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

Read More..

Hamas Celebrates Cease-Fire With National Holiday













With a tenuous cease-fire in place and no rocket fire between Israel and Hamas for the first time in more than a week, Palestinians have begun to clean up rubble and damage inflicted by Israeli missiles.


People in Gaza filled the streets Thursday morning, inspecting damage to homes and businesses. Overnight, gunfire erupted in the crowded streets of the Palestinian enclave to celebrate the announcement of a cease-fire in the bloody conflict between Israel and Hamas, the Palestinian militant political group in de facto control the Gaza Strip.


FULL COVERAGE: Israel-Gaza Conflict


"It's a nice message from Palestinians - don't mess with Palestinians," said Jalal Marzen Wednesday night during a celebration outside Gaza's Al-Shifa Hospital. He and others pointed to the targeting of Tel Aviv by Hamas rockets as a shifting in the balance of power, arguing Israel's calculations would be forced to change ahead of the next flare-up. "It's huge, it's huge for us!" Marzen exclaimed.


Later, however, Israeli officials said several missiles from Gaza flew into Israel after the cease-fire. Israel did not respond with the air srikes that have blanketed Gaza in the past week.


Hamas has declared Nov. 22 a national holiday and said it would be celebrated every year.


"We call on everyone to celebrate, visit the families of martyrs, the wounded, those who lost homes," Hamas said.










Hillary Clinton Announces Israel-Hamas Ceasefire Watch Video









Iron Dome Main Player in New War in The Middle East Watch Video





A sense of normalcy returned to Gaza Thursday morning, with traffic again clogging busy intersections and stores opening for business.



PHOTOS: Israel, Hamas Fight Over Gaza


"For first time, the Israeli people felt what bombs mean, what rockets mean, what war means, what killing people means," said clothing store owner Bassem Diazeda, who said he only became a supporter of Hamas since the escalation.


The fighting came to an end after a meeting between Egyptian President Mohammed Morsi and U.S. Secretary of State Hillary. Clinton, who said Egypt and the U.S. would help support the peace process going forward.
The eight days of fighting left more than 160 Palestinians and five Israelis dead.


The concern now among top diplomats is whether the cease-fire will hold while Israeli Prime Minister Benjamin Benjamin Netanyahu and Hamas leaders work on a long term solution for peace. Israel is demanding an end to rocket fire from Gaza, while Hamas wants an end to Israel's blockade of Gaza and targeted assassinations, the kind that launched Israel's operation "Pillar of Defense."


Hamas was not the only group firing rockets from Gaza into Israel. Other militant groups in Gaza, such as Islamic Jihad, fired rockets during the eight-day assault. A splinter Palestinian group took responsibility for Wednesday's bus bombing in Tel Aviv that wounded 23 people.


So the question is whether Hamas can control the more rogue groups in Gaza and stake out a real leadership role.


Clinton said that Egypt and the U.S. would help support the peace process going forward.


"Ultimately, every step must move us toward a comprehensive peace for people of the region," Clinton said.


An Israeli official told ABC News that the cease-fire would mean a "quiet for quiet" deal in which both sides stop shooting and "wait and see what happens."


"I agree that that it was a good idea to give an opportunity to the cease-fire ... in order to enable Israeli citizens to return to their day-to-day lives," Netanyahu said.






Read More..

Gaza shakes, bus explodes in Tel Aviv as Clinton seeks truce

GAZA/JERUSALEM (Reuters) - U.S. Secretary of State Hillary Clinton on Wednesday pursued a Gaza truce, with Israel and Hamas still at odds over key terms, as Israeli air strikes shook the enclave and a bomb exploded on a Tel Aviv bus.


After talks in Ramallah with Palestinian President Mahmoud Abbas, Clinton held a second meeting with Israeli Prime Minister Benjamin Netanyahu before heading to Egypt, the main broker in efforts to end eight days of fighting and avert a possible Israeli ground offensive.


In Tel Aviv, at least 10 people were wounded when a bus was blown up on a main street near the Defence Ministry and military headquarters. Israel's government called it a terrorist attack.


The explosion, which police said was caused by a bomb placed on the vehicle, touched off celebratory gunfire from militants in Gaza and threatened to complicate truce efforts.


Israel's best-selling Yedioth Ahronoth newspaper said an emerging outline of a ceasefire agreement called for Egypt to announce a 72-hour ceasefire followed by further talks on long-term understandings.


Under the proposed document, which the newspaper said neither party would be required to sign, Israel would hold its fire, end attacks against top militants and promise to examine ways to ease its blockade of the enclave.


Hamas, the report said, would pledge not to strike any Israeli target and ensure other Palestinian factions in the Gaza Strip also stop their attacks.


An Israeli political source said differences holding up a deal centered on a Hamas demand to lift the Gaza blockade completely and the kind of activity that would be allowed along the frontier, where Israeli troops often fire into the enclave to keep Palestinians away from an area near a border fence.


Hamas official Ezzat al-Rishq said the main stumbling block was "the temporary timeframe for a ceasefire that the Israelis want us to agree to".


"GOOD INTENTIONS"


The London-based Al Hayat newspaper, citing sources in Hamas and Islamic Jihad, said Israel wanted a 90-day period to determine "good intentions" before discussing Palestinian demands, a position the report said the groups have rejected.


Rishq said a short-term truce, whose proposed duration he did not disclose, "would only buy (Israel) time" until a general election in January and "we would have accomplished nothing in the way of a long-term truce".


Hamas sources said the group was also demanding control over Gaza's Rafah borders with Egypt, so that Palestinians could cross easily, and Israeli guarantees to stop assassinating Hamas leaders.


Israel, one of the Hamas sources said, wanted a commitment from the group to stop smuggling through tunnels that run into Gaza under the Egyptian border. The tunnel network is a conduit for weapons and commercial goods.


News of the Tel Aviv bus bombing, the first serious blast in Israel's commercial capital since 2006, emerged just after Clinton and Netanyahu ended their meeting. A spokesman for Netanyahu declined to give details on their discussions, which followed talks on Tuesday.


Clinton, who flew to the region from an Asian summit, said in her public remarks after Tuesday's meeting with Netanyahu that it was "essential to de-escalate the situation".


"The rocket attacks from terrorist organizations inside Gaza on Israeli cities and towns must end and a broader calm restored," she said.


Clinton earlier assured Netanyahu of "rock-solid" U.S. support for Israel's security, and praised Egyptian President Mohamed Mursi's "personal leadership and Egypt's efforts thus far" to end the Gaza conflict and promote regional stability.


"As a regional leader and neighbor, Egypt has the opportunity and responsibility to continue playing a crucial and constructive role in this process. I will carry this message to Cairo tomorrow (Wednesday)," she said.


"LONG-TERM" SOLUTION


Netanyahu told Clinton he wanted a "long-term" solution. Failing that, Netanyahu made clear, that he stood ready to step up the military campaign to silence Hamas' rockets.


"A band-aid solution will only cause another round of violence," said Ofir Gendelman, a Netanyahu spokesman.


While diplomatic efforts continued, Israel struck more than 100 targets in Gaza overnight, killing a Hamas gunman and destroying a cluster of Hamas government buildings.


Palestinians militants fired 31 rockets at Israel, causing no casualties, and Israel's Iron Dome interceptor system shot down 14 of them, police said.


Israel has carried out more than 1,500 strikes since the offensive began. Medical officials in Gaza said 139 Palestinians, most of them civilians, including 34 children, have been killed. Nearly 1,400 rockets have been fired into Israel, killing four civilians and a soldier, the Israeli military said.


In the West Bank city of Ramallah, Clinton held talks with Palestinian President Abbas, whose bid to upgrade the Palestinians' status at the United Nations, in the absence of peace negotiations with Israel, is opposed by Washington.


"Secretary Clinton informed the president that the U.S. administration is exerting every possible effort to reach an immediate ceasefire and the president expressed his full support for this endeavor," said Palestinian chief negotiator Saeb Erekat.


"Once the Israelis accept to stop their bombardments, their assassinations, there will be a comprehensive ceasefire sustained from all parties," Erekat said.


A Palestinian official with knowledge of Cairo's mediation told Reuters that Egyptian intelligence officials would hold further discussions on Wednesday with leaders of Hamas and the Islamic Jihad group.


"There may be a response from Israel that Egyptian mediators want to present to Hamas and Islamic Jihad leaders," the official said. "Let's be hopeful it would be something Palestinian factions can accept."


Like most Western powers, Washington shuns Hamas as an obstacle to peace and has blamed it for the Gaza conflagration. A U.N. Security Council statement condemning the conflict was blocked on Tuesday by the United States, which complained that it "failed to address the root cause," the Palestinian rockets.


Hamas for its part is exploring the opportunities that last year's Arab Spring has given it to enjoy favor from new Islamist governments, and from Sunni Gulf powers keen to woo it away from Shi'ite Iran.


It may count on some sympathy from Mursi, although Egypt's first freely elected leader, whose Muslim Brotherhood inspired Hamas' founders, has been careful to stick by the 1979 peace deal with Israel struck by Cairo's former military rulers.


Along the Gaza border, Israeli tanks, artillery and infantry remained poised for a possible ground offensive in the densely populated enclave of 1.7 million Palestinians.


But an invasion, likely to entail heavy casualties, would be a major political risk for Netanyahu, who is currently favored to win the upcoming Israeli election. More than 1,400 Palestinians were killed in Israel's three-week war in the Gaza Strip in 2008-9, prompting international criticism of Israel.


(Additional reporting by Ari Rabinovitch in Jerusalem and Cairo bureau; Writing by Jeffrey Heller; Editing by Giles Elgood)


Read More..

Foreign Minister Shanmugam to visit Timor-Leste on Nov 22-24






SINGAPORE: Minister for Foreign Affairs and Law K Shanmugam will make his first official visit to Timor-Leste from 22 to 24 November 2012.

During his visit, Mr Shanmugan will call on President Taur Matan Ruak, Prime Minister Xanana Gusmao, Foreign Minister Jose Luis Guterres, Minister of Petroleum and Natural Resources Alfredo Pires, Minister of Justice Dionisio Babo-Soares and Opposition leader Mari Alkatiri.

Mr Shanmugam will also be hosted to an official dinner by Mr Guterres.

While in Timor-Leste, Mr Shanmugam will take the opportunity to meet the Singaporean community there.

Mr Shanmugam will be accompanied by his wife Dr Seetha Shanmugam, Singapore's Non-Resident Ambassador to Timor-Leste, Mr Lee Chiong Giam, and officials from the Ministry of Foreign Affairs.

- CNA/de



Read More..

Kasab executed in great secrecy, Mumbaikars celebrate news

NEW DELHI/MUMBAI: Authorities secretly hanged Mohammad Ajmal Kasab, the lone survivor of the Pakistan-based terrorist squad responsible for a rampage through Mumbai that killed 166 people, sparking celebrations days before the fourth anniversary of the assault on the financial capital.

Pakistan national Mohammad Ajmal Kasab was the enduring image of the bloody assault, which traumatized the nation and raised fears of copycat attacks on foreign cities. Pictures of the young gunman wearing a black T-shirt and toting an AK-47 rifle as he strode through Mumbai's train station were published around the world.

Kasab was hanged on Wednesday morning amid great secrecy, underscoring the political sensitivity of the November 26, 2008, massacre, which still casts a pall over relations between nuclear-armed rivals Pakistan and India. The hanging was kept so secret that home minister Sushil Kumar Shinde said that even Prime Manmohan Singh and UPA chairperson Sonia Gandhi didn't know about Kasab hanging, according to TV reports.

"All the police officers and personnel who lost their life in the battle against the terrorists have today been served justice," home minister said after Kasab was hanged in a jail in Pune, southeast of Mumbai.

It was the first time a capital sentence had been carried out in India since 2004. There was celebration on the streets of Mumbai and other cities as news of the execution spread, but militant groups in Pakistan reacted angrily.

People set of fireworks and handed out sweets. Some held up photos of Kasab with a rope noose superimposed over his head.

Attack survivor Vishnu Zende, who was working at Mumbai's train station where nearly 60 people were killed, said the execution brought it all back.

"When I heard the news of Kasab's execution today, I remembered those horrifying moments of the attack," Zende said.

"My eyes were filled with tears."

A senior commander of Pakistan's Lashkar-e-Taiba (LeT) militant group, which India blames for the assault on Mumbai, called Kasab a hero and said he would inspire more attacks.

"To die like Kasab is the dream of every fighter," the commander told Reuters by telephone from an undisclosed location.

The Pakistan Taliban said they were shocked by the hanging.

"There is no doubt that it's very shocking news and a big loss that a Muslim has been hanged on Indian soil," Taliban spokesman Ihsanullah Ihsan told Reuters.

Kasab was buried inside the prison where he was hanged, officials said. He was quiet and seemed nervous before the execution, a prison guard told the NDTV network. He prayed and asked if his family had been informed, which they had.

Government said it would hand over the body to Pakistan if asked. Talking to Reuters from Kasab's home village, his aunt said she was proud of him and wanted his body back.

This year, Saudi Arabia extradited an Indian-born militant accused of being one of the masterminds of the Mumbai attacks. Police say Sayeed Zabiuddin Ansari, also known as Abu Jindal, helped coordinate the attack from a "control room" in the Pakistani city of Karachi and also helped to train the gunmen.

In August, the Supreme Court upheld Kasab's 2010 death sentence over the attacks. President Pranab Mukherjee rejected his plea for clemency on November 5, although this was not made public until Tuesday night.

The timing of the execution, shortly before a series of state elections, may be beneficial for the government, which opposition leaders accuse of being soft on national security.

Narendra Modi, the opposition chief minister of Gujarat state, which goes to the polls in December and borders Pakistan, said on Twitter the government should move faster to execute Afzal Guru, convicted of a 2001 attack on parliament.

'Foot soldier'

Ten militants arrived on the Mumbai shoreline in a dinghy on November 26, 2008, before splitting into four groups and embarking on a killing spree. They held off elite commandos for up to 60 hours in two luxury hotels and a Jewish centre in the city.

India says Islamabad is failing to act against those behind the raids, including LeT founder Hafiz Saeed, who has a $10 million US bounty on his head. Pakistan admits the attacks were planned on its soil, but denies official involvement.

It says seven suspects are being prosecuted for their role.

"Kasab was a foot soldier, the generals are in Islamabad, in Pakistan, and full justice will be done when they are brought to justice," Gopalapuram Parthasarathy, a former ambassador to Pakistan, told Reuters.

Improving relations with Pakistan is a keystone of Prime Minister Manmohan Singh's foreign policy. Singh, who was born in present-day Pakistan when it was still part of British India, has repeatedly postponed visiting the country because of lack of progress on convicting the Mumbai suspects.

However, India and Pakistan's relations have gradually improved since the attacks, with progress made on trade and economic ties.

Possibly because of the planned execution, India on Tuesday asked Pakistan to postpone a visit this week by Interior Minister Rehman Malik, saying the dates were "not suitable for us". Malik was due to put the final seal on a deal to ease visa restriction for travellers.

Kasab's execution happened very quickly for India's usually glacial justice system. Three people convicted of the assassination of former Prime Minister Rajiv Gandhi are still on death row, 21 years after he was killed by a suicide bomb.

In Pakistan, many said the hanging happened quickly only because of his nationality. People questioned whether Kasab was really guilty, despite the video evidence.

"We have images of him but do we have any other evidence? Is that enough?," said Jehan Zulqarnain, a primary school teacher in Islamabad.

Pakistan was informed beforehand about Kasab's execution, said a Pakistani foreign ministry official who asked not to be identified. "If all judicial procedures were followed, then the decision is acceptable," the official said.

Read More..

OB/GYNs back over-the-counter birth control pills

WASHINGTON (AP) — No prescription or doctor's exam needed: The nation's largest group of obstetricians and gynecologists says birth control pills should be sold over the counter, like condoms.

Tuesday's surprise opinion from these gatekeepers of contraception could boost longtime efforts by women's advocates to make the pill more accessible.

But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance.

Still, momentum may be building.

Already, anyone 17 or older doesn't need to see a doctor before buying the morning-after pill — a higher-dose version of regular birth control that can prevent pregnancy if taken shortly after unprotected sex. Earlier this year, the Food and Drug Administration held a meeting to gather ideas about how to sell regular oral contraceptives without a prescription, too.

Now the influential American College of Obstetricians and Gynecologists is declaring it's safe to sell the pill that way.

Wait, why would doctors who make money from women's yearly visits for a birth-control prescription advocate giving that up?

Half of the nation's pregnancies every year are unintended, a rate that hasn't changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor's visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn't require a prescription, women could "pick it up in the middle of the night if they run out," she said. "It removes those types of barriers."

Tuesday, the FDA said it was willing to meet with any company interested in making the pill nonprescription, to discuss what if any studies would be needed.

Then there's the price question. The Obama administration's new health care law requires FDA-approved contraceptives to be available without copays for women enrolled in most workplace health plans.

If the pill were sold without a prescription, it wouldn't be covered under that provision, just as condoms aren't, said Health and Human Services spokesman Tait Sye.

ACOG's opinion, published in the journal Obstetrics & Gynecology, says any move toward making the pill nonprescription should address that cost issue. Not all women are eligible for the free birth control provision, it noted, citing a recent survey that found young women and the uninsured pay an average of $16 per month's supply.

The doctors group made clear that:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there's no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they'd like to discuss other forms of birth control such as implantable contraceptives that do require a physician's involvement.

The group didn't address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires girls younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers' ages. Presumably regular birth control pills would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don't require a prescription.

Switching isn't a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor's involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country's health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

"Being able to easily get the pill when you need it makes a difference," he said.

___

Online:

OB/GYN group: http://www.acog.org

Read More..

Bus Explodes in Tel Aviv Amid Truce Talks













A bomb exploaded on an Israeli bus near the nation's military headquarters in Tel Aviv, wounding at least 10 people, Israeli officials said today.


The bus exploded about noon local time Wednesday in one of the city's busiest areas, near the Tel Aviv museum. Police spokesman Micky Rosenfeld said authorities were investigating whether the bomb had been planted and left on the bus or whether it was the work of a suicide bomber. This is the first terror attack in Israel since 2006.


Upon landing in Cairo to meet with Egyptian President Mohamed Morsi, Secretary of State Hillary Clinton released a statement condemning the attack.


"The United States strongly condemns this terrorist attack and our thoughts and prayers are with the victims and the people of Israel. As I arrive in Cairo, I am closely monitoring reports from Tel Aviv, and we will stay in close contact with Prime Minister Netanyahu's team. The United States stands ready to provide any assistance that Israel requires," she said.


Overnight, the violence between Israel and the neighboring Gaza Strip continued as Israeli aircraft pounded Gaza with dozens of strikes, hitting government ministries, underground tunnels, a banker's empty villa and a Hamas-linked media office. Gaza health officials said there were no deaths or injuries.








Clinton on Mideast Ceasefire: 'America's Commitment to Israel's Security Is Rock Solid' Watch Video











Israeli-Palestinian Conflict: Families Pray for Ceasefire Watch Video





The Israeli Defense Force said they've now destroyed 50 underground rocket launching sites in Gaza. The IDF also said that two rockets were fired from Gaza toward densely populated areas in Israel, but were intercepted by the "Iron Dome" missile shield.


In Gaza at least four strikes within seconds of each other pulverized a complex of government ministries the size of a city block, rattling nearby buildings and shattering windows. Hours later, clouds of acrid dust still hung over the area and smoke still rose from the rubble.


In downtown Gaza City, another strike leveled the empty, two-story home of a well-known banker and buried a police car parked nearby in rubble.


Clinton met with Palestinian President Abbas in Ramallah early Wednesday to try to help broker a truce between Israel and Hamas in the Gaza Strip to end a week of tit-for-tat missile and rocket fire.


Israel and the Hamas militant group seemed to edge closer to a ceasefire Tuesday to end a weeklong Israeli offensive in the Gaza Strip, but after a day of furious diplomatic efforts, a deal remained elusive and fighting raged on both sides of the border.


Israeli officials told ABC News that a window of opportunity for a deal could close, if Hamas refuses to agree to a long-term ceasefire. That ceasefire would be measured in years, not months. Hamas is demanding that Israel loosen its iron grip on Gaza's borders and ease its maritime blockade.


On Tuesday, Clinton met with Israeli Prime Minister Benjamin Netanyahu for more than two hours behind closed doors, saying she sought to "de-escalate the situation in Gaza." Clinton hinted it would take some time to finally reach an agreement.


The meeting came amid statements from Hamas earlier in the day that a ceasefire would soon be announced.
Netanyahu said he would prefer to use "diplomatic means" to find a solution to the fighting, but that Israel would take "whatever actions necessary" to defend its people.


Clinton relayed a message from President Obama, reinforcing America's commitment to Israel's security and calling for an end to the rockets coming from "terrorist organizations in Gaza."






Read More..

World pressure for Gaza truce intensifies

GAZA/JERUSALEM (Reuters) - The U.N. chief called for an immediate ceasefire in the Gaza Strip on Tuesday and U.S. Secretary of State Hillary Clinton headed to the region with a message that escalation of the week-long conflict was in nobody's interest.


Nevertheless, Israeli air strikes and Palestinian rocket fire continued for a seventh day.


Egypt was trying to broker a truce between Israel and Gaza's ruling Hamas movement. An Egyptian intelligence source said "there is still no breakthrough and Egypt is working to find middle ground".


Israel's military on Tuesday targeted about 100 sites in Gaza, including ammunition stores and the Gaza headquarters of the National Islamic Bank. Gaza's Hamas-run Health Ministry said six Palestinians were killed.


Israeli police said more than 60 rockets were fired from Gaza by mid-day, and 25 of the projectiles were intercepted by Israel's Iron Dome system. The military said an officer was wounded.


Some 115 Palestinians have died in a week of fighting, the majority of them civilians, including 27 children, hospital officials said. Three Israelis died last week when a rocket from Gaza struck their house.


In Cairo, U.N. Secretary-General Ban Ki-moon called for an immediate ceasefire and said an Israeli ground operation in Gaza would be a "dangerous escalation" that must be avoided.


He had held talks in Cairo with Arab League chief Nabil Elaraby and Egyptian Prime Minister Hisham Kandil before travelling to Israel for discussions with its leader, Benjamin Netanyahu. Ban planned to return to Egypt on Wednesday to see Egypt's Islamist President Mohamed Mursi, who was unavailable on Tuesday due to the death of his sister.


Israel's leaders weighed the benefits and risks of sending tanks and infantry into the densely populated coastal enclave two months before an Israeli election, and indicated they would prefer a diplomatic path backed by world powers, including U.S. President Barack Obama, the European Union and Russia.


The White House said Clinton was going to the Middle East for talks in Jerusalem, Ramallah and Cairo to try to calm the conflict. An Israeli source said she was expected to meet Netanyahu on Wednesday.


Netanyahu and his top ministers debated their next moves in a meeting that lasted into the early hours of Tuesday.


"Before deciding on a ground invasion, the prime minister intends to exhaust the diplomatic move in order to see if a long-term ceasefire can be achieved," a senior Israeli official, speaking on condition of anonymity, said after the meeting.


A delegation of nine Arab ministers, led by the Egyptian foreign minister, was due in Gaza later on Tuesday in a further signal of heightened Arab solidarity with the Palestinians.


EGYPT KEY PLAYER


Any diplomatic solution may involve Egypt, Gaza's other neighbor and the biggest Arab nation, where the ousting of U.S. ally Hosni Mubarak and the election of Mursi is part of a dramatic reshaping of the Middle East wrought by Arab uprisings and now affecting the Israeli-Palestinian conflict.


Mursi, whose Muslim Brotherhood was mentor to the founders of Hamas, on Monday took a call from Obama, who told him Hamas must stop rocket fire into Israel - effectively endorsing Israel's stated aim in launching the offensive last week. Obama also said he regretted civilian deaths - which have been predominantly among the Palestinians.


"The two leaders discussed ways to de-escalate the situation in Gaza, and President Obama underscored the necessity of Hamas ending rocket fire into Israel," the White House said, adding that the U.S. leader had also called Netanyahu.


"In both calls, President Obama expressed regret for the loss of Israeli and Palestinian civilian lives."


Mursi has warned Netanyahu of serious consequences from a ground invasion of the kind that killed more than 1,400 people in Gaza four years ago. But he has been careful not to alienate Israel, with whom Egypt's former military rulers signed a peace treaty in 1979, or Washington, a major aid donor to Egypt.


Egypt's Kandil told Reuters a ceasefire was possible: "I think we are close, but the nature of this kind of negotiation, (means) it is very difficult to predict."


After Hamas leader Khaled Meshaal laid out demands in Cairo that Israel take the first step in restoring calm, and warned Netanyahu that a ground war in Gaza could wreck his re-election prospects in January, a senior Israeli official denied a Hamas assertion that the prime minister had asked for a truce.


"Whoever started the war must end it," Meshaal said, referring to Israel's assassination from the air on Wednesday of Hamas's Gaza military chief, a move that followed a scaling up of rocket fire onto Israeli towns over several weeks and attacks against Israeli troops along the border.


An official close to Netanyahu told Reuters: "We would prefer to see a diplomatic solution that would guarantee the peace for Israel's population in the south. If that is possible, then a ground operation would no longer be required."


Fortified by the ascendancy of fellow Islamists in Egypt and elsewhere, and courted by Sunni Arab leaders in the Gulf keen to draw the Palestinian group away from old ties to Shi'ite Iran, Hamas has tested its room for maneuver, as well as longer-range rockets that have reached the Tel Aviv metropolis.


Hamas said four-year-old twin boys had died with their parents when their house in the town of Beit Lahiya was struck from the air during the night. Neighbors said the occupants were not involved with militant groups.


Israel had no immediate comment on that attack. It says it takes extreme care to avoid civilians and accuses Hamas and other militant groups of deliberately placing Gaza's 1.7 million people in harm's way by placing rocket launchers among them.


Nonetheless, fighting Israel, whose right to exist Hamas refuses to recognize, is popular with many Palestinians and has kept the movement competitive with the secular Fatah movement of Palestinian President Mahmoud Abbas, who remains in the West Bank after losing Gaza to Hamas in a civil war five years ago.


"Hamas and the others, they're our sons and our brothers, we're fingers on the same hand," said 55-year-old Faraj al-Sawafir, whose home was blasted by Israeli forces. "They fight for us and are martyred, they take losses and we sacrifice too."


In scenes recalling Israel's 2008-2009 winter invasion of the coastal enclave, tanks, artillery and infantry have massed in field encampments along the sandy, fenced-off border.


(Writing by Alastair Macdonald, Jeffrey Heller; and Crispian Balmer; Editing by Giles Elgood)


Read More..

Facebook post on Thackeray: Girl says she will not visit FB, 9 held for vandalism

MUMBAI/DELHI: One of the girls held for posting comments on Facebook questioning the shutdown in Mumbai for Shiv Sena Chief Bal Thackeray's funeral today said she will never again visit the social networking site while police arrested 9 Shiv Sainiks for vandalising her uncle's clinic.
Shaheen Dhada and Renu were arrested for posting comments opposing the Mumbai shutdown. However, they were granted bail after they furnished personal bonds, police said.

"So far, we have arrested nine persons in connection with ransacking the clinic of Abdul Dhada. We are looking for some more people," SP Thane rural Ravindra Sengaokar told PTI.

Shaheen said police was polite to her and she had no complaints against any police personnel. "I have apologised for the post," she said adding that whatever happened was unfair.

However, Shaheen said she would never use the social media network henceforth. She had no comments to offer on whether she had done anything wrong. She described Thackeray as a "great guy" whom she "truly respected".

Shaheen had allegedly commented on Facebook that one should not observe bandh for Thackeray's funeral. "We should remember Bhagat Singh and Sukhdev," the post said.

Her friend Renu, who was arrested for 'liking' the post, felt that she was "wrongfully" arrested.

Renu said, "I regret what I did. This should not have happened. I never dreamt that I would be in court. What we did was not a crime. Now I will think twice before posting anything on Facebook."

She further said, "The arrest was not necessary. Police treated us well. I was amazed at what was happening to me."

Their advocate Sudhir Gupta said both were arrested under section 505(2) IPC (statements creating or promoting enmity, hatred or ill-will between classes) following a police complaint lodged by a local Sena leader.

Police sources said a FIR has been registered against more than 50 people including some Shiv Sainiks who have been named in the report following the attack.

Also, a probe has been ordered into whether the contents of the Facebook post constituted an offence and even if the offence was registered why were the arrests made, Maharashtra Police's IG (law and order) Deven Bharti said.

Abdul Dhada, whose clinic was ransacked, said, "For our security they have posted the police because what has gone wrong should not happen again...we don't have any complaint against anybody and treatment we received from the police station is absolutely fine".

TOI had reported in its edition dated November 19 that Shiv Sainiks, angered by Shaheen Dhada's post on a social networking site, vandalized a clinic in Palghar owned by her uncle.

On Sunday, Shaheen Dhada (21) posted a comment on her Facebook page questioning the shutdown (following Bal Thackeray's death). Local Shiv Sainiks in Palghar objected and asked her to apologize, which she allegedly refused to initially. Despite her later posting of an apology, a big mob of activists vandalized the Dhada orthopaedic hospital belonging to her uncle Dr Abdul Dhada and manhandled staff and patients.

Under Sainiks' pressure, police detained Shaheen and her friend Rini Srinivasan (21, who had 'liked' Shaheen's comment on FB) late at night and arrested them on Monday morning for "hurting religious sentiments." The charge was later reduced and the two girls granted bail on surety of Rs 15,000 each.

(With PTI inputs)

Read More..

Clinton Heading to Middle East to Meet With Leaders













Secretary of State Hillary Clinton is headed to the Middle East with the hope that she can help bring an end to the escalating violence that has gripped the region for the last week.


Clinton is scheduled to arrive in Jerusalem later tonight to meet with Israel Prime Minister Benjamin Netanyahu, according to Deputy National Security Advisor Ben Rhodes. Clinton will also meet with Palestinian officials in Ramallah before heading to Cairo to meet with leaders in Egypt.


A senior Israeli government official told ABC News that Netanyahu has decided to hold off on a ground invasion for a "limited time" in favor of a diplomatic solution.


Overnight, Israeli jets hit more than 100 targets, killing five people. Gaza militants blasted more than 60 rockets in retaliation, with one of them hitting a bus in southern Israel.


Click HERE for Photos from Airstrikes and Rocket Attacks in the Middle East


An Israeli man armed with an axe and knife stabbed a guard at the U.S. Embassy in Tel Aviv. The guard was wounded in the attack, but expected to live. Police apprehended the man at the scene, police said.


The man, in his early 40s, attacked the guard outside the embassy gates, police spokesman Micky Rosenfeld told The Associated Press. He said the man's motive was unknown, but political motives were not suspected and the incident had nothing to do with Israel's battle with Hamas militants in the Gaza Strip.








Middle East on the Brink: Israel Prepared to Invade Gaza Watch Video









Gaza Violence: More Missiles Fired, Death Toll Rises Watch Video







"It's in nobody's interest to see this escalate," Rhodes said at a press conference in Phnom Penh, Cambodia, where President Obama is attending the East Asia Summit.


Clinton, who was with Obama on his trip to Southeast Asia, hastily departed from Cambodia for the Middle East following the announcement.


A State Department official tells ABC News that Clinton's visit "will build on American engagement with regional leaders over the past days."


A White House official said they believe face-to-face diplomacy could help, but no concrete details were offered.


President Obama was on the phone until 2:30 a.m. local time with leaders in the region trying to de-escalate the violence, Rhodes told reporters. The president spoke with Netanyahu and Egyptian President Morsi on Monday as well.


"To date, we're encouraged by the cooperation and the consultation we've had with the Egyptian leadership. We want to see that, again, support a process that can de-escalate the situation," Rhodes said. "But again, the bottom line still remains that Hamas has to stop this rocket fire."


Rhodes insisted that Palestinian officials need to be a part of the discussions to end the violence and rocket fire coming out of the Hamas-ruled territory.


"The Palestinian Authority, as the elected leaders of the Palestinian people, need to be a part of this discussion," Rhodes said. "And they're clearly going to play a role in the future of the Palestinian people—a leading role."


With the death toll rising, Egypt accelerated efforts to broker a cease-fire Monday. Anger boiled over in Gaza as the death toll passed 100 and the civilian casualties mounted. Volleys of Palestinian militant rockets flew into Israel as Israeli drones buzzed endlessly overhead and warplanes streaked through the air to unleash missile strikes.


An Israeli strike on a Gaza City high-rise Monday killed Ramez Harb, one of the top militant leaders of Islamic Jihad, the Palestinian militant group said.


It is also the second high profile commander taken out in the Israeli offensive, which began seven days ago with a missile strike that killed Ahmed Jibari, Hamas' top military commander.


ABC News' Reena Ninan, Dana Hughes, Mary Bruce and Matt Gutman contributed to this report.



Read More..