French politicians argue over who 'owns' Joan of Arc

In an election year Joan of Arc represents 600-year-old values that fit political messages on both sides of the aisle.

? A local, slice-of-life story from a Monitor correspondent.

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France is celebrating 600 years of its most famous daughter, Joan of Arc. A young peasant girl hearing heavenly voices, fierce yet compassionate and rising as a military leader to end a foreign siege, Joan of Arc still retains a hold on the French imagination.

Starting as a nobody, she broke nearly every 15th-century gender barrier. In 2012 she?s a Christian heroine in a secular state: For the right, a holy warrior of the sacred soil; on the left, a brave iconoclast fighting corrupt elites.

Now in Orl?ans, where in 1429 she instructed French generals how to kick out the British in nine days, there?s a year of conferences, films, art, music, and parades.

But a fight is brewing. In France, culture is politics, and this is an election year. Nationalists have long claimed Joan as theirs. She?s an icon for the far-right National Front, run by Marine Le Pen.

So on Joan?s official birthday, Jan. 6, President Nicolas Sarkozy visited Joan?s birthplace. ?Joan belongs to no party, to no faction, to no clan,? Mr. Sarkozy said. Ms. Le Pen retorted that Sarkozy had abandoned Joan?s values, as well as French national sovereignty, seen in the ?Islamization? of France.

So it goes. What remains outside politics for the French is a life that got the attention of Shakespeare and Mark Twain alike.

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Source: http://rss.csmonitor.com/~r/csmonitor/globalnews/~3/ejU6ikYa4R0/French-politicians-argue-over-who-owns-Joan-of-Arc

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Video: Carly Fiorina: Cut Small Business Slack

"We need to fix the things that are making it hard for the people who create jobs, starting with small business," says Carly Fiorina, former Hewlett-Packard chairman/CEO/National Republican Senatorial Committee vice chair. Fiorina says taxing the wealt...

Source: http://video.msnbc.msn.com/cnbc/46145777/

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LMFAO Joining Madonna At Super Bowl?

Will.i.am says party rockers will perform with Queen of Pop for halftime show on February 5.
By Gil Kaufman


LMFAO
Photo: Steven Lawton/ FilmMagic

It's a good thing the Super Bowl provides its halftime performer with the biggest platform in television, because according to the latest rumors Madonna is going to need a seriously massive stage to hold all her guests at the February 5 game.

Following reports that Nicki Minaj and M.I.A. as well as "The Voice" coach Cee Lo Green may make appearances comes news that LMFAO could be called off the bench also.

A year after his group, the on-hiatus Black Eyed Peas, played the big game,
 will.i.am told English radio station Capital FM that his party-rocking homies will be in the mix. "I'm going to the Super Bowl this year to see my group LMFAO perform with Madonna," he said. "Check that out, Will.i.am Music Group is pretty freaking two for two! One year the Super Bowl, the next year another group part of the Super Bowl in collaboration with Madonna. That's still happening."

According to sources, Madonna asked Green to perform with her at the showdown in Indianapolis between the New York Giants and the New England Patriots, which is traditionally the most-watched TV event of the year. TheInsider.com reports that he's been flying to New York to rehearse with the pop icon. The sources add that he will contribute his signature flair to some of her classic tunes.

The pairing would make sense given that the new season of "The Voice" premieres right after the Super Bowl next month. MTV News caught up with the Queen of Pop at her "W.E." premiere earlier this week in New York, and the singer only had one tease about the Super Bowl gig. "I am not saying 'Yes,' and "I am not saying yes and I am not saying no," she replied when asked whether Minaj and M.I.A. will join her onstage, adding, "Pom-poms. That's all I can tell you."

As if the pom-poms and all the alleged guests aren't enough, the halftime show will be "imagined" by trippy Canadian circus troupe Cirque du Soleil and Madonna's longtime choreographer and creative director Jamie King. According to reports, the set list could include Madonna's new single, "Give Me All Your Luvin," as well as such classics as "Ray of Light," "Vogue" and "Music."

In addition to her Super Bowl performance, Madonna's fans are awaiting the release of her next studio album, M.D.N.A., out later this year.

Related Artists

Source: http://www.mtv.com/news/articles/1678014/lmfao-madonna-super-bowl-halftime.jhtml

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Costume designer Eiko Ishioka has died at 73 (AP)

NEW YORK ? Eiko Ishioka, a bold, Academy Award-winning visual artist whose surreal and sensual costumes were worn by Broadway actors, Olympic athletes, Cirque du Soleil performers and movie stars like Jennifer Lopez, has died in Tokyo. She was 73.

Her studio manager, Tracy Roberts, said Thursday that the designer died of pancreatic cancer.

Ishioka, who also worked in advertising and other graphic arts, won the 1992 Academy Award for Best Costume Design for the film "Bram Stoker's `Dracula,'" directed by Francis Ford Coppola. Her dreamlike, billowing designs were featured in the 2001 film "The Cell," staring Lopez.

She won a Grammy Award in 1986 for her cover design of Miles Davis' album "Tutu" and she directed the music video for the single "Cocoon" from Bjork's album "Vespertine." She also won the 1985 Cannes Film Festival Award for Artistic Contribution for her production design work on the Paul Schrader film "Mishima."

Ishioka, who died Saturday, was the director of costume design for the opening ceremony of the 2008 Summer Olympics in Beijing and designed racing uniforms and outerwear for the 2002 Winter Olympic Games in Salt Lake City.

A graduate of Tokyo National University of Fine Arts and Music, she became the first woman to be elected a member of the Tokyo Art Directors Club. She opened her own design studio in 1970 and was known for a bold, thought-provoking style even when advertising Japanese shopping complexes.

In 1983, she published a retrospective of her graphic design and art direction work entitled "Eiko by Eiko." She also wrote the book "Eiko on Stage," which focuses on her stage and screen work.

On Broadway, she made the sets and costumes for David Henry Hwang's 1988 Tony Award-winning drama "M. Butterfly," which earned her two Tony Award nominations for scenic design and costume design. She also tried her hand at opera with her costume design for Richard Wagner's "Ring Cycle" at the Netherlands National Opera.

She designed over 130 costumes for the Cirque du Soleil show "Varekai" and was the visual artistic director for a David Copperfield show on Broadway in 1996. Her comic book inspired costumes can currently be seen in "Spider-Man: Turn Off the Dark."

"Her work will continue to touch audiences for years to come," said "Spider-Man" producers Michael Cohl and Jeremiah J. Harris said in a joint statement, adding that Thursday's performance would be dedicated to her memory.

She was honored in 1992 to be named to the Hall of Fame by the Art Directors Club Hall of Fame. Her work can be seen at museums including the Museum of Modern Art in New York.

___

Entertainment Writer Frazier Moore contributed to this report.

Source: http://us.rd.yahoo.com/dailynews/rss/obits/*http%3A//news.yahoo.com/s/ap/20120126/ap_en_mu/us_obit_ishioka

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Obama speech echoes in town with failed factory (AP)

MOBERLY, Mo. ? After 19 years running state unemployment offices across northern Missouri, Steve Moore can rattle off the names of shuttered factories in this old railroad town with ease.

There's Matcor Automotive, a parts manufacturer that at its peak employed 300 workers but closed in June 2010 in response to declining production by General Motors. Textbook publisher Scholastic Inc. is closing its Moberly packaging center, costing the town another 100 jobs.

Then there's the biggest blow of all: the failed promises of Mamtek U.S. Inc., a Chinese-owned artificial sweetener factory offered about $17 million in state tax incentives and $39 million of local bonds that went belly up in 2011 when the company couldn't make the bond payments. More than 600 promised jobs went up in smoke, with the deal now facing scrutiny by Missouri lawmakers and a pair of investigations by the state's attorney general and the U.S. Securities and Exchange Commission.

"There was a lot of anticipation, and then a lot of disappointment," Moore said. "Let's be honest. Everybody had hoped that something was going to come out of it."

As President Barack Obama again pledged to repair the American economy in his annual State of the Union address Tuesday night, some Moberly residents chalked up his pronouncements as just more rosy rhetoric by a politician ? not unlike the July 2010 day when Missouri Gov. Jay Nixon and former Gov. Bob Holden came to the town of nearly 14,000 and hailed the Mamtek project's potential.

Others blamed an intractable Congress for not working more closely with the president to lift the country's economy. Still more held out hope that manufacturing companies lured by the region's low cost-of-living and central location would once again seek out Moberly, a 136-year-old railroad hub that became known as the Magic City in the late 19th century for its seemingly overnight emergence on once-empty prairie.

"We got a promise that he didn't keep," said business owner Diane Harlan. "He promised our economy was going to be better, and it's not. In this small community, we were under the false hope that everything was going to be OK, and it's not."

Harlan spent seven years as executive director of Main Street Moberly, which represents downtown business owners, before opening the Darn It Yarn store seven months ago after the business group cut her full-time job to 20 hours a week. She voted for John McCain in 2008 but hasn't yet made up her mind about the 2012 election.

While vacant storefronts dot downtown Moberly, Harlan said her business has succeeded beyond expectations, allowing her to drop that part-time job starting next week. A handful of similar small businesses have sprouted nearby, from a sewing shop to a secondhand furniture store.

"People are finally figuring out, we can't depend on our leader to get us out of something that we've created," she said. "We've got to go back to the grassroots. More self-sufficiency, doing things on our own, teaching our children, instead of depending on a man sitting in a white castle to take care of us and make things right."

David Gaines, a vice president with the Moberly Area Economic Development Commission, is among the local officials who helped court Mamtek in a deal given the code name "Project Sugar" before it was publicly disclosed. Count him among those looking for more leadership from those in the audience at Tuesday night's speech.

"It's not so much what he says but what they do," Gaines said, referring to Congress. "They need to quit talking and do something.

"That's what is holding consumer confidence down, is the inability of Congress on both sides of the aisle to do what the people elected them to do," he added.

After the speech, Gaines said he was heartened to hear the president urge lawmakers to work together, not against one another.

"I do like the fact that he said it's time to stop the divisiveness between the two parties," Gaines said. "If they set the right tone, everyone will follow along. If they don't, the nation will just drift."

Political affiliation aside, Moberly residents interviewed Tuesday tended to agree that improving the economy and creating more local jobs are the most important issues facing their community and the country. Look no further than a commuter parking lot along U.S. 63 packed with cars while their owners work 35 miles south in the college town of Columbia. Moberly, in turn, attracts workers from dozens of surrounding rural towns.

"Folks are regularly commuting 40 or 50 or 60 miles to go to work every day," Gaines said. "When we share that with the folks we talk to in Atlanta and Chicago and LA, they are quite amazed that people are willing to commute that far for a good job. But they have to."

Elsewhere in Moberly, Obama's speech was met with disinterest, if not outright scorn. At Nelly's Someplace Else restaurant, dozens of Republicans filed past a pair of televisions showing the president's address as the monthly meeting of the Randolph Area Pachyderms Club. Few stopped to listen, though some jeered as they walked past.

___

Follow Alan Scher Zagier at http://twitter.com/azagier

Source: http://us.rd.yahoo.com/dailynews/rss/economy/*http%3A//news.yahoo.com/s/ap/20120125/ap_on_re_us/us_state_of_the_union_reaction

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Could 'Magic' Mushrooms Ease Depression? (HealthDay)

TUESDAY, Jan. 24 (HealthDay News) -- Psychedelic mushrooms may point to new ways to treat depression, suggest two small brain imaging studies that seem to show how psilocybin -- the active ingredient in such mushrooms -- affects the brain.

One study included 30 healthy people who had psilocybin inserted into their blood while magnetic resonance imaging (MRI) scanners measured changes in their brain activity. The scans revealed that psilocybin caused decreased activity in what the researchers described as the brain's "hub" regions -- areas especially well-connected with other areas.

That study was published in this week's issue of the Proceedings of the National Academy of Sciences.

The second study included 10 healthy volunteers and found that psilocybin boosted their recall of personal memories and their emotional well-being for up to two weeks. The researchers said this suggests that psilocybin might prove useful as an adjunct to psychotherapy. That study will be published online Thursday in the British Journal of Psychiatry.

A study published last year found that people with anxiety who received a single psilocybin treatment had lower depression scores six months later.

David Nutt, who's with the Department of Medicine at Imperial College London, was the senior author of both of the new studies.

"Psychedelics are thought of as 'mind-expanding' drugs, so it has commonly been assumed that they work by increasing brain activity, but surprisingly, we found that psilocybin actually caused activity to decrease in areas that have the densest connections with other areas," Nutt said in a college news release. "These hubs constrain our experience of the world and keep it orderly. We now know that deactivating these regions leads to a state in which the world is experienced as strange."

The impact of psilocybin reported by the study participants -- such as seeing "geometric" patterns, experiencing an altered sense of time and space, and unusual physical sensations -- correlated with a decreased flow of oxygen and blood to parts in the brain's posterior cingulate cortex and medial prefrontal cortex (mPFC), the study authors said.

It's thought that the posterior cingulate cortex plays a role in consciousness and self-identity. Research has shown the medial prefrontal cortex to be especially active in people struggling with depression, so psilocybin's effect on this area of the brain could be responsible for some of the antidepressant effects reported in previous research, the study authors said.

Nutt and his colleagues also found that psilocybin reduced blood flow in the hypothalamus, where blood flow increases in people with cluster headaches. Some headache sufferers have reported that psilocybin improved their symptoms.

"Psilocybin was used extensively in psychotherapy in the 1950s, but the biological rationale for its use has not been properly investigated until now. Our findings support the idea that psilocybin facilitates access to personal memories and emotions," Dr. Robin Carhart-Harris, from the Department of Medicine at Imperial College London, and first author of both studies, said in the news release.

"Previous studies have suggested that psilocybin can improve people's sense of emotional well-being and even reduce depression in people with anxiety. This is consistent with our finding that psilocybin decreases mPFC activity, as many effective depression treatments do. The effects need to be investigated further and ours was only a small study, but we are interested in exploring psilocybin's potential as a therapeutic tool," Carhart-Harris added.

The study authors reiterated that both trials contained small numbers of participants, and further research into psilocybin's effects on the brain is needed.

More information

The U.S. National Institute of Mental Health has more about depression.

Source: http://us.rd.yahoo.com/dailynews/rss/diseases/*http%3A//news.yahoo.com/s/hsn/20120125/hl_hsn/couldmagicmushroomseasedepression

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Jobs, energy, values top issues in Obama address (AP)

Highlights of President Barack Obama's State of the Union address:

TAXES

Said the wealthy should pay their fair share in taxes, arguing that anyone who makes more than $1 million should pay a minimum tax rate of at least 30 percent. He also provided more details about the so-called Buffett rule, which sets a goal of a minimum tax rate for those earning $1 million or more a year.

EDUCATION

Pushed measures for college affordability, including taking federal aid from colleges that don't keep net tuition down and provide good value, and urged Congress to make permanent a tuition tax credit worth $10,000 over four years. He also called for a new emphasis on the teaching profession to include better evaluation systems and incentives for teachers and improved teacher education. And he challenged state governments to require students to stay in school until they graduate or turn 18, as 20 states already do.

HOUSING

Proposed a nationwide program to allow homeowners with privately held mortgages to refinance at lower interest rates. It would cover both loans issued by government-controlled mortgage giants Fannie Mae and Freddie Mac and private bank mortgage lenders. Congress would have to approve, a difficult hurdle. Under the plan, any homeowner current on his or her mortgage could take advantage of lending rates now at 4 percent or below. Administration officials offered few details but estimated savings of about $3,000 a year for average borrowers.

IMMIGRATION AND WORKFORCE

Reiterated a call for comprehensive immigration reform, including giving responsible young people a chance to earn their citizenship. He suggested creating a Veterans Job Corps to help communities hire veterans, and he committed to closing the wage gap between men and women.

TRADE ENFORCEMENT

Called for the creation of a new trade enforcement unit that would go after unfair trade practices around the world, including China. Obama said the U.S. would provide financing to put its companies on even footing when the Chinese or other competitors use unfair export financing to help their businesses. He also called for better inspections to stop counterfeit, pirated or unsafe goods from entering the U.S.

USING WAR SAVINGS FOR INFRASTRUCTURE

Proposed using half the savings achieved by winding down the wars in Iraq and Afghanistan to cover costs of new investments in infrastructure. Obama wants the money to go toward fixing existing roads and building new high-speed rail projects. He also plans to sign an executive order in the coming weeks to clear some of the bureaucratic roadblocks that have slowed work on projects that have already been funded. The White House says the other half of the savings from drawing down the wars would go toward reducing the national debt.

OUTSOURCING/INSOURCING

Proposed eliminating tax incentives that make it more attractive for companies to ship jobs overseas. The proposal would require American companies to pay a minimum tax on their overseas profits in order to prevent other countries from attracting U.S. businesses with unusually low tax rates. Obama also wants to eliminate tax deductions companies receive for the cost of shutting down factories and moving production overseas. Instead, Obama wants to create a new tax credit to cover moving expenses for companies that close production overseas and bring jobs back to the U.S. He also wants to reduce tax rates for manufacturers and double the tax deduction for high-tech manufacturers in order to create more manufacturing jobs in the U.S.

ENERGY

Directed his administration to develop a plan for safe extraction of natural gas from shale deposits, which the White House says will support more than 600,000 jobs. The administration is moving forward with what it calls "common-sense" rules to ensure that safe drilling practices are followed and the types of chemicals used in the so-called fracking method are disclosed for operations on public lands. Obama said he would offer incentives to manufacturers to boost the energy efficiency of the industrial sector by upgrading equipment and eliminating wasted energy in their facilities. The White House estimates those incentives and efforts to reduce regulatory barriers could save $100 billion from the nation's energy bills and cut energy imports. Obama also said he will direct the Defense Department to make the largest renewable energy purchase in history ? 1 gigawatt, or 1 billion watts. Obama plans to direct his administration to establish solar energy zones and wind energy areas on public lands to power 3 million homes by the end of 2012.

FINANCIAL FRAUD

Proposed steps to target fraud in the financial sector and mortgage industry, with a Financial Crimes Unit to crack down on bankers and financial service professionals, and a separate special unit of federal prosecutors and state attorneys general to expand investigations into abusive lending that led to the housing crisis. "This new unit will hold accountable those who broke the law, speed assistance to homeowners, and help turn the page on an era of recklessness that hurt so many Americans," Obama said.

POLITICS

Responded to criticism from Republican presidential challengers, who have accused him of inciting class warfare by seeking higher taxes on millionaires and assailed his administration's ties to Solyndra, a clean energy company which went bankrupt despite receiving a $528 million federal loan. Obama said critics could "call this class warfare all you want," but argued that most people would consider it common sense for a billionaire to pay at least as much as his secretary in taxes. Obama did not mention Solyndra by name, but defended the promise of renewable energy from wind and solar power, saying he would "not walk away from the promise of clean energy."

Source: http://us.rd.yahoo.com/dailynews/rss/obama/*http%3A//news.yahoo.com/s/ap/20120125/ap_on_go_pr_wh/us_state_of_union_highlights

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HPV testing: Indications of a benefit in primary screening

[ Back to EurekAlert! ] Public release date: 24-Jan-2012
[ | E-mail | Share Share ]

Contact: Dr. Anna-Sabine Ernst
presse@iqwig.de
49-221-356-850
Institute for Quality and Efficiency in Health Care

Precursors of cervical cancer can be detected and treated earlier; risk of over-treatment

This release is available in German.

Studies currently available provide indications and a "hint" that precursors of cervical cancer can be detected and treated earlier, and consequently tumours occur less often, in women who underwent testing for human papillomavirus (HPV). In this context, an HPV test can be used alone or in addition to a Papanicolaou test (Pap smear). However, both screening procedures also carry a risk of harm in the form of unnecessary treatments after testing (over-treatment). This is the result of a final report published by the German Institute for Quality and Efficiency in Health Care (IQWiG) on 24th of January 2012.

HPV testing is not reimbursed by SHI funds

In screening for cervical cancer, the German statutory health insurance (SHI) funds currently offer an annual (cytologic) examination of mucosal cells from a smear taken from the neck of the womb (cervix). This test is called a Pap smear. Since it became known that infection with HPV is the main risk factor for developing cervical cancer, experts have been discussing whether HPV testing is also a suitable screening method or is even superior to a cytologic test.

The SHI funds currently only reimburse HPV testing in exceptional cases, for example, in cases where the result of a Pap smear is unclear. The Federal Joint Committee (G-BA) therefore commissioned IQWiG to assess the benefit of HPV testing in primary screening and also to compare different screening strategies with each other.

Lower rates of cancers and their precursors are independent outcome criteria

Cancer screening is usually assessed by determining whether this procedure demonstrably contributes to the prevention of cancer-related deaths. However, in cervical cancer the fact whether or not fully developed (invasive) tumours occur less often can also be a criterion for a screening benefit. Similar to the case of colon cancer, screening for cervical cancer aims to detect and treat cellular changes (dysplasia) from which a cancerous tumour could develop, as treatment of such (advanced) precursors of cancer is far less burdensome for patients than later treatment of a tumour.

Studies with a total of 235,613 participants included

IQWiG searched for studies comparing primary screening strategies for cervical cancer based on different screening tests: a strategy including HPV testing alone or in combination with cytology-based testing and a strategy including cytology-based testing alone.

Six randomized controlled trials conducted in the United Kingdom, Finland, Sweden, the Netherlands, and Italy were included in the assessment. A total of 235,613 women had been recruited for the studies in order to be examined for precursors of invasive cervical cancer in at least two screening rounds with an interval of at least three years. However, all of these studies were susceptible to bias, which limits their informative value.

Fewer cancer diagnoses in the second screening round

In the assessment IQWiG distinguished between different outcome criteria. The composite outcome "CIN3+" was analysed, which comprises both invasive cervical cancer and advanced precursors of cancer (high grade cervical intraepithelial dysplasia or in-situ cervical cancer, i.e. CIN3/CIS). In addition, the outcomes "invasive cervical cancer"- that is, not just the occurrence of a cancer precursor but of a tumour - as well as "CIN3/CIS" were analysed separately.

In the second screening round, the number of diagnoses for the two outcomes "CIN3+" and "invasive cervical cancer" was lower in the HPV group than in the group of women who had only been examined with a cytology-based screening strategy (e.g. Pap smear) in the first screening round. IQWiG therefore determined an indication of a benefit for these two outcomes.

If solely the advanced precursors of cancer are considered (CIN3/CIS), the data only provide a "hint" of a benefit. This is primarily due to a relatively large study that showed no difference between the HPV group and the comparator group. The new category "hint" expresses that certain minimum requirements for the available studies are fulfilled, but that conclusions on benefit and harm are only of low certainty.

No evaluable data on survival and quality of life

Conclusions on overall survival, mortality related to cervical cancer, and quality of life are not possible, as no data or no evaluable data were available for these outcomes.

Neither were evaluable data on potential screening-related harm available. For instance, unnecessary diagnostic procedures (e.g. biopsies) as a result of false-positive test results may harm patients. Moreover, the diagnosis itself can be a psychological burden, triggering anxieties or feelings of guilt.

Harm can also be caused by over-treatment. It is notable that women with moderate grade (CIN2) or sometimes even low grade cancer precursors were also treated in the included studies; in a great number of cases these precursors regress and only rarely progress into cancer. However, it cannot be estimated on the basis of these studies how often women who underwent HPV testing and/or a Pap smear were subjected to unnecessary treatment.

No recommendation for specific screening strategy possible

The complex screening strategies applied in the studies varied greatly and can therefore hardly be compared with each other. This applies to the participants' age and the intervals between follow-up examinations, as well as to the questions in which sequence or combination the HPV or cytology test should be applied and what measures should be undertaken after certain test results.

The study results therefore do not allow a recommendation for a specific screening strategy in the German health care system. The few common factors of the studies include the fact that the screening interval lasted at least three years and the screening programme was conducted in an organized population-based and quality assured context.

###

Procedure of report production

IQWiG published the preliminary results in the form of the preliminary report in June 2011 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the contracting agency, the G-BA, in November 2011. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

?


AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


[ Back to EurekAlert! ] Public release date: 24-Jan-2012
[ | E-mail | Share Share ]

Contact: Dr. Anna-Sabine Ernst
presse@iqwig.de
49-221-356-850
Institute for Quality and Efficiency in Health Care

Precursors of cervical cancer can be detected and treated earlier; risk of over-treatment

This release is available in German.

Studies currently available provide indications and a "hint" that precursors of cervical cancer can be detected and treated earlier, and consequently tumours occur less often, in women who underwent testing for human papillomavirus (HPV). In this context, an HPV test can be used alone or in addition to a Papanicolaou test (Pap smear). However, both screening procedures also carry a risk of harm in the form of unnecessary treatments after testing (over-treatment). This is the result of a final report published by the German Institute for Quality and Efficiency in Health Care (IQWiG) on 24th of January 2012.

HPV testing is not reimbursed by SHI funds

In screening for cervical cancer, the German statutory health insurance (SHI) funds currently offer an annual (cytologic) examination of mucosal cells from a smear taken from the neck of the womb (cervix). This test is called a Pap smear. Since it became known that infection with HPV is the main risk factor for developing cervical cancer, experts have been discussing whether HPV testing is also a suitable screening method or is even superior to a cytologic test.

The SHI funds currently only reimburse HPV testing in exceptional cases, for example, in cases where the result of a Pap smear is unclear. The Federal Joint Committee (G-BA) therefore commissioned IQWiG to assess the benefit of HPV testing in primary screening and also to compare different screening strategies with each other.

Lower rates of cancers and their precursors are independent outcome criteria

Cancer screening is usually assessed by determining whether this procedure demonstrably contributes to the prevention of cancer-related deaths. However, in cervical cancer the fact whether or not fully developed (invasive) tumours occur less often can also be a criterion for a screening benefit. Similar to the case of colon cancer, screening for cervical cancer aims to detect and treat cellular changes (dysplasia) from which a cancerous tumour could develop, as treatment of such (advanced) precursors of cancer is far less burdensome for patients than later treatment of a tumour.

Studies with a total of 235,613 participants included

IQWiG searched for studies comparing primary screening strategies for cervical cancer based on different screening tests: a strategy including HPV testing alone or in combination with cytology-based testing and a strategy including cytology-based testing alone.

Six randomized controlled trials conducted in the United Kingdom, Finland, Sweden, the Netherlands, and Italy were included in the assessment. A total of 235,613 women had been recruited for the studies in order to be examined for precursors of invasive cervical cancer in at least two screening rounds with an interval of at least three years. However, all of these studies were susceptible to bias, which limits their informative value.

Fewer cancer diagnoses in the second screening round

In the assessment IQWiG distinguished between different outcome criteria. The composite outcome "CIN3+" was analysed, which comprises both invasive cervical cancer and advanced precursors of cancer (high grade cervical intraepithelial dysplasia or in-situ cervical cancer, i.e. CIN3/CIS). In addition, the outcomes "invasive cervical cancer"- that is, not just the occurrence of a cancer precursor but of a tumour - as well as "CIN3/CIS" were analysed separately.

In the second screening round, the number of diagnoses for the two outcomes "CIN3+" and "invasive cervical cancer" was lower in the HPV group than in the group of women who had only been examined with a cytology-based screening strategy (e.g. Pap smear) in the first screening round. IQWiG therefore determined an indication of a benefit for these two outcomes.

If solely the advanced precursors of cancer are considered (CIN3/CIS), the data only provide a "hint" of a benefit. This is primarily due to a relatively large study that showed no difference between the HPV group and the comparator group. The new category "hint" expresses that certain minimum requirements for the available studies are fulfilled, but that conclusions on benefit and harm are only of low certainty.

No evaluable data on survival and quality of life

Conclusions on overall survival, mortality related to cervical cancer, and quality of life are not possible, as no data or no evaluable data were available for these outcomes.

Neither were evaluable data on potential screening-related harm available. For instance, unnecessary diagnostic procedures (e.g. biopsies) as a result of false-positive test results may harm patients. Moreover, the diagnosis itself can be a psychological burden, triggering anxieties or feelings of guilt.

Harm can also be caused by over-treatment. It is notable that women with moderate grade (CIN2) or sometimes even low grade cancer precursors were also treated in the included studies; in a great number of cases these precursors regress and only rarely progress into cancer. However, it cannot be estimated on the basis of these studies how often women who underwent HPV testing and/or a Pap smear were subjected to unnecessary treatment.

No recommendation for specific screening strategy possible

The complex screening strategies applied in the studies varied greatly and can therefore hardly be compared with each other. This applies to the participants' age and the intervals between follow-up examinations, as well as to the questions in which sequence or combination the HPV or cytology test should be applied and what measures should be undertaken after certain test results.

The study results therefore do not allow a recommendation for a specific screening strategy in the German health care system. The few common factors of the studies include the fact that the screening interval lasted at least three years and the screening programme was conducted in an organized population-based and quality assured context.

###

Procedure of report production

IQWiG published the preliminary results in the form of the preliminary report in June 2011 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the contracting agency, the G-BA, in November 2011. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.


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Source: http://www.eurekalert.org/pub_releases/2012-01/ifqa-hti012412.php

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US warship sails into Persian Gulf amid Iran tension

By Jim Miklaszewski, NBC News

US Navy officials report the aircraft carrier Abraham Lincoln and its battle group steamed through the Strait of Hormuz into the Persian Gulf Sunday without incident. It's the first US carrier to pass through the Strait since the Iranians threatened to attack the aircraft carrier Stennis three weeks ago, if it attempted to return to the Persian Gulf. Pentagon and US military officials have made it clear that?Iranian threats would not deter the US Navy from operating in international waters in the Strait and the Gulf.


US military officials say the Lincoln, with its guided-missile cruiser and two guided-missile destroyers, saw no sign of the Iranian navy speed boats which occasionally harass US warships as they pass through the Strait. Those incidents have increased, and in fact become somewhat routine since Iran's radical Revolutionary Guard has taken control of Iran's naval forces in the Strait and Persian Gulf.

Navy officials say the Lincoln battle group is in the Gulf on routine and regularly-scheduled exercises.

A second battle group led by the aircraft carrier USS Carl Vinson is in the Northern Arabian Sea conducting flight missions over Afghanistan.

More from msnbc.com and NBC News:

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Source: http://worldnews.msnbc.msn.com/_news/2012/01/23/10213179-uss-lincoln-sails-through-strait-of-hormuz

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