BJP national executive to meet today

NEW DELHI: BJP will chalk out a road-map for evolving its strategy to project itself as an alternative in the next general elections, at the meeting of its national executive and national council starting on Friday.

While the BJP national executive will hold a closed-door meeting on Friday, its national council, a broader body having members from across the country, will hold its two-day meeting on Saturday and Sunday.

The conclave is crucial as it will be the first such meeting after the election of Rajnath Singh as party chief.

During the next three days, the party leadership will discuss a host of issues including the internal security situation in the wake of Hyderabad blasts, scams including the VVIP chopper deal, economic slowdown and Indo-Pak ties.

The BJP national executive and council will also examine details of how to take on the UPA government by highlighting its "failures" on the economic and security front.

Sources said significant decisions like appointment of the new team of central office-bearers and elevation of Gujarat chief minister Narendra Modi and his Madhya Pradesh counterpart Shivraj Singh Chouhan to the central parliamentary board are likely to take place after the conclave.

These issues are likely to come up for discussion informally during the meet, sources said.

BJP vice-president Mukhtar Abbas Naqvi said the meeting will start with the address of party president Rajnath Singh and will discuss the economic, social and political issues of the country.

Naqvi said the national executive and nation council meetings will have four and nine sessions, respectively. "In three days of the meeting we will discuss the strategy for upcoming elections with the motto 'Sushasan sankalp BJP vikalp' (BJP is promise to good governance).

Naqvi said the economic, social, political situation and challenges before the country will be discussed in the council and executive meeting.

Issues like graft, inflation, internal and national security will also be discussed along with "antyodaya and good governance", he added.

The national council, will pass two resolutions. There will be a resolution on the political situation prevailing in the country and will deal with the "policy paralysis" within the UPA government and the "grim" internal security scenario.

It will mainly focus on terrorism in the wake of the Hyderabad blasts. The government's allegations of BJP and RSS sponsoring terrorism, and the Ram Settu issue are also likely to figure in the discussions.

All members of the national council and executive, MPs and MLAs in state assemblies, state office bearers, national co-ordinators of morchas, co-coordinators, all district presidents and general secretaries among others will participate in the council meeting.

The national executive meeting, with about 200 members, will be held in NDMC convention centre and the national council comprising of over 2,000 leaders will be held in Talkatora Indoor stadium.

The economic resolution will point out the "wrong economic policies" of the UPA government which has led to price rise, fall in GDP growth to 5 per cent, plight of farmers, lack of foreign investment in multi-brand retail sector among other issues.

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Arias Recounts Each Moment of Stabbing, Slashing

Accused murderer Jodi Arias was forced to recount today each detail of how she killed her ex-boyfriend, Travis Alexander, including re-enacting how he allegedly tackled her when she shot him, leaving her crying in her hands on the witness stand.

During hours of dramatic cross-examination by prosecutor Juan Martinez, Arias bawled as he asked her about stabbing, slashing and shooting Alexander on June 4, 2008.

"You would acknowledge that Mr. Alexander was stabbed, and that the stabbing was with the knife, and it was after the shooting according to you, right?" Martinez said in rapid succession.

"Yes, I don't remember," Arias said, covering her face with her hands.

"Do you acknowledge the stab wounds, and we can count them together, were to the back of the head and the torso?" Martinez said, flashing a photo of Alexander's bloodied body onto the courtroom projector. " Do you want to take a look at the photo?"

Arias, burying her face in her hands and shutting her eyes on the stand, mumbled, "No."

Alexander's sisters, seated in the front row of the gallery, also looked away, crying.

Arias, 32, is accused of killing Alexander on June 4, 2008 out of jealousy. He was stabbed 27 times, his throat was slashed and he was shot in the head twice.

Arias claims she killed in self-defense after Alexander had become increasingly violent with her. She could face the death penalty if convicted.

Martinez also forced Arias to demonstrate in court today how she claims Alexander lunged at her "like a linebacker," causing her to fire the gun at him. The pair argued over how exactly Alexander was positioned, and Martinez pushed her to explain what she meant.

"He lunges at me like a linebacker," Arias said.

"Like a linebacker, what does that mean?" Martinez asked.

Jodi Arias Under Attack in Third Day of Cross-Examination Watch Video

Jodi Arias, Prosecutor Butt Heads in Cross-Examination Watch Video

Jodi Arias Maintains She 'Felt Like a Prostitute' Watch Video

"He was low. It was almost like he dove," she said, and trying to explain it further, added, "He was like a linebacker is the only way I can describe it unless I get up to act it out which I'd rather not do."

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

Timeline of the Jodi Arias Trial

"Go ahead and do it," Martinez said. "Just stand. Go ahead."

Judge Sherry Stephens initially cleared the court as Arias demonstrated and then Martinez had her do it again after the jury and spectators were allowed back into the courtroom.

Standing and moving away from the witness box, Arias bent at the waist and spread out her arms and meekly made a slight lunging motion.

According to her testimony, Arias fired the gun as Alexander rushed at her, tackling her to the ground. She said she does not remember how she stabbed or slashed him.

It was a day of dramatics and anger as the prosecution pressed Arias on the details of the killing, with Martinez ending the afternoon of questioning by accusing Arias of lying throughout her direct testimony.

At one point Arias dissolved into tears, unable to answer pointed questions when shown a photo of Alexander's body lying crumpled in the bottom of the stall shower.

After a short pause, Martinez asked dryly, "Were you crying when you were shooting him?"

"I don't remember," Arias moaned.

"Were you crying when you stabbed him?" he said. "How about when you slashed his throat?"

"I don't remember, I don't know."

Martinez pressed on, "You're the one that did this right? And lied about all this right?"

"Yes."

"So then take a look at it," he barked.

Arias did not answer Martinez's question, crying into her hands instead. The judge, after a moment, called for the lunch recess to take a break from the testimony. Arias' attorney walked over and consoled her, telling her to "take a moment."

Until that moment, Arias had given vague answers to Martinez as he asked about the hours leading up to the murder. Arias, 32, has testified that she drove to Alexander's house on June 4, 2008, for a sexual liaison, that she had sex with Alexander and the pair took nude photos before an explosive confrontation ended with her killing him. She claims she doesn't remember stabbing Alexander, but insists it was in self-defense.

Martinez questioned her claims, asking exactly what they argued about and who encouraged whom to take the nude photos. He pointed out that Arias told Detective Esteban Flores of the Mesa police department that she had to convince Alexander to take the nude photos in the shower, but that she testified on the stand that Alexander had wanted them.

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Australian government pension fund dumps tobacco

SYDNEY: The Australian government's pension fund for public servants Thursday announced it would sell off its A$222 (US$228) million holdings in tobacco companies following the nation's move towards plain packaging.

The Future Fund, which manages some A$80 billion in retirement savings for government workers, said it had decided to "exclude primary tobacco producers from its investment portfolio" after a review of its holdings.

"The board noted tobacco's very particular characteristics including its damaging health effects, addictive properties and that there is no safe level of consumption," said fund chairman David Gonski.

"In doing so the board also considered its investment policies and approach to environmental, social and governance issues."

It relates to shares worth A$222 million in 14 companies engaged in tobacco production -- 0.3 per cent of the fund's total holdings -- including the four giants that took legal action against Australia's plain packets plan.

Health groups and Australia's left-wing Greens party had questioned the fund's investment in tobacco as inconsistent with public values following the shift in December to plain packaging for tobacco in a bid to curb smoking.

The fund has previously jettisoned holdings on ethical grounds, selling off its stock in 10 defence companies that manufactured cluster munitions and land-mines in 2011.

Similar moves against tobacco firms were taken by the Norwegian government's pension fund in 2010.

Australia estimates there are 15,000 deaths nationally each year from tobacco-related illnesses and that smoking costs more than A$30 billion a year in healthcare and lost productivity.

- AFP/ck

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Assembly polls: Meghalaya, Nagaland and Tripura to get new govts today

NEW DELHI/KOHIMA/AGARTALA/ SHILLONG: Meghalaya, Nagaland and Tripura will get new governments today. Counting of votes began at 8am in all the three northeast states.

Tight security for Nagaland assembly poll counting

PARTY	LEADS	WINS
CONGRESS	4	0
UNDP	1	0
NPF	15	0
OTHERS	2	0

Adequate security arrangements have been made for the counting of votes to the 59 assembly seats of the 60-member House in Nagaland today.

Peaceful elections were held in the state on February 23 while re-polling was done in nine polling stations at eight assembly constituencies spread over seven districts on Wednesday.

Among those whose electoral fortunes will be decided today are chief minister Neiphiu Rio, Speaker Kiyanilie Peseyie, opposition leader Tokheho Yepthomi, state Congress president S I Jamir and former home minister Imkong L Imchen.

A total of 59 halls have been provided in the districts with three-tier security layers created in each counting hall.

Over 10,000 counting personnel including counting supervisors and counting assistants are engaged in the counting process along with micro observers and Election Commission appointed observers.

In consonance with an Election Commission directive, the international border has been sealed so that no unwanted elements can enter into the state during the counting of votes.

The entire process will be videographed, he said.

Meghalaya: Amid split verdict fears, Congress dreams victory

PARTY	LEADS	WINS
CONGRESS	12	0
UDP	6	0
NCP	1	0
OTHERS	6	0
Hill state People's Democratic party	2	2

With counting of votes underway in Meghalaya, both the ruling Congress and non-Congress parties are confident of winning the elections.

A whopping 88 percent of the 1.5 million voters exercised their franchise Feb 16 to pick a new 60-member house in the state bordering Bangladesh.

There were 345 candidates, including 25 women and 122 independents.

But some experts fear that Meghalaya may be headed for a fractured mandate.

"I have always believed that Meghalaya will never get a clear mandate since elections here are conducted based on the personality of the candidate and trivial issues," AK Baruah, a retired professor of political science who taught at the North Eastern Hill University said.

Carved out of Assam in 1972, Meghalaya has seen 23 chief ministers in a span of 41 years.

Captain Williamson Sangma, who led the government for the first time, was the only one to ever lead a single-party government in the state.

Since then, Meghalaya has seen fractured mandates, leading to volatile coalition governments.

However, outgoing chief minster Mukul Sangma, 47, hopes to return to the assembly for a fifth consecutive time from Ampati constituency.

"We are close to half-way mark and we are hoping to get more," the Congress leader said.

The Congress fielded candidates in all 60 constituencies while the United Democratic Party (UDP) contested 50 seats.

The Purno Sangma-led Nationalist People's Party (NPP) had 32 candidates, and the Nationalist Congress Party 21.

The UDP is confident of ousting the Congress.

"We will cross 15 seats and if luck favours we might even cross 20," UDP leader Bindo M Lanong said.

Lanong said UDP was in touch with "like-minded parties" for post-poll alliances.

Predicting a Congress failure, Purno Sangma's son Conrad, leader of the opposition in the assembly, claimed that Chief Minister Mukul Sangma would bite the dust.

"We are hopeful of increasing our tally," Conrad said.

Counting begins in Tripura

PARTY	LEADS	WINS
CONGRESS	4	0
CPM	32	0
CPI	1	0
OTHERS	2	0

Counting of votes for the 60 assembly seats in Tripura began at 8am on Thursday morning amidst tight security.

The counting began at 17 venues in eight districts of the state with three-tier security in each counting hall, sources in the office of chief electoral officer said.

Among prominent candidates whose electoral fates would be decided are chief minister Manik Sarkar from Dhanpur, finance minister Badal Chowdhury from Hrishyamukh, higher education minister Anil Sarkar from Pratapgarh, industries and commerce minister Jitendra Chowdhury from Manu (ST).

The electoral fortunes of TPCC President Sudip Ray Barman from Agartala, leader of the opposition Ratan Lal Nath of Congress from Mohanpur and president of the Indigenous Nationalist Party of Tripura Bijay Hrankhwal from Ambassa would also be decided.

Around 2,500 employees, including counting supervisors and counting assistants, have been engaged together with micro observers and Election Commission appointed observers.

Prohibitory orders have been imposed within 100 meter of each counting hall where CCTV have been installed.

The 856 km border with neighbouring Bangladesh has been sealed since Wednesday.

The elections were held on February 14.

(With inputs from agencies)

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Huge study: 5 mental disorders share genetic links

WASHINGTON (AP) — The largest genetic study of mental illnesses to date finds five major disorders may not look much alike but they share some gene-based risks. The surprising discovery comes in the quest to unravel what causes psychiatric disorders and how to better diagnose and treat them.

The disorders — autism, attention deficit-hyperactivity disorder or ADHD, bipolar disorder, major depressive disorder and schizophrenia — are considered distinct problems. But findings published online Wednesday suggest they're related in some way.

"These disorders that we thought of as quite different may not have such sharp boundaries," said Dr. Jordan Smoller of Massachusetts General Hospital, one of the lead researchers for the international study appearing in The Lancet.

That has implications for learning how to diagnose mental illnesses with the same precision that physical illnesses are diagnosed, said Dr. Bruce Cuthbert of the National Institute on Mental Health, which funded the research.

Consider: Just because someone has chest pain doesn't mean it's a heart attack; doctors have a variety of tests to find out. But there's no blood test for schizophrenia or other mental illnesses. Instead, doctors rely on symptoms agreed upon by experts. Learning the genetic underpinnings of mental illnesses is part of one day knowing if someone's symptoms really are schizophrenia and not something a bit different.

"If we really want to diagnose and treat people effectively, we have to get to these more fine-grained understandings of what's actually going wrong biologically," Cuthbert explained.

Added Mass General's Smoller: "We are still in the early stages of understanding what are the causes of mental illnesses, so these are clues."

The Psychiatric Genomics Consortium, a collaboration of researchers in 19 countries, analyzed the genomes of more than 61,000 people, some with one of the five disorders and some without. They found four regions of the genetic code where variation was linked to all five disorders.

Of particular interest are disruptions in two specific genes that regulate the flow of calcium in brain cells, key to how neurons signal each other. That suggests that this change in a basic brain function could be one early pathway that leaves someone vulnerable to developing these disorders, depending on what else goes wrong.

For patients and their families, the research offers no immediate benefit. These disorders are thought to be caused by a complex mix of numerous genes and other risk factors that range from exposures in the womb to the experiences of daily life.

"There may be many paths to each of these illnesses," Smoller cautioned.

But the study offers a lead in the hunt for psychiatric treatments, said NIMH's Cuthbert. Drugs that affect calcium channels in other parts of the body are used for such conditions as high blood pressure, and scientists could explore whether they'd be useful for psychiatric disorders as well.

The findings make sense, as there is some overlap in the symptoms of the different disorders, he said. People with schizophrenia can have some of the same social withdrawal that's so characteristic of autism, for example. Nor is it uncommon for people to be affected by more than one psychiatric disorder.

___

Online:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60223-8/abstract

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Arias Prosecutor Too Combative, Experts Say

He has barked, yelled, been sarcastic and demanded answers from accused murderer Jodi Arias this week.

And in doing so, prosecutor Juan Martinez and his aggressive antics may be turning off the jury he is hoping to convince that Arias killed her ex-boyfriend Travis Alexander in June 2008, experts told ABCNews.com today.

"Martinez is his own worst enemy," Mel McDonald, a prominent Phoenix defense attorney and former judge, told ABC News. "He takes it to the point where it's ad nauseam. You have difficulty recognizing when he's driving the point home because he's always angry and pushy and pacing around the courtroom. He loses the effectiveness, rather than build it up."

"He's like a rabid dog and believes you've got to go to everybody's throat," he said.

"If they convict her and give her death, they do it in spite of Juan, not because of him," McDonald added.

Martinez's needling style was on display again today as he pestered Arias to admit that she willingly participated in kinky sex with Alexander, though she previously testified that she only succumbed to his erotic fantasies to please him.

Arias, now 32, and Alexander, who was 27 at the time of his death, dated for a year and continued to sleep together for another year following their break-up.

Arias drove to his house in Mesa, Ariz., in June 2008, had sex with him, they took nude photos together and she killed him in his shower. She claims it was in self-defense. If convicted, Arias could face the death penalty.

Jodi Arias, Prosecutor Butt Heads in Cross-Examination Watch Video

Jodi Arias Maintains She 'Felt Like a Prostitute' Watch Video

Jodi Arias Admits to Killing Man, Lying to Police Watch Video

Martinez also attempted to point out inconsistencies in her story of the killing, bickering with her over details about her journey from Yreka, Calif., to Mesa, Ariz., including why she borrowed gas cans from an ex-boyfriend, when she allegedly took naps and got lost while driving, and why she spontaneously decided to visit Alexander at his home in Mesa for a sexual liaison.

"I want to know what you're talking about," Arias said to Martinez at one point.

"No, I'm asking you," he yelled.

Later, he bellowed, "Am I asking you if you're telling the truth?"

"I don't know," Arias said, firing back at him. "Are you?"

During three days of cross examining Arias this week, Martinez has spent hours going back and forth with the defendant over word choice, her memory, and her answers to his questions.

"Everyone who takes witness stand for defense is an enemy," McDonald said. "He prides himself on being able to work by rarely referring to his notes, but what he's giving up in that is that there's so much time he wastes on stupid comments. A lot of what I've heard is utterly objectionable."

Martinez's behavior has spurred frequent objections of "witness badgering" from Arias' attorney Kirk Nurmi, who at one point Tuesday stood up in court and appealed to the judge to have a conference with all of the attorneys before questioning continued. Judge Sherry Stephens at one point admonished Martinez and Arias for speaking over one another.

Andy Hill, a former spokesperson for the Phoenix police department, and Steven Pitt, a forensic psychiatrist who has testified as an expert witness at many trials in the Phoenix area, both said that despite his aggressive style, Martinez would likely succeed in obtaining a guilty verdict.

"When it comes to cross examination, one size does not fit all," said Pitt. "But if you set aside the incessant sparring, what the prosecutor I believe is effectively doing is pointing out the various inconsistencies in the defendant's version of events."

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Iran upbeat on nuclear talks, West still wary

ALMATY (Reuters) - Iran was upbeat on Wednesday after talks with world powers about its nuclear work ended with an agreement to meet again, but Western officials said it had yet to take concrete steps to ease their fears about its atomic ambitions.

Rapid progress was unlikely with Iran's presidential election, due in June, raising domestic political tensions, diplomats and analysts had said ahead of the February 26-27 meeting in the Kazakh city of Almaty, the first in eight months.

The United States, China, France, Russia, Britain and Germany offered modest sanctions relief in return for Iran curbing its most sensitive nuclear work but made clear that they expected no immediate breakthrough.

In an attempt to make their proposals more palatable to Iran, the six powers appeared to have softened previous demands somewhat, for example regarding their requirement that the Islamic state ship out its stockpile of higher-grade uranium.

Iran's chief nuclear negotiator Saeed Jalili said the powers had tried to "get closer to our viewpoint", which he said was positive.

In Paris, U.S. Secretary of State John Kerry commented that the talks had been "useful" and that a serious engagement by Iran could lead to a comprehensive deal in a decade-old dispute that has threatened to trigger a new Middle East war.

Iran's foreign minister said in Vienna he was "very confident" an agreement could be reached and Jalili, the chief negotiator, said he believed the Almaty meeting could be a "turning point".

However, one diplomat said Iranian officials at the negotiations appeared to be suggesting that they were opening new avenues, but it was not clear if this was really the case.

Iran expert Dina Esfandiary of the International Institute for Strategic Studies said: "Everyone is saying Iran was more positive and portrayed the talks as a win."

"I reckon the reason for that is that they are saving face internally while buying time with the West until after the elections," she said.

The two sides agreed to hold expert-level talks in Istanbul on March 18 to discuss the powers' proposals, and return to Almaty for political discussions on April 5-6, when Western diplomats made clear they wanted to see a substantive response from Iran.

"Iran knows what it needs to do, the president has made clear his determination to implement his policy that Iran will not have a nuclear weapon," Kerry said.

A senior U.S. official in Almaty said, "What we care about at the end is concrete results."

ISRAELI WARNING

Israel, assumed to be the Middle East's only nuclear-armed power, was watching the talks closely. It has strongly hinted it might attack Iran if diplomacy and sanctions fail to ensure that it cannot build a nuclear weapon. Iran denies any such aim.

Israeli Prime Minister Benjamin Netanyahu said economic sanctions were failing and urged the international community to threaten Iran with military action.

Western officials said the offer presented by the six powers included an easing of a ban on trade in gold and other precious metals, and a relaxation of an import embargo on Iranian petrochemical products. They gave no further details.

In exchange, a senior U.S. official said, Iran would among other things have to suspend uranium enrichment to a fissile concentration of 20 percent at its Fordow underground facility and "constrain the ability to quickly resume operations there".

The official did not describe what was being asked of Iran as a "shutdown" of the plant as Western diplomats had said in previous meetings with Iran last year.

Iran says it has a sovereign right to enrich uranium for peaceful purposes, and wants to fuel nuclear power plants so that it can export more oil.

But 20-percent purity is far higher than that needed for nuclear power, and rings alarm bells abroad because it is only a short technical step away from weapons-grade uranium. Iran says it produces higher-grade uranium to fuel a research reactor.

Iran's growing stockpile of 20-percent-enriched uranium is already more than half-way to a "red line" that Israel has made clear it would consider sufficient for a bomb.

In Vienna on Wednesday, a senior U.N. nuclear agency official told diplomats in a closed-door briefing that Iran was technically ready to sharply increase this higher-grade enrichment, two Western diplomats said.

"Iran can triple 20 percent production in the blink of an eye," one of the diplomats said.

The U.S. official in Almaty said the powers' latest proposal would "significantly restrict the accumulation of near-20-percent enriched uranium in Iran, while enabling the Iranians to produce sufficient fuel" for their Tehran medical reactor.

This appeared to be a softening of a previous demand that Iran ship out its stockpile of higher-grade enriched uranium, which it says it needs to produce medical isotopes.

Iran has often indicated that 20-percent enrichment could be up for negotiation if it received the fuel from abroad instead.

Jalili suggested Iran could discuss the issue, although he appeared to rule out shutting down Fordow. He said the powers had not made that specific demand.

The Iranian rial, which has lost more than half its foreign exchange value in the last year as sanctions bite, rose some 2 percent on Wednesday, currency tracking websites reported.

(Additional reporting by Fredrik Dahl and Yeganeh Torbati in Almaty, Georgina Prodhan in Vienna, Zahra Hosseinian in Zurich, Gabriela Baczynska in Moscow, Dan Williams in Jerusalem and Marcus George in Dubai; Writing by Timothy Heritage and Fredrik Dahl; Editing by Louise Ireland)

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Blaze in illegal Kolkata market kills 13: officials

KOLKATA: A fire swept through a six-storey building housing an illegal market in the eastern Indian city of Kolkata on Wednesday, killing 13 people who were unable to escape the inferno, local officials said.

"The death toll in the Surya Sen Market fire has jumped to 13," state fire services minister Javed Khan told AFP. "The market has only one exit point and those who stayed in the market at night were trapped after the fire broke out."

Hundreds of firefighters were at the scene of the blaze near the railway station in the centre of the former colonial capital of India, where decrepit and poorly maintained buildings are vulnerable to fires.

The victims of Wednesday's blaze were thought to be men who were sleeping in the building when the fire broke out at around 04:00 am (2230 GMT) director of fire services for West Bengal state Gopal Bhattacharya told AFP.

"The market housed in the two floors of the building has no legal sanction," he explained.

In late 2011, 90 people were killed when a fire engulfed a hospital in Kolkata while in March 2010 a huge blaze on one of the city's most exclusive streets left at least 43 dead.

- AFP/ck

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No need to be ashamed of House attack: Afzal Guru's letter

NEW DELHI: Parliament attack convict Mohammad Afzal Guru had in a letter purportedly written by him over four years ago said that there was no need to be ashamed of the December 13 attack on Parliament, but had stopped short of owning any responsibility for it.

In the letter written to editor of a local Urdu weekly, Guru, asked Hizbul Mujahideen chief Syed Salahuddin not to be "ashamed of December 13" and stop terming the attack as a "conspiracy".

Editor of the Urdu weekly Shabnum Qayoom said that he has been receiving Guru's letters and articles and is sure that this letter was written by him. "I used to receive his (Guru's) letters and articles, so this was nothing new. The handwriting is the same as the previous letters and articles" he said.

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Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

____

Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

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