Violence in cities; Mubarak deja vu?

CAIRO (Reuters) - Angry youths hurled rocks at security forces and burned a police truck as thousands gathered in central Cairo to protest at Egyptian President Mohamed Mursi's decision to grab sweeping new powers.

Police fired tear gas near Tahrir Square, heart of the 2011 uprising that toppled Hosni Mubarak at the height of the Arab Spring. Thousands demanded that Mursi should quit and accused him of launching a "coup".

There were also violent protests in Alexandria, Port Said and Suez.

Mursi on Thursday issued a decree that puts his decisions beyond any legal challenge until a new parliament is elected. Opponents immediately accused him of turning into a new Mubarak and hijacking the Egyptian revolution.

"This is the point of no return for Mursi. He has dug himself deeper in a hole and won't know how to get out of it," said Ahmed Saleh, an activist who said many would stay in Tahrir square until Mursi withdrew the decree.

"The people want to bring down the regime," shouted protesters in Tahrir, echoing a chant used in the uprising that forced Mubarak to step down.

The United States, the European Union and the United Nations expressed concern at Mursi's move.

Mursi's rivals condemned him as an autocratic pharaoh who wanted to impose his Islamist vision on Egypt.

The president's aides said the decree was intended to speed up a protracted transition to democracy that has been hindered by legal obstacles

"I am for all Egyptians," Mursi said on a stage outside the presidential palace, adding that he was working for social and economic stability and remained committed to the revolution.

JUDGES MEET

Egyptian judges will meet on Saturday to respond to Mursi's move, which put him above the judicial oversight. The judges could threaten to go on strike, which would bring the judiciary to a halt.

Some non-Islamist political parties called for a million-strong march on Tuesday to demand that Mursi rescinds his decree.

But Islamist parties, including the Building and Development Party, accused Mursi's opponents of undermining the democratic process that brought him to office.

"Those calling for the downfall of President Mohamed Mursi have rejected democracy because President Mursi has been democratically elected by popular will," the party said in a statement. Mursi's decree would "save the revolution from the remnants of Mubarak's regime", it said.

Buoyed by accolades from around the world for mediating a truce between Hamas and Israel in the Gaza Strip, Mursi on Thursday ordered that an Islamist-dominated assembly writing the new constitution could not be dissolved by legal challenges.

Mursi, an Islamist whose roots are in the Muslim Brotherhood, also gave himself wide powers that allowed him to sack the unpopular public prosecutor and opened the door for a retrial for Mubarak and his aides.

TURBULENCE AND TURMOIL

The president's decree has consolidated his power but looks set to polarize Egypt further, threatening more turmoil in a nation at the heart of the Arab Spring.

In Alexandria, north of Cairo, protesters ransacked an office of the Brotherhood's political party, burning books and chairs in the street. Supporters of Mursi and opponents clashed elsewhere in the city, leaving 12 injured.

A party building was attacked by stone-throwing protesters in Port Said, and demonstrators in Suez threw petrol bombs that burned banners outside the party building.

Although Washington has praised Egypt for its part in bringing Israelis and Palestinians to a ceasefire on Wednesday, it expressed reservations about Mursi's latest move.

"The decisions and declarations announced on November 22 raise concerns for many Egyptians and for the international community," State Department spokeswoman Victoria Nuland said in a statement.

The European Union urged Mursi to respect the democratic process, while the United Nations expressed fears about human rights.

"The decree is basically a coup on state institutions and the rule of law that is likely to undermine the revolution and the transition to democracy," said Mervat Ahmed, an independent activist in Tahrir protesting against the decree.

Leading liberal Mohamed ElBaradei, who joined other politicians on Thursday night to demand the decree was withdrawn, wrote on his Twitter account that Mursi had "usurped all state powers and appointed himself Egypt's new pharaoh".

Almost two years after Mubarak was toppled and about five months since Mursi took office, Egypt has no permanent constitution, which must be in place before new parliamentary elections are held.

An assembly drawing up the constitution has yet to complete its work. Many liberals, Christians and others have walked out accusing the Islamists who dominate it of ignoring their voices over the extent that Islam should be enshrined in the new state.

(Additional reporting by Tom Miles in Geneva and Sebastian Moffett in Brussels; Editing by Giles Elgood)

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Low wage protests target Walmart sales day

SECAUCUS, New Jersey: Protesters targeted Walmart stores across the United States on Friday, the busiest shopping day of the year, accusing the bargain superstore of ripping off its own employees.

The protests were designed to disrupt the Black Friday shopping frenzy after Thursday's Thanksgiving holiday, when deep discounts pull in waves of customers.

About 200 activists outside a huge Walmart in Secaucus, New Jersey chanted against what they called the dark side of the biggest US private employer, which has 1.3 million non-unionized workers, or "associates," as they're called. Critics say the average Walmart hourly wage is a meager $8.81, although the company says the figure is closer to $13.

"Walmart pushes wages down!" they chanted.

"I'm here because they should be paid a working wage, they should be able to buy things on Black Friday, not being forced to work on Thanksgiving," said Barry Kushnir, 43, a New Jersey road maintenance worker.

Protesters included unionized workers, street activists from the Occupy movement, a roller-skating woman in a Marie-Antoinette mini-dress, a faux pastor known for his anti-capitalist campaigns, and a lively brass band.

There did not appear to be any employees from the Walmart outlet, where the doors were open to a steady stream of shoppers, many reemerging with shopping carts piled high.

Jaclyn Kessel, one of the organizers of the demonstration, said Walmart employees "are afraid of getting fired" and she didn't expect any to come.

However, discontent at Walmart has become unusually visible this year, with strikes and protests planned in more than 100 cities, according to the United Food & Commercial Workers union, or UFCW, which is campaigning for Walmart employees.

The main force behind the demonstrations, the Organization United for Respect at Walmart (OUR Walmart), said it was pressuring for "decent pay, regular hours, affordable healthcare and respect."

The powerful UAW auto-workers union also came on board, saying that because of Walmart's size, the company "has enormous power to set the trends not just for the retail and service industries, but for the economy as a whole."

Another prominent supporter was Robert Reich, labour secretary under president Bill Clinton, who saw the debate over conditions at Walmart, owned by the multi-billionaire Walton family, as reflecting deeper problems in US society.

"The widening inequality reflected in the gap between the pay of Walmart workers and the returns to Walmart investors, including the Walton family, haunts the American economy," Reich wrote in a post to his blog titled, "Why You Shouldn't Shop at Walmart on Friday."

Walmart, which denies there are any widespread complaints, last week filed a complaint with the National Labor Relations Board to try to block the Black Friday protests.

On Friday, Walmart downplayed the controversy, saying in a statement that "only 26 protests occurred at stores last night and many of them did not include any Walmart associates."

In addition, Walmart US said it had its "best ever Black Friday events," featuring 1.8 million towels, 1.3 million televisions and 1.3 million dolls sold in the first hours.

In Secaucus, shoppers had to negotiate an increasingly thick crowd of protesters in the entrance, many of whom were dancing to the brass band, watched by a half-dozen patient police officers.

Drivers in several passing cars tooted horns in support, but most paid no attention to the disturbance.

Karen Mendoza, 30, expressed sympathy with the protesters as she went into Walmart with her 55-year-old mother, saying that the kind of low-end jobs the store offers are part of an increasingly unforgiving economy.

"With the economy today it's really, really hard to get a job anywhere," she said. "My mother works at a factory, she's been there for 27 years, and they're getting rid of people all the time. Now you're not enjoying work anymore."

The roller skating Marie-Antoinette figure, whose name is Marni Halasa, agreed.

"I'm here to support the low-wage worker. Basically, unless you come from money and have access, there's very little social mobility in America," Halasa, 46, said, before gliding away on her skates.

-AFP/ac

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Lost the battle but will win the war: Mamata Banerjee

KOLKATA: Mamata Banerjee on Friday brushed off the hurt of another failed Delhi mission, believing she would win the war even if she has lost the battle to topple the government through a no-confidence motion.

A day after she stood in isolation in national politics, with the Left Front chairman Biman Bose saying the Trinamool Congress chief was still "politically immature", Mamata put up a defiant face and tried to project her cause as one fought on ideals, not numbers. Not that she had too many numbers to play with — the motion could muster the support of just 21 MPs on Thursday, far short of the 50 needed for the motion to be admitted.

"I am not bothered about my defeat. I am happy that I have waged a war based on ideology and values. I will hold on to my principles till my last breath, and go down fighting for them no matter how tough the road ahead is," Mamata told her audience at Ashutosh College auditorium in Kolkata, speaking on the occasion of her alma mater Jogomaya Devi College completing 80 years. She also took refuge in Ramakrishna Paramhansa to explain her warfare of ideals, saying, "Don't forget to hiss once in a while, but don't bite."

The refrain of ideals were similar to those made earlier this year, when Mamata was outmanoeuvered by the Mulayam Singh Yadav when she opposed Pranab Mukherjee's presidential candidature. After a campaign on Facebook, Mamata eventually backed Mukherjee.

But the renewed confidence in Mamata could probably also be attributed to the deadlock in Parliament as the government refused to blink before the Left and BJP's demand for a vote on FDI in multi-brand retail, which both parties preferred over supporting the Trinamool's no-trust motion.

"There is no gurantee that the Manmohan Singh government will allow a discussion in Lok Sabha, followed by voting. They (Left and BJP) wouldn't have to labour so much to initiate a discussion on FDI if they had supported our no-confidence notice," Trinamool Parliamentary Party leader Sudip Bandyopadhyay said.

Whatever the consequence, Mamata said she won't budge an inch from her policies — be it FDI or land acquisition.

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AP PHOTOS: Simple surgery heals blind Indonesians

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

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

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

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

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

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

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

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

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

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Black Friday: Bargains, Brawls and Gunfire

Two people were shot outside a Walmart in Florida today, one of a rash of fights, robberies and other incidents that have cropped up on one of the most ballyhooed shopping days of the year.

The shooting took place at Walmart in Tallahassee about 12:30 p.m., said Dave Northway, public information officer for the Tallahassee Police Department.

He said a scuffle outside the store escalated into gunplay leaving two people shot. The two victims, whose names and genders have not been released, suffered non-life threatening injuries.

Police do not have a suspect at this time.

At a Walmart parking lot on Thanksgiving night in Covington, Wash., two people were run down by a driver police suspected of being intoxicated.

The 71-year-old driver was arrested on a vehicular assault charge after the incident, spokeswoman Sgt. Cindi West of the Kings County Sheriff's Office said.

The female victim, whose identity has yet to be released, was pinned beneath the driver's Mercury SUV until being rescued by the fire department. She was flown to Harborview Medical Center, where she was listed in serious condition, West said.

The male victim was also taken to Harborview Medical Center, where, West said, he was listed in good condition.

Shoppers Descend on Black Friday Deals

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Tensions were high at the entrances as people lined up outside stores, waiting for the doors to open.

At a San Antonio, Texas, Sears, one man argued with customers and even punched one in order to get to the front of the line, prompting a man with a concealed carry permit to pull a gun, said Matthew Porter, public information officer of the San Antonio Police Department.

"It was a little chaotic. People were exiting the store," Porter said. "Fortunately for us, officers responded quickly and were able to ease the commotion."

The man who allegedly caused the altercation fled the scene and remains at large, Porter said. The shopper who pulled the gun will not face charges, he said, because of his concealed carry permit.

One man was treated at the scene for injuries sustained when people rushed out of the store, Porter said.

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The crush of shoppers in the middle of the night were prey once again this year for thieves, who hid out in parking lots.

In Myrtle Beach, S.C., a woman said a man pulled a gun on her just as she exited her car to go inside a Best Buy store. The thief made off with $200, according to a police report.

In Maryland, 14-year-old boy told police he was robbed of his Thanksgiving night purchases by five men in the parking lot of a Bed Bath and Beyond store early this morning, the Baltimore Sun reported.

And in Massachusetts, Kmart employees tried to locate a shopper over the intercom after a 2-year-old was reported to be alone in a car, ABC News affiliate WCVB-TV reported.

Police arrived to break into the car and remove the child. The boy's caretaker, his mother's boyfriend, denied the incident took place, according to the station, and was not arrested.

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Gaza ceasefire holds but mistrust runs deep

GAZA/JERUSALEM (Reuters) - A ceasefire between Israel and Hamas held firm on Thursday with scenes of joy among the ruins in Gaza over what Palestinians hailed as a victory, and both sides saying their fingers were still on the trigger.

In the sudden calm, Palestinians who had been under Israeli bombs for eight days poured into Gaza streets for a celebratory rally, walking past wrecked houses and government buildings.

But as a precaution, schools stayed closed in southern Israel, where nerves were jangled by warning sirens - a false alarm, the army said - after a constant rain of rockets during the most serious Israeli-Palestinian fighting in four years.

Israel had launched its strikes last week with a declared aim of ending rocket attacks on its territory from Gaza, ruled by the Islamist militant group Hamas, which denies Israel's right to exist. Hamas had responded with more rockets.

The truce brokered by Egypt's new Islamist leaders, working with the United States, headed off an Israeli invasion of Gaza.

It was the fruit of intensive diplomacy spurred by U.S. President Barack Obama, who sent his secretary of state to Cairo and backed her up with phone calls to Israeli Prime Minister Benjamin Netanyahu and Egyptian President Mohamed Mursi.

Mursi's role in cajoling his Islamist soulmates in Gaza into the U.S.-backed deal with Israel suggested that Washington can find ways to cooperate with the Muslim Brotherhood leader whom Egyptians elected after toppling former U.S. ally Hosni Mubarak, a bulwark of American policy in the Middle East for 30 years.

Mursi, preoccupied with Egypt's economic crisis, cannot afford to tamper with a 1979 peace treaty with Israel, despite its unpopularity with Egyptians, and needs U.S. financial aid.

MORE DEATHS

Despite the quiet on the battlefield, the death toll from the Gaza conflict crept up on both sides.

The body of Mohammed al-Dalu, 25, was recovered from the rubble of a house where nine of his relatives - four children and five women - were killed by an Israeli bomb this week.

That raised to 163 the number of Palestinians killed, more than half of them civilians, including 37 children, during the Israeli onslaught, according to Gaza medical officials.

Nearly 1,400 rockets struck Israel, killing four civilians and two soldiers, including an officer who died on Thursday of wounds sustained the day before, the Israeli army said.

Israel dropped 1,000 times as much explosive on the Gaza Strip as landed on its soil, Defense Minister Ehud Barak said.

Municipal workers in Gaza began cleaning streets and removing the rubble of bombed buildings. Stores opened and people flocked to markets to buy food.

Jubilant crowds celebrated, with most people waving green Hamas flags but some carrying the yellow emblems of the rival Fatah group, led by Western-backed President Mahmoud Abbas.

That marked a rare show of unity five years after Hamas, which won a Palestinian poll in 2006, forcibly wrested Gaza from Fatah, still dominant in the Israeli-occupied West Bank.

Israel began ferrying tanks northwards, away from the border, on transporters. It plans to discharge gradually tens of thousands of reservists called up for a possible Gaza invasion.

But trust between Israel and Hamas remains in short supply and both said they might well have to fight again.

"The battle with the enemy has not ended yet," Abu Ubaida, spokesman of Hamas's armed wing Izz el-Deen Al-Qassam Brigades, said at an event to mourn its acting military chief Ahmed al-Jaabari, whose killing by Israel on November 14 set off this round.

"HANDS ON TRIGGER"

The exiled leader of Hamas, Khaled Meshaal, said in Cairo his Islamist movement would respect the truce, but warned that if Israel violated it "our hands are on the trigger".

Netanyahu said he had agreed to "exhaust this opportunity for an extended truce", but told Israelis a tougher approach might be required in the future.

Facing a national election in two months, he swiftly came under fire from opposition politicians who had rallied to his side during the fighting but now contend he emerged from the conflict with no real gains for Israel.

"You don't settle with terrorism, you defeat it. And unfortunately, a decisive victory has not been achieved and we did not recharge our deterrence," Shaul Mofaz, leader of the main opposition Kadima party, wrote on his Facebook page.

In a speech, Ismail Haniyeh, Hamas's prime minister in Gaza, urged all Palestinian factions to respect the ceasefire and said his government and security services would monitor compliance.

According to a text of the agreement seen by Reuters, both sides should halt all hostilities, with Israel desisting from incursions and targeting of individuals, while all Palestinian factions should cease rocket fire and cross-border attacks.

The deal also provides for easing Israeli curbs on Gaza's residents, but the two sides disagreed on what this meant.

Israeli sources said Israel would not lift a blockade of the enclave it enforced after Hamas won a Palestinian election in 2006, but Meshaal said the deal covered the opening of all of the territory's border crossings with Israel and Egypt.

Israel let dozens of trucks carry supplies into the Palestinian enclave during the fighting. Residents there have long complained that Israeli restrictions blight their economy.

Barak said Hamas, which declared November 22 a national holiday to mark its "victory", had suffered heavy military blows.

"A large part of the mid-range rockets were destroyed. Hamas managed to hit Israel's built-up areas with around a metric tone of explosives, and Gaza targets got around 1,000 metric tonnes," he said.

He dismissed a ceasefire text published by Hamas, saying: "The right to self-defense trumps any piece of paper."

He appeared to confirm, however, a Hamas claim that the Israelis would no longer enforce a no-go zone on the Gaza side of the frontier that the army says has prevented Hamas raids.

(Additional reporting by Noah Browning in Gaza, Ori Lewis, Crispian Balmer and Dan Williams in Jerusalem; Writing by Jeffrey Heller and Alistair Lyon; Editing by Giles Elgood)

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Football: Stalemates mean Liverpool, Spurs must wait

PARIS: Five-time European champions they may be but Liverpool must wait before they can take their place in the last 32 of the Europa League after allowing Swiss side Young Boys to draw 2-2 at Anfield on Thursday.

A much-changed Liverpool side - coach Brendan Rodgers left Luis Suarez and Steven Gerrard on the bench to begin with - let the Swiss off the hook after Jonjo Shelvey and the recalled Joe Cole had scored to sandwich a riposte from Raul Bobadilla.

With just two minutes remaining Elsad Zverotic had the 2,500-strong visiting contingent on their feet as he thrashed a fine strike past Pepe Reina, the Spaniard beating Ray Clemence's European goalkeeping appearances record in Europe in his 81st game.

"Conceding a late goal is disappointing," said Cole.

"It was just game management at the end, to see the game out, which let us down. We've got a lot of young lads on the pitch, but we should have seen the game out."

Rodgers was likewise frustrated.

"We didn't control the game well in the final few minutes. But it's another point and we can still control our own destiny. It makes it harder than we would have liked."

The draw means Liverpool may need to win their final game at Udinese as Young Boys joined the Merseysiders on seven points.

Russia's Anzhi Makhachkala are already through from Group A after Cameroon striker Samuel Eto'o scored in a 2-0 success over Udinese.

Tottenham could only draw 0-0 at Lazio - who qualify - meaning they also have to gain a point in their final game at home to Panathinaikos, who trail the Londoners by two points.

Former England star Paul Gascoigne, who played for both clubs with distinction, was close to tears as he received an ovation on attending the game in the Italian capital.

Lazio fans hailed him as a "lionheart" and "still our hero" on his return to the city where he spent three seasons.

Another English Premier League side, Newcastle, did book their passage, however, despite being held to a 1-1 draw at home by Portugal's Maritimo after Fidelis levelled Sylvain Marveaux's opener for the Magpies.

Bordeaux of France join Newcastle in the hat for the last 32 after a 2-1 win at Belgium's Brugge.

Joey Barton finished on the losing side as Marseille of France went down 1-0 at home to Fenerbahce of Turkey, who win Group C while Borussia Moenchengladbach also advanced after seeing of Cypriot side AEL Limassol 2-0.

Holders Atletico Madrid and Viktoria Plzen are through from Group B after a win over Israel's Hapoel Tel Aviv and a draw at Coimbra respectively and Group F is cut and dried with Dnipropetrovsk and Napoli through, PSV Eindhoven losing out.

Group H sees Rubin Kazan advance with former European champions Inter Milan, despite the latter going down 3-0 in Russia.

Other sides through include Metalist Kharkov of Ukraine, Germany's Bayer Leverkusen, Lyon, Genk of Belgium, Hanover of Germany and Spain's Levante.

There is still all to play for in Group E after Stuttgart won 5-1 at leaders Steaua Bucharest, whom they now trail by two points with FC Copenhagen a point further back and in contention after a 2-1 at Norway's Molde.

The 24 group qualifiers will be joined by eight teams who finish third in the Champions League group stages.

-AFP/ac

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7-year-old battles for life after circumcision in hospital

ALWAR: A seven-year-old boy is battling for life after a circumcision surgery went horribly wrong at a private hospital in Alwar on Thursday. The boy's genitals had to be cut off in an attempt to save his life, said sources. An FIR has been lodged against the hospital authorities after the relatives of the boy created a ruckus.

The boy, Imran, was admitted to Sania hospital in Alwar town on November 10 for circumcision. According to sources, after the operation, some equipment was used to prevent bleeding. However, electric current accidentally passed into his private parts and the boy suffered serious injury. On November 13, the boy was referred to a private hospital in Jaipur. After investigating the case, the doctors in Jaipur advised the boy's relatives to remove his genitals as it was necessary to save his life. The operation was conducted and his genitals were removed. Three days after the operation, the boy was again admitted to Sania hospital in Alwar.

The boy is now fighting for life while his relatives are protesting outside the hospital in Alwar.

Imran's grandfather Ayub Khan said: "The circumcision was carried out by Dr Tayyab Khan, a physician at Sania Hospital. He is not a surgeon. The licence of the hospital should be cancelled for carelessness."

Imran's uncle Fakruddin Khan said that the operation was to be completed in just 30 minutes but the doctors took four hours. "Two days after the circumcision, the doctors advised us to take the boy to Jaipur. When we took the boy to Jaipur, the doctors there immediately informed us that the boy's private parts were completely damaged and his genitals had to be removed. After operation, we tried to admit the boy in different hospitals but no hospital admitted him. The last option for us was Sania hospital. So we brought him here back after his genitals were removed in Jaipur."

However, denying the allegation, Dr Tayyab Khan said the circumcision was carried out by a surgeon Hariram Gupta. He said it was just an accident.

Former minister Nasru Khan also reached the spot to calm down the situation but all his efforts went in vain. Nasru Khan and the protestors were involved in a heated argument at the spot. The protestors alleged that he was taking the side of the hospital.

The hospital administration assured the relatives of the boy that the hospital would bear the expenses of the boy's treatment.

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Study finds mammograms lead to unneeded treatment

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

___

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

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2 Dead, Dozens to Hospital After 100-Car Pileup

At least two people died and more than 80 were injured after a 100-plus car pileup in Texas today, according the Department of Public Safety.

A man and a woman died from their injuries, ABC News affiliate KBMT-TV reported. Their names were not immediately available.

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The DPS said it won't know the exact number of cars involved in the pileup until officials finish untangling the wrecks.

At least five people who were taken to the hospital are in critical condition, KBMT reported.

The accident happened in Jefferson County shortly after 8 a.m. Thanksgiving morning on Interstate 10 between Taylor Bayou and Hampshire Road. There was reportedly dense fog in the area at the time of the initial crash.

An 18-wheeler tanker truck began leaking after the chain-reaction accident, KBMT reported.

The eastbound side of the freeway will remain closed for another six hours at least, DPS told ABC News. The westbound lanes opened shortly after noon.

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