Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand name version of tamoxifen.

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Northridge shooting probe yields more arrests, sources say

Los Angeles Police Department detectives have made additional arrests in connection with a quadruple homicide in Northridge, sources familiar with the investigation said.

The sources would not immediately identify the suspects nor would they detail what offenses they were arrested for. One of the arrests took place in Las Vegas overnight; it was not clear where the others occurred.

Sources familiar with the investigation said the killings appeared to stem from a dispute over personal property, although they would not say what kind of items were involved.

Los Angeles City Councilman Mitchell Englander said one of the suspects was believed to have lived in the illegal boardinghouse where the shootings occurred. Englander stressed that the information came from people briefed on the case but outside the LAPD.

A news conference is planned for later Tuesday, when the LAPD is expected to reveal more information about the case.

Officers responded to the home in the 17400 block of Devonshire Street about 4:25 a.m. Sunday after a 911 caller reported yelling and shots fired, police said. Authorities found four people -- two men and two women -- shot dead outside.

No weapon was recovered at the home, prompting police to rule out a murder-suicide. Three of the victims -- a man and two women -- were shot on the walkway on the left side of the home, a source familiar with the case told The Times on Monday. They were all wearing hooded sweat shirts and were about two feet apart from one another. All three had at least one bullet wound to the head.

One victim was crumpled on her knees, the source said, her face buried in the palms of her hands, "almost like she was praying." The other two victims on the walkway were face down.

The fourth victim -- a man -- was farther away and appeared as if he was trying to run to the backyard when he was shot. He had at least one gunshot wound, according to the source.

"It looked like a quick kill," said the source, who spoke on the condition of anonymity because the case is ongoing.

The names of the victims have not been released. Police said the women were in their mid-20s; one man was in his mid-30s and the other man in his late 40s.

Authorities said the home was an illegal boardinghouse, with up to 17 people living in conditions that Englander described as "deplorable." The home had so much debris and so many partitions that one room could be accessed only through a window, he said.

A trail of extension cords led investigators to the backyard, where several makeshift living quarters had been assembled.

The owner of the home, Yag Kapil, said he rented out rooms but denied he was running a boardinghouse. Kapil, 78, who lives at the home, said he is bedridden and was sleeping at the time of the shootings. He said he didn't hear anything and didn't know the victims.

The slayings stunned the quiet Northridge street, which residents said was the kind where neighbors knew one another and walked to the grocery store or synagogue nearby.

"It's usually sleepy-time America," said Richard Rutherford, 58, who was awakened by the gunfire. The violent-crime rate for Northridge falls in the middle of all Los Angeles neighborhoods, but homicide is rare in the community, according to LAPD data analyzed in The Times' Crime L.A. database. In the previous six months, Northridge had one homicide out of the 89 violent crimes reported.

Since 2007 and before Sunday's quadruple homicide, Northridge had 11 homicides, 10 of them south of Nordhoff Street. The location of Sunday's slayings is on the border with Granada Hills, which typically has a much lower violent-crime rate than Northridge.

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32% of Young People Use Social Media in the Bathroom

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Huston's "Infrared" wins Bad Sex fiction prize

LONDON (AP) — It's the prize no author wants to win.

Award-winning novelist Nancy Huston won Britain's Bad Sex in Fiction award Tuesday for her novel "Infrared," whose tale of a photographer who takes pictures of her lovers during sex proved too revealing for the judges.

The choice was announced by "Downton Abbey" actress Samantha Bond during a ceremony at the Naval & Military Club in London.

Judges of the tongue-in-cheek prize — which is run by the Literary Review magazine — said they were struck by a description of "flesh, that archaic kingdom that brings forth tears and terrors, nightmares, babies and bedazzlements," and by a long passage that builds to a climax of "undulating space."

Huston, who lives in Paris, was not on hand to collect her prize. In a statement read by her publicist, the 59-year-old author said she hoped her victory would "incite thousands of British women to take close-up photos of their lovers' bodies in all states of array and disarray."

The Canada-born Huston, who writes in both French and English, is the author of more than a dozen novels, including "Plainsong" and "Fault Lines." She has previously won France's Prix Goncourt prize and was a finalist for Britain's Orange Prize for fiction by women.

She is only the third woman to win the annual Bad Sex prize, founded in 1993 to name and shame authors of "crude, tasteless and ... redundant passages of sexual description in contemporary novels."

Some critics, however, have praised the sexual passages in "Infrared." Shirley Whiteside in the Independent on Sunday newspaper said there were "none of the lazy cliches of pornography or the purple prose of modern romantic fiction" — though she conceded the book's sex scenes were "more perfunctory than erotic."

Huston beat finalists including previous winner Tom Wolfe — for his passage in "Back to Blood" describing "his big generative jockey" — and Booker Prize-nominated Nicola Barker, whose novel "The Yips" compares a woman to "a plump Bakewell pudding."

Previous recipients of the dubious honor, usually accepted with good grace, include Sebastian Faulks, the late Norman Mailer and the late John Updike, who was awarded a Bad Sex lifetime achievement award in 2008.

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Online: http://www.literaryreview.co.uk

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Stocks close lower as budget talks continue

Stocks are closed slightly lower on Wall Street as budget talks continue in Washington.

The Dow Jones industrial average fell 14 points to close at 12,952 Tuesday. It traded in a narrow range of just 82 points.

The Standard and Poor's 500 index lost two points to 1,407. The Nasdaq composite was down five and a half points at 2,997.

Investors are waiting on developments from Washington in the budget talks, which are aimed at avoiding a series of sharp government spending cuts and tax increases that begin to kick in Jan. 1.

Big Lots soared after the discount retailer raised its forecast for full-year profits.

Falling stocks narrowly outnumbered rising ones on the New York Stock Exchange. Volume was light at 3.2 billion shares.

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Two Mexican nationals charged in killing of U.S. Coast Guardsman

Federal prosecutors charged two Mexican nationals in connection with killing U.S. Coast Guardsmen Terrell Horne III after they allegedly rammed his vessel with a drug-smuggling panga boat.

The two men, boat captain Jose Mejia-Leyva and Manuel Beltra-Higuera, are expected to appear in court Monday afternoon to face charges that they killed a federal officer.

Horne, 34, of Redondo Beach, was killed Sunday after suspected smugglers in a panga rammed his vessel off the Ventura County coast. He died of severe head trauma, officials said.

The Redondo Beach resident was second in command of the Halibut, an 87-foot patrol cutter based in Marina del Rey. Authorities said they could not recall a Coast Guard chief petty officer being killed in such a manner off the coast of California.

Early Sunday morning, the Halibut was dispatched to investigate a boat operating near Santa Cruz Island, the largest of California's eight Channel Islands. The island is roughly 25 miles southwest of Oxnard.

The boat, first detected by a patrol plane, had come under suspicion because it was operating in the middle of the night without lights and was a "panga"-style vessel, an open-hulled boat that has become "the choice of smugglers operating off the coast of California," said Coast Guard spokesman Adam Eggers.

The Coast Guard cutter contains a smaller boat, a rigid-hull inflatable used routinely for search-and-rescue operations and missions that require a nimble approach. When Horne and his team approached in the inflatable, the suspect boat gunned its engine, maneuvered directly toward the Coast Guard inflatable, rammed it and fled.

The impact knocked Horne and another guardsman into the water. Both were quickly plucked from the sea. Horne had suffered a traumatic head injury. While receiving medical care, he was raced to shore aboard the Halibut. Paramedics met the Halibut at the pier in Port Hueneme and declared Horne dead at 2:21 a.m.

The second crew member knocked into the water suffered minor injuries and was treated and released from a hospital later Sunday. He was not identified.

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Four Things Google’s Nexus 4 Has in Common with the iPhone 4

Besides being each company’s flagship smartphone (and having the number 4 in their names), Google‘s new Nexus 4 and the 2010 iPhone 4 have a fair bit in common with each other.

This could be a good thing, if you remember just how popular the iPhone 4 was. Unfortunately, in this case it’s more of a bad thing, and hearkens back to “Antennagate” and the iPhone 4′s other problems. Do any of these features remind you of anything?

​A glass back

With the iPhone 5, Apple finally moved from a crack- and scratch-prone glass backplate to a solid, aluminum unibody construction. Google doesn’t seem to have gotten the memo that the former may have been a bad idea, however, and the Nexus 4 has a sparkly glass back surface.

While sparkly things obviously have their fans, the Nexus 4′s chassis also seems to lean towards the brittle side. Joshua Topolsky, who reviewed the Nexus 4 for The Verge, managed to crack the glass when he accidentally knocked his phone off the table. Meanwhile, Droid-Life’s Kellex found that setting the phone on a stone countertop caused its glass back to fracture in two.

​No 4G

Even Topolsky’s glowing review of the Nexus 4 said “It feels slow,” and “There’s simply no way to ignore this deficit.” That’s because, like the iPhone 4, the Nexus 4 lacks a 4G radio (even though it has the chip to support one if it had it).

The iPhone 4, however, was released in 2010, when 4G was still a new thing and the Android “superphones” which supported it had enormous screens and horrible battery life. Today, even the iPhone has 4G. Possibly because of bad blood between Google and the wireless carriers, which appear to resent Google’s selling phones unsubsidized and sans “customizations,” the Nexus 4 does not.

​Selling out fast

Every one of Apple’s iPhone models has sold out faster, and more dramatically, than the one before. Google’s Android devices, in contrast, haven’t tended to do so … although the new Nexus smartphones and tablets are starting to have this problem.

How bad is it? After Google finally got a new wave of Nexus 4s up for sale, they sold out in about a half-hour. Google claims that it hasn’t actually sold out, but even if you spotted the Nexus 4 on Google Play, chances are you ran into technical glitches which kept it out of your shopping cart. Tipster “Syko Pompos” told the Android Police blog how to get around this and place your order, but expect to wait months to receive it.

​Public relations nightmares

It hasn’t quite reached Antennagate levels yet, perhaps partly because the Nexus brand isn’t as well-known as the iPhone (the iPhone 4′s antenna problems were actually shared by many smartphones). But most of the press coverage of the Nexus 4 lately has been about how you can’t get one. Or else, how if you want one you’ll have to either buy it on contract or pay a lot more to get it unsubsidized from T-Mobile.

On the plus side (for the Nexus), this problem is only partly caused by the Google Play store’s technical errors. The biggest reason it’s taking so long to get out to people is, like with the iPhone 4, simply how popular it is.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

Linux/Open Source News Headlines – Yahoo! News

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Additional copies of 'Lincoln' headed to theaters

LOS ANGELES (AP) — "Lincoln" is marching to more movie theaters.

Disney, which distributed the DreamWorks film, is making additional prints of director Steven Spielberg's historical saga starring Daniel Day-Lewis to meet an unexpected demand that has left some moviegoers in Alaska out in the cold.

"To say that we're encouraged by the results to date or that they've exceeded our expectations is an understatement," said Dave Hollis, head of distribution at the Walt Disney Co. "We're in the midst of making additional prints to accommodate demand and will have them available to our partners in exhibition by mid-December for what we hope will be a great run through the holiday and awards corridor."

The film, which opened in wide release Nov. 9 and has earned $83.6 million in North America so far, has been unavailable at some smaller venues, such as the Gross Alaska theaters in Juneau.

But the extra prints are coming a little too late to fit the movie into the five-screen Glacier Cinemas theater during the holiday season, said Kenny Solomon-Gross, general manager of the Gross Alaska, which runs two theaters in Juneau and one in Ketchikan, Alaska.

"When we had the room for 'Lincoln,' Disney didn't have a copy for us," Solomon-Gross said Monday.

His film lineup is pretty booked through the end of the year, and he probably can't screen "Lincoln" until after the first of the new year. Yes, the excitement over the film will have dimmed, but then the Academy Awards season will be stirring up, he said. That should kick up the buzz.

In the meantime, Solomon-Gross plans to head to Las Vegas this week and catch the film there.

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Follow AP Entertainment Writer Derrik J. Lang on Twitter at http://www.twitter.com/derrikjlang . Associated Press writer Rachel D'Oro in Anchorage, Alaska, contributed to this report.

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Online:

http://www.thelincolnmovie.com

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Global Update: GlaxoSmithKline Tops Access to Medicines Index

Sang Tan/Associated Press

GlaxoSmithKline hung on to its perennial top spot in the new Access to Medicines Index released last week, but its competitors are closing in.

Every two years, the index ranks the world’s top 20 pharmaceutical companies based on how readily they get medicines they hold patents on to the world’s poor, how much research they do on tropical diseases, how ethically they conduct clinical trials in poor countries, and similar issues.

Johnson & Johnson shot up to second place, while AstraZeneca fell to 16th from 7th. AstraZeneca has had major management shake-ups. It did not do less, but the industry is improving so rapidly that others outscored it, the report said.

The index was greeted with skepticism by some drugmakers when it was introduced in 2008. But now 19 of the 20 companies have a board member or subcommittee tracking how well they do at what the index measures, said David Sampson, the chief author.

The one exception was a Japanese company. As before, Japanese drugmakers ranked at or near the index’s bottom, and European companies clustered near the top. Generic companies — most of them Indian — that export to poor countries are ranked separately.

Johnson & Johnson moved up because it created an access team, disclosed more and bought Crucell, a vaccine company.

The foundation that creates the index now has enough money to continue for five more years, said its founder, Wim Leereveld, a former pharmaceutical executive.

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Chinese units of 5 big U.S. audit firms charged

WASHINGTON — Federal regulators have charged the Chinese affiliates of five of the biggest U.S. accounting firms with impeding the government's investigation of Chinese companies by refusing to turn over documents.

The Securities and Exchange Commission said Monday it has started proceedings against the Chinese affiliates of all so-called Big Four accounting firms — Deloitte, Ernst & Young, KPMG and PricewaterhouseCoopers — and a fifth major firm, BDO.

Hundreds of Chinese companies trade on U.S. stock exchanges. The SEC has been investigating many of them for possible accounting fraud. The agency says the accounting firms, which audit Chinese companies, have refused to cooperate in investigations of nine companies and to provide documents.

The Chinese affiliates of the firms, which are subject to Chinese law, say they cannot hand over the documents because the Chinese government won't allow them to do so, and could penalize them if they do. The Chinese government maintains that providing the documents to U.S. regulators would violate Chinese sovereignty and its secrecy laws.

In statements Monday, some of the Chinese affiliates said they hoped the issue could be resolved in negotiations between Chinese and U.S. authorities.

Ernst & Young Hua Ming said "We hope that an agreement can be reached between U.S. and Chinese regulators that will enable our compliance with all applicable laws and regulations."

"While it is unfortunate that the two countries have not yet been able to find common ground on these issues, we remain hopeful that a diplomatic agreement can be reached," Deloitte Touche Tohmatsu said in its statement.

And PwC China said that it "has cooperated with the SEC at every opportunity" but that it will, and must, comply with Chinese law.

Representatives for the affiliates of KPMG and BDO could not immediately be reached for comment.

SEC Enforcement Director Robert Khuzami said the agency needs to have access to the documents in order to verify the accuracy of the firms' audits and protect investors from accounting fraud. "Firms that conduct audits knowing they cannot comply with laws requiring access to these work papers face serious sanctions," he said in a statement.

The SEC's case against the firms' affiliates will go before an administrative law judge at the agency. If the judge rules in favor of the SEC, the judge will determine what sanctions the affiliates could face.

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