988-93).

Read More..

Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

___

On the Web:

The OIG report: http://1.usa.gov/VaztQm

The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1

___

Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

Read More..

Benedict Pledges 'Obedience' to New Pope

In his farewell remarks to colleagues in the Roman Catholic Church, Pope Benedict XVI, the first pontiff to resign in nearly 600 years, promised "unconditional reverence and obedience" to his eventual successor.

Benedict, in a morning meeting at the Vatican, urged the cardinals to act "like an orchestra" to find "harmony" moving forward.

Benedict, 85, is spending a quiet final day as pope, bidding farewell to his colleagues and moving on to a secluded life of prayer, far from the grueling demands of the papacy and the scandals that have recently plagued the church.

His first order of business was a morning meeting with the cardinals in the Clementine Hall, a room in the Apostolic Palace. Despite the historical nature of Benedict's resignation, not all cardinals attended the event.

With their first working meeting not until Monday, only around 100 cardinals were set to attend, the Vatican press office said Wednesday. Those who are there for Benedict's departure will be greeted by seniority.

Angelo Sodano, the dean of the College of Cardinals, thanked Benedict for his service to the church during the eight years he has spent as pontiff.

Pope Benedict XVI Delivers Farewell Address

In the evening, at 5:00 p.m. local time, Benedict will leave the Vatican palace for the last time to head to Castel Gandolfo, the papal summer residence outside Rome. Before his departure, the German-born theologian will say some goodbyes in the Courtyard of San Damaso, inside the Vatican, first to his Secretary of State Cardinal Tarcisio Bertone and then to the Swiss Guards who have protected him as pontiff.

9 Men Who Could Replace Pope Benedict XVI

From there it is a short drive to a heliport for the 15-minute flight via helicopter to Castel Gandolfo, just south of the city. Benedict will not be alone on his journey, accompanied by members of the Pontifical Household such as two private secretaries, the head of protocol, his personal physician and his butler.

Once Benedict lands in the gardens at Castel Gandolfo, he will be greeted a group of dignitaries, such as the governor of the Vatican City state Giovanni Bertello, two bishops, the director of the pontifical villas, and the mayor and parish priest. Off the helicopter and into a car, Benedict will head to the palace that he will call home for the coming months. From a window of the palace, Benedict will make one final wave to the crowd at the papal retreat.

It is there, at 8:00 p.m., that Benedict's resignation will take effect once and for all. Once the gates to the residence close, the Swiss Guards will leave Benedict's side for the last time, their time protecting the pontiff completed.

Pope Benedict's Last Sunday Prayer Service

For some U.S. Catholics in Rome for the historic occasion, Benedict's departure is bittersweet. Christopher Kerzich, a Chicago resident studying at the Pontifical North American College of Rome, said Wednesday he is sad to see Benedict leave, but excited to see what comes next.

"Many Catholics have come to love this pontiff, this very humble man," Kerzich said. "He is a man who's really fought this and prayed this through and has peace in his heart. I take comfort in that and I think a lot of Catholics should take comfort in that."

Read More..

Rehabilitative care innovation can alleviate manpower crunch: govt

SINGAPORE: The government said the use of technology not only accelerates the rehabilitation process of patients, but also helps ease manpower shortages in healthcare.

The latest in "rehab innovations" for those with disabilities are on display at the inaugural Rehab Tech Asia exhibition in Singapore.

The showcase includes a robot arm which allows users who are paralysed in their upper bodies to do daily functions, such as drinking a glass of water.

Laurie Piquet, director of rehabilitation development at KINOVA, said: "When we demonstrate this to users, often the first comments that we have are, 'that's the first time I'm drinking a glass of water by myself'."

The innovation from Canada is compatible with any powered wheelchair and can be controlled by a joystick or through neck movements.

A special wheelchair also improves mobility by making it easier for users to climb stairs and cross pavements.

Other than technology for patients to use, there are also devices for caregivers.

"The Body Up", distributed by Lifeline, is a transfer assist device for bed-ridden patients. The contraption can be used to lift a patient who weighs less than 120kg.

With a growing demand for special needs care, those in the field of rehabilitation said such technology can alleviate problems of manpower shortage.

Dr Kong Keng He, senior consultant at department of rehabilitation medicine at Tan Tock Seng Hospital, said: "It is still very hospital-centric. The patient goes to the hospital to get treatment. I think it will be better off to make it more patient-centric. Deploy this treatment, whether it is rehabilitation, back to the community. And it's always possible for community centres, day rehabilitation centres to acquire these equipment and to have patients to receive their therapy there."

Minister of State for Health Dr Amy Khor agreed, saying the high cost of some technology may be offset by productivity gains in the long run.

She said: "Where it is viable and applicable, I think we should adopt them because it's helpful in terms of improving, accelerating the rehabilitation experience as well as in terms of better use of manpower, improving productivity, and this is something we need to look at. Where it is still costly, I think technology will develop and we will have to continue to monitor this."

With the recent enhancements made to the Senior's Mobility and Enabling Fund, Dr Khor said the subsides should encourage the elderly to go for rehabilitation services within the community.

On how the fund will be disbursed to help home care patients, especially those who are not in touch with intermediate- and long-term care providers, Dr Khor said the Agency for Integrated Care will work with the operators to help spread awareness of the fund. The agency will also work with the grassroots organisations and Community Development Councils to publicise the fund among needy residents.

- CNA/xq

Read More..

Helicopter scam: I feel ashamed, taxpayers' money can't be wasted, Antony says

NEW DELHI: Defence minister AK Antony has said that the culprits in the VVIP helicopter scam will be punished and any company found guilty in the deal will be blacklisted.

Responding to the debate on the chopper deal in the Rajya Sabha on Wednesday, Antony said, "I feel ashamed of this scam.

"It's a matter of shame for us every time a scam is reported," Antony said, adding that I want to find the truth and punish the guilty.

The defence minister said that taxpayers' money can't be wasted and claimed that procedures were followed at all levels in the deal.

He stressed the need to get to the root of the scam.

Earlier, initiating a debate in the upper House, the BJP accused the government of delaying the probe into the VVIP helicopter deal and demanded that the money trail be traced so that those who received kickbacks could be punished.

BJP member Prakash Javadekar alleged that Rs 400 crore had been paid in kickbacks for the deal.

He said the country wants to know who "the family", referred to in documents of Italian investigators, was.

Javadekar said alleged middlemen including Guido Ralph Haschke, Karlo Valentino Ferdinando Gerosa and Christian Michel had received money in the deal; part of the money was sent to India through circuitous channels.

He said Italy had started a probe on how "corruption took place", though it was a country which benefited from the Rs 3,600-crore deal for the purchase of 12 VVIP helicopters from AgustaWestland.

Attacking the United Progressive Alliance government, Javadekar accused it of not acting on the voluminous documents on the deal prepared by Italian investigators.

He said the documents of the investigators twice mentioned "the family".

The CBI had on Monday registered a preliminary enquiry against 11 people, including former Indian Air Force chief SP Tyagi, and four companies, in the purchase of VVIP helicopters from AgustaWestland.

Besides Tyagi, the inquiry names his cousins Sanjeev alias 'Julie' Tyagi, Docsa Tyagi, Sandeep Tyagi, advocate Gautam Khaitan, formerly associated with Aeromatrix, and the company's CEO, Praveen Bakshi.

Others named in the inquiry include Orsi, Bruno Spagnolini, CEO of AgustaWestland -- a Britain-based subsidiary of Finmeccanica -- and alleged middlemen Guido Ralph Haschke, Karlo Valentino, Ferdinando Gerosa, and Christian Michel.

The firms named are Finmeccanica, AgustaWestland, IDS Infotech Ltd. (India) and Aeromatrix India.

A Central Bureau of Investigation (CBI) and defence ministry team last week went to Italy to collect documents concerning alleged kickbacks paid to clinch the deal.

The government had on February 15 initiated action for cancellation of the contract for procurement and issued a formal show cause notice to AgustaWestland seeking cancellation of contract.

Two days earlier, it put on hold further payments to the company.

The contract for purchase of 12 AW101 helicopters for the use of VVIPs was signed in 2010.
(Inputs from IANS)

Read More..

Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

____

Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

Read More..