Issue link: https://www.epageflip.net/i/625411
ByLauranNeergaard The Associated Press WASHINGTON Mammo- grams do the most good later in life, a government task force declared Mon- day in recommending that women get one every other year starting at age 50. It said 40-somethings should make their own choice af- ter weighing the pros and cons. When to start routine mammograms and how frequently to get them has long been controver- sial. The latest guidelines from the U.S. Preven- tive Services Task Force stick with its advice that women should one every two years between ages 50 and 74. But they also make clear that it's an op- tion for younger women even though they're less likely to benefit. Some health groups urge mammograms every year starting at 40 — al- though last year the Amer- ican Cancer Society upped its starting age to 45. There is some common ground emerging, that mammography advice shouldn't always be one- size-fits all. "Age 50 isn't magic," said task force past chairman Dr. Michael LeFevre of the University of Missouri. Whattaskforcesays Women in their 60s are the most likely to avoid dying from breast cancer thanks to mammograms, but there's clearly enough benefit for the average woman to start at 50, the task force found. The advisory group wants younger women to understand the trade- offs before deciding: Among every 1,000 women screened, one additional death could be prevented by starting mammograms at 40 instead of 50. But there would be 576 more false alarms and 58 addi- tional unneeded biopsies. Also, two extra women would be overdiagnosed, treated for cancer that never would have become life-threatening. Monday's update, pub- lished in Annals of Inter- nal Medicine, is largely a rewording of guidelines originally issued in 2009 and reconsidered in draft form last spring. This time, the task force stresses that "we think the science sup- ports a range of options" for 40-somethings, LeFe- vre said. Differing guidelines Mammograms aren't perfect, and different health organizations weigh the trade-offs dif- ferently. So do women and their physicians. The American Cancer Society says to begin an- nual mammograms at 45 but switch to every other year at 55. After meno- pause, tumors tend to grow more slowly and women's breast tissue be- comes less dense and eas- ier for mammograms to penetrate, says chief medi- cal officer Dr. Otis Brawley. Between ages 40 and 44, when breast cancer is espe- cially uncommon, the soci- ety also says women should make their own choice. "We're moving away from paternalistic medi- cine where we doctor or- ganizations used to tell women, 'You must do this,'" Brawleysaid."We'resaying, 'This woman is at higher risk, therefore maybe she should get screened at 40. This woman is at lower risk, maybe she can wait a little later.'" The American College of Obstetricians and Gy- necologists stands by an- nual mammograms start- ing at 40, while urging pa- tient education and shared decision-making. Things to consider More than 200,000 women are diagnosed with breast cancer each year, and about 40,000 die from it. It is most fre- quently diagnosed among women ages 55 to 64, and the median age of death from breast cancer is 68. Women with a mother, sister or daughter with breast cancer have a higher risk than the aver- age 40-year-old. Other fac- tors can play a role, too, including genetics, breast density and menstrual and pregnancy history. Personalizedscreening Dueling guidelines mean "some people get so confused they don't get screened at all. Some are too anxious or afraid not to do more, and it may not be better for them," said breast cancer special- ist Dr. Laura Esserman of the University of Califor- nia, San Francisco. Esserman leads the first-of-its-kind WISDOM study that soon will begin enrolling 100,000 women to test whether tailor- ing screening to some- one's individual risk is better than age-based mammograms. Women given annual mammo- grams starting at 40 will be compared with oth- ers assigned more or less frequent screenings, starting at different ages, based on in-depth risk as- sessments. Insurance coverage Insurance usually pays for mammograms. Be- cause of concern about how the task force recom- mendations might be im- plemented, Congress re- cently extended for two years legislation preserv- ing access to routine mam- mograms without copays starting at age 40. HEALTH Mammograms an option at 40, do more good at 50, reports task force By Lisa Lerer and Ken Thomas The Associated Press WATERLOO, IOWA Hillary Clinton has spent much of her presidential campaign looking past Democratic rival Bernie Sanders, focus- ing instead on Republicans and the November general election. No longer. Three weeks before the lead-off Iowa caucuses and with polls suggesting a tightening race, she now is confronting the Vermont senator more directly, at- tempting to undermine his liberal credentials on gun control, health care and even the Wall Street regu- lations that have been the core of his insurgent cam- paign. "It's time for us to have the kind of spirited debate that you deserve us to have," Clinton told voters on Mon- day. "We do have differ- ences." After months with a com- fortable edge in most Iowa polls, the former secretary of state finds herself bat- tling an underdog rival in a state that has a history of rewarding anti-establish- ment campaigns — a situa- tion that brings back echoes of her 2008 loss to Barack Obama. While she has locked up the vast majority of support from party leaders and large donors, Sanders has cap- tured the hearts of many in the Democratic base with his unapologetically liberal economic message. An NBC/The Wall Street Journal/Marist poll re- leased Sunday found Clin- ton with 48 percent and Sanders with 45 percent of likely caucus goers, rep- resenting a closer margin than past polls have indi- cated. Sanders has maintained an edge in New Hampshire, which borders his home state of Vermont, making Iowa even more important for Clinton. The NBC/ Wall Street Journal/Marist poll showed Sanders with 50 percent and Clinton with 46 percent in that primary. Clinton still holds a strong advantage among black and Latino voters who play a bigger role in the pri- maries in late February and March. But even if Clinton pulls out a win in Iowa, a narrow victory could set off alarms among Democrats about her strength against Sanders, who started the campaign as an obscure senator polling in the sin- gle digits. Until now, Clinton has rarely mentioned Sanders by name at her campaign events, choosing instead to warn voters about the risks of electing a Republican. She has pointed to efforts by Republicans to repeal Obama's signature health care law — the president vetoed the most recent try — as a sign of what could come if Democrats lose the White House. But on Monday, she wid- ened her health care cri- tique to include Sanders, saying he would "rip up" the law and put power in the hands of states. Sand- ers said during a town hall meeting in Perry that large numbers of under- insured and sky-high de- ductibles demand a better health care system, which he would seek through his single-payer, Medicare-for- all system. Said Clinton: "I sure don't want to turn over health care to Republican governors for heaven's sake. I think it's a risky deal." That's not quite the sit- uation: While states would have some leeway under Sanders' plan, his office says they would not be allowed to opt out completely as Republican governors have done with the Medicaid ex- pansion provided under the current health care law. Clinton also announced a new plan that would impose a 4 percent fee on taxpayers making more than $5 mil- lion — an effort to match Sanders' focus on income inequality. And she talked about guns. When Obama said last week he would not support a Democratic nominee who didn't support "common- sense gun reform," Clin- ton's team quickly sought to turn it to their advan- tage, reminding voters that Sanders had backed legisla- tion in 2005 that protected gun-makers from lawsuits. PRESIDENTIAL RACE Cl in to n co nf ro nt s ri va l Sanders as Iowa polls tighten STEVENSENNE—THEASSOCIATEDPRESS Democratic presidential candidate Hillary Clinton, right, stands with Cecile Richards, Planned Parenthood's president, during an event on Sunday in Hooksett, N.H. By Juliet Linderman and David Dishneau The Associated Press BALTIMORE A Maryland appeals court postponed the trial of a police van driver charged with second-degree murder in the death of Fred- die Gray, saying it needs to address whether another Baltimore officer should be compelled to testify against Caesar Goodson. Jury selection for Good- son's trial was supposed to start Monday. Prosecutors have indicated that testi- mony from Officer William Porter, whose trial ended in a hung jury last month, is crucial to their case against Goodson. Baltimore Circuit Judge Barry Williams, who is overseeing the trial, ruled last week that Porter must testify against Goodson de- spite Porter's assertion that he has a right not to incrim- inate himself. Porter's trial is post- poned indefinitely, pend- ing further proceedings, in- cluding more written filings from both sides, followed by oral arguments before the Court of Special Appeals, Maryland courts spokes- woman Terri Charles said. Gray died in April, a week after his neck was broken during a van ride. Goodson was with Gray for every sec- ond of his 45-minute trip from the site of his arrest to the Western District po- lice station, where Gray ar- rived critically injured and unresponsive. The trial could provide the public with its first chance to hear Goodson's side of the story. He has not spoken with investi- gators or made any public comments. He faces the most seri- ous charge of the six offi- cers charged — second-de- gree murder, which carries a maximum sentence of 30 years in prison. To be con- victed, prosecutors must prove Goodson was so cal- lous in his disregard for Gray's life that he deliber- ately allowed him to die. Since Porter's case ended in a mistrial, the stakes for Goodson's trial have grown in a city still on edge from the rioting and unrest in April. Porter's lawyers say he risks going to jail for con- tempt if he refuses an or- der to testify, but if he does testify, he could be charged with perjury if he makes any statements that differ from what he said or will say in his own defense. Prosecutors say Porter has immunity at Goodson's trial and they can't use his statements against him later. But defense attorney Gary Proctor wrote in court documents: "The bell can- not be unrung." The judge himself ac- knowledged that he was entering "uncharted terri- tory" before issuing his rul- ing last week. His order is unprece- dented in Maryland and could have tremendous im- plications for future cases with multiple defendants. Gray's death exposed the deep divide between the public and the police in Bal- timore, and became a na- tional symbol of the Black Lives Matter movement. Prosecutors say the offi- cers should be held account- able for Gray's fatal injuries because they left him hand- cuffed and shackled at the legs but unbuckled by a seatbelt, making him vul- nerable to injury inside the metal compartment. BALTIMORE Trial of Freddie Gray van driver delayed by court 604 Main St. Red Bluff Join Us For Our Daily Breakfast Special Breakfast: 9am-11am, 7 days a week www.redblufflosmariachis.com (530) 529-5154 Best Tire Value PROMISE ® 522 Antelope Blvd., Red Bluff (530) 529-1654 FREEWITHEVERYPASSENGERCAR AND LIGHT TRUCK TIRE PURCHASE www.lesschwab.com 819 Jefferson St. Red Bluff Individual&GroupMedicalInsurance Variouscompaniestochoosefrom ~ Medical Insurance (basic&highdeductibles) ~ Dental & Vision Insurance ~ Life Insurance ~ Medicare Supplements ~ Prescription Drug Plans ~ Supplemental Insurance with AFLAC products ~ Asset Preserver SINCE 1959 Jennifer & Michelle have over 35 years combined experience in Insurance Services Call for appointment (530) 527-6761 We have Buicks, Chevys, Chryslers, Dodge Cars, Dodge Trucks, Fiat, Ford Cars, Ford Trucks, GMC's, Hyundais, Jeeps, Kias, Nissans, Volkswagen & Lots of Toyotas 545 Adobe Rd., Red Bluff 530-366-3166 www.redbluffdodge.com Over 100 Pre-Owned in Stock! Check out Red Bluff Dodge.com or Better Yet... Like Bob Barker Said.... COME ON DOWN! TUESDAY, JANUARY 12, 2016 REDBLUFFDAILYNEWS.COM | NEWS | 5 B