Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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Deficit hawks' 'generational theft' argument is a sham

Here's a phrase you can expect to be hearing a lot in the national debate over fiscal policy, as we move past the "sequester," which is today's crisis du jour, and toward the budget cliff/government shutdown deadline looming at the end of March:

"Generational theft."

The core idea the term expresses is that we're spending so much more on our seniors than our children that future generations are being cheated. An important corollary is that the government debt we incur today will come slamming down upon the shoulders of our children and grandchildren.

The generational theft trope has already been receiving a vigorous workout in the press. Earlier this month, the Washington Post gave great play to a study by the Urban Institute stating that the federal government spends $7 on the elderly for every dollar it spends on kids. As we shall see, this is true as far as it goes, but it doesn't go nearly far enough to render an accurate picture of government spending.

The National Journal, another influential publication in Washington, picked up the theme last week by observing that because the sequester exempts Social Security and Medicare from budget cuts, the automatic spending reductions it mandates will fall disproportionately on education and other such boons to the young. This will "deepen the budget's generational imbalance."

This is also a bedrock argument of the anti-deficit organizations, such as Fix the Debt, associated with hedge fund billionaire Peter G. Peterson. For decades he has pursued a wearisome and spectacularly self-interested campaign to cut Social Security and Medicare benefits for the working class so taxes won't go up too much on the wealthy.

One of those organizations, called "The Can Kicks Back," promotes a "Millennial-driven campaign to fix the national debt." But backstopping its twenty- and thirty-something leaders is an advisory board comprising such Peterson frontmen as Morgan Stanley board member Erskine Bowles and former Sen. Alan Simpson (R-Wyo.). These guys are "millennials" only if we're talking about the last millennium before this one.

So here's the truth about the "generational theft" theme: It's wrong on the numbers and wrong on the implications.

Let's start with that 7-to-1 spending ratio on seniors versus children. Among the flaws in the calculation is that the vast majority of government dollars spent on children comes from state and local governments, which pay most of the cost of education. On a per capita basis, state and local spending on kids swamps the federal government's spending 8 to 1.

Moreover, there are twice as many children 18 and under as seniors 65 and over (this 2008 figure also comes from the Urban Institute report). Put the numbers together and you discover that spending by governments at all levels in 2008 came to about $1 trillion on seniors and $936 billion on children. In other words, very close to 1 to 1.

The notion underlying the comparison of spending on seniors and children is that "if you save a dollar on Social Security it would be transferred automatically to children," observes Theodore R. Marmor, an emeritus professor of public policy at Yale and a long-term student of social welfare programs. He traces this notion to deficit hawks and dismisses it as "not naive, but cynical."

That's because most of the spending on seniors is in Social Security and Medicare, and therefore has been largely paid for by those very beneficiaries over the course of their working lives.

Payroll taxes have more than covered what today's average retiree will receive back from Social Security. They won't cover the average payout on Medicare, but that's an artifact of uncontrolled healthcare costs, not of the structure of Medicare itself. Changing the terms of that program, say by raising the eligibility age (currently 65) won't save money and may actually raise costs.

In other ways, treating Social Security and Medicare spending on the one hand and spending on kids on the other as though they're opposite sides of a zero-sum game is just an act of ideological legerdemain aimed at undermining those programs.

If America wants to spend more on children, it's plenty rich enough to do so without eating away at the income of their grandparents. The money can come from the defense budget, farm supports or dozens of other places, even higher income taxes.

Let's not forget, too, that the people who will really suffer from gutting Social Security won't be today's seniors, who will escape the worst of the cutbacks — they'll be today's young people, for whom Social Security would become much less supportive when they retire.

What about the debt load we're supposedly imposing on future generations? This is another transparently Petersonian feat of sleight of hand, based on the assertion that while it's we who incur the debt, it's our children who will have to pay if off.

All the hand-wringing over today's borrowing conveniently assumes that the debt buys nothing, which makes it easier for debt hawks to pretend that it's only an expense and not an investment.

But money borrowed for the stimulus has bought jobs and unemployment benefits, which have helped sustain families through the Great Recession. (At least a few of those families have children, wouldn't you guess?)

In a larger sense, money borrowed by every generation is typically invested in programs and infrastructure — highway, schools, research and conservation, for example — that will add to future generations' wealth.

It's the persistence of the "generational theft" claim, which bubbles up every few years, that exposes its ideological roots.

It's a fundamental piece of a decades-long campaign to distract Americans into thinking that the threat to their way of life comes from a war of old against young, rather than an intra-generational class war in which the vast majority of economic gains from improvements in worker's productivity has flowed to the wealthy, not to the workers.

The economist Dean Baker observes, for example, if the federal hourly minimum wage had merely kept up with productivity growth after 1969 rather than stagnating (and getting eaten away by inflation) it would be more than $16.54, and we wouldn't be arguing about whether the country can "afford" an increase to $9.

The "generational theft" argument is a sham. It's an attempt to get around the fact, so distasteful to the enemies of government social programs, that Social Security and Medicare are hugely popular. As Marmor observes, if you can't put across the case that these programs are undesirable, "you have to make them look uncontrollable, ungovernable, and therefore unaffordable."

The argument has been tried out on several generations in the past, and they've seen through it. Today's generation should see through it too.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

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Mike Piazza softens stance on Dodgers' Vin Scully

PHOENIX — Calling Vin Scully "a class act" and saying he had "the utmost respect" for him, Mike Piazza on Monday defended what he wrote in his recently released autobiography about the Hall of Fame broadcaster.

In his book, "Long Shot," Piazza described Scully as instrumental in turning the fans of Los Angeles against him during the contract stalemate that led to his trade to the Florida Marlins in 1998. Piazza wrote that Scully "was crushing me" on the air, a charge Scully vehemently denied.

"I can't say that I have regrets," Piazza said. "I was just trying to explain the situation."

The former All-Star catcher was at the Dodgers' spring-training facility with Italy's World Baseball Classic team, for which he is a coach. Scully was also at the complex, to call the Dodgers' 7-6 victory over the Chicago Cubs.

"I'd love to see him," Piazza said.

The two didn't meet.

"I always liked him," Scully said. "I admired him. I think either he made a mistake or got some bad advice. I still think of him as a great player and I hope he gets into the Hall of Fame. I really do. Whatever disappointment I feel, I'll put aside."

Scully declined to comment further on Piazza or his book.

Piazza complimented Scully as he tried to defend what he wrote.

"Vin is a class act; he's an icon," Piazza said. "To this day, I have the utmost respect for him. But the problem is, you have to go back in time and understand that at that point in time in my career with the Dodgers was a very tumultuous time. I was more or less telling my version of the story, at least what I was experiencing. And I said at the end of the book, it's not coming from a place of malice or anger. I think anybody who remembers that time knows it was a very tumultuous time."

Piazza said his intent wasn't to blame Scully.

"I don't think anybody who read the passage from start to finish felt that way," Piazza said. "Anybody who reads it knows it wasn't me blaming. That was definitely not the only factor. There were other factors. The team made the mistake, I made the mistake, of speaking publicly."

Piazza acknowledged that he never heard Scully's broadcasts and that his impressions of them were based on what he heard from others.

"My perception was that he was given the Dodgers' versions of the negotiations, which, I feel, wasn't 100% accurate," Piazza said.

In his book, Piazza also took issue with how Scully asked him about his contract demands during a spring-training interview. Piazza said Monday that he was "taken aback" by the line of questioning because he previously hadn't talked publicly about the negotiations.

To reach the practice fields at Camelback Ranch on Monday, Piazza had to pass through a gauntlet of Dodgers fans. Piazza said he wasn't nervous.

"I did a book signing a couple of weeks ago in Pasadena and the fans were really nice," he said.

Piazza denied that he hadn't returned to Dodger Stadium in recent years out of fear of being booed, as Tom Lasorda told The Times last month.

Piazza said he always associated the Dodgers with the O'Malley family, which sold the team to News Corp. in 1998.

"Since then, obviously, they've taken on a different identity," Piazza said.

Piazza was non-committal about visiting the ballpark in the future. "We'll see," he said. "I'll never say never."

Wouldn't it be harder to return now that his portrayal of Scully has upset fans?

"I don't know," he said. "I can't answer that."

Piazza also spoke about falling short of being elected to the Hall of Fame in his first year of eligibility.

"I definitely couldn't lie and say I wasn't a little disappointed," he said.

He is hopeful he would one day be inducted. "I trust the process," he said.

Piazza wouldn't say whether he thought Barry Bonds and Roger Clemens deserved to be in the Hall of Fame. Both players, who have been linked to performance-enhancing drugs, also were denied election.

Piazza has denied using performance-enhancing drugs and has never faced detailed allegations that he did. Asked if he was upset that the indiscretions of others might have altered others' perceptions of him, he replied, "Unfortunately, that's the way life is sometimes. I can't control and worry about what people think."

dylan.hernandez@latimes.com

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Singer Morrissey says no to Kimmel, 'Duck Dynasty'

LOS ANGELES (AP) — The TV series "Duck Dynasty" is coming between Morrissey and Jimmy Kimmel.

The singer and animal rights activist says he canceled his appearance Tuesday on ABC's "Jimmy Kimmel Live" because "Duck Dynasty" cast members will be on the talk show.

Morrissey says he can't perform on a show with what he called people who "amount to animal serial killers."

A&E's "Duck Dynasty" reality show follows a Louisiana family with a business selling duck calls and decoys.

A&E did not immediately respond to requests for comment from it and the Robertson family.

A person familiar with the Kimmel show's plans confirmed that Morrissey was to appear. The person lacked authority to discuss the matter publicly and spoke on condition of anonymity.

The person says Morrissey's performance will be rescheduled.

ABC says the Churchill band will perform Tuesday on Kimmel's show but declined comment on the switch.

___

Reach AP Television Writer Lynn Elber at http://www.twitter.com/lynnelber .

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative, which will provide the vaccine and help pay for the campaign.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

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Bill would bar some athletes from California workers' comp claims

SACRAMENTO — Players for professional sports teams based outside of California would be barred from filing compensation claims for job-related injuries under proposed legislation supported by owners of football, baseball, basketball, hockey and soccer franchises.

A bill unveiled Monday by Assembly Insurance Committee Chairman Henry Perea (D-Fresno) would ban retired athletes from seeking workers' compensation benefits from California courts after they've played relatively few games in California stadiums and arenas during their careers.

The proposal, AB 1309, is expected to be one of the most hotly debated issues of the legislative session, with team owners lining up against the players' unions and their labor allies.

The bill, said Perea, is expected to be a "starting point" for a lively legislative debate over whether claims from out-of-state retired players represent abuse of the California workers' compensation system and wind up hitting all California employers with higher premiums and surcharges that pay for outstanding claims left by failed insurance companies.

"It's a question of fairness," Perea said.

Workers' compensation is 100% employer funded and does not depend on taxpayers' support.

The cost argument is phony, countered Richard Berthelsen, a consulting lawyer with the National Football League Players Assn. A prorated share of a team's workers' compensation bill is calculated into athletes' salary caps, so, in effect, they're paying for their own insurance coverage, Berthelsen contended. "They pay for their own benefits," he said.

Perea's bill would affect professional athletes from only the five big sports and not members of other professions whose work takes them from state to state, such as horse racing jockeys, truck drivers and salesmen. It would bar the filing of claims for cumulative trauma — caused by years of stress and pounding on a body rather than a broken bone or other specific injury — unless a player worked at least 90 days in California during the year prior to seeking benefits.

California is the only state that makes it relatively easy for long-retired players to claim cumulative trauma injuries. About 4,500 out-of-state players have won judgments or settlements since the early 1980s, according to a study commissioned by the professional sports leagues.

The bill, if it should become law, would apply to thousands of out-of-state athletes' claims currently pending before California workers' compensation judges.

Perea's legislation, by restricting benefits only for professional athletes, is potentially unfair, labor officials argued.

Regardless of whether they play for out-of-state teams, said Angie Wei, legislative director of the California Labor Federation, "these players are workers and they deserve to have access to their benefits. They work for short durations of time at an intense level and get injured."

marc.lifsher@latimes.com

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California GOP faces steep road back

SACRAMENTO — The Republican Party has become so pathetic in California that it can't even find a candidate to run for governor next year.

Correct that. It isn't even looking. Wouldn't know where to begin.

The party's in no position to recruit anyway. It has little to offer. Certainly not a brand name, not in a state where the GOP steadily has been losing market share. Definitely not money. The party's deep in debt.

Actually, neither major party historically has had to recruit top-of-ticket candidates. They're usually lined up begging, jockeying for position to win the party's nomination.

Republicans will hold a state convention next weekend in Sacramento. Normally, there'd be a parade of gubernatorial wannabes fighting for the mike and opening up hospitality suites during the silly hours. But not this time.

This convention apparently will have all the excitement of a Saturday at the dump. The big event will be the election of a former Republican legislative leader, Jim Brulte, as the new state chairman.

Brulte wants to rebuild the party from the ground up. That includes recruiting local candidates and building a farm system for major office.

But no one can name a Republican who would have a snowball's chance of beating Democratic Gov. Jerry Brown next year — at least someone who might run.

The name of former Secretary of State Condoleezza Rice always is tossed out. But everyone concedes that's fantasy. She's committed to education reform, a Brown vulnerability. She loves her life in academia at Stanford, however, and shuns smelly state politics.

Another name is U.S. Rep. Kevin McCarthy of Bakersfield, the Republican whip. As a former Assembly GOP leader, he understands Sacramento and perhaps could make it work. But he's not going to surrender his No. 3 party leadership post in Congress.

One big red flag for any Republican is Brown's remarkable strength. He seems practically unbeatable in his expected quest for a record fourth term as governor. (In October, he'll surpass Gov. Earl Warren's record for years served in the office.)

A Field Poll last week showed that Brown's job approval rating among voters has risen to an eye-popping 57%. Moreover, 61% said he "can be trusted to do what is right." And 56% thought he "deserves credit for turning around the state's finances."

But — pointing to some weakness — 57% also said that Brown "advocates too many big-government projects that the state cannot afford" (bullet train). And 47% said he "favors organized labor too much" (public pensions).

So there are some sores for opponents to peck away at. And, after all, he will be 76.

Brown probably can't be bounced from office, however. So forget about trying to find a Republican winner. Just settle for a credible candidate who can pass the laugh test.

Ideally, the candidate would be someone relatively young who runs on the high road — avoiding the gutter — and finishes in position to wage a successful encore race when Brown gets booted by term limits in 2018.

Being a Latino could be a plus, attracting voters from a growing ethnic group that has been repulsed by what it perceives as GOP immigrant bashing.

But who? Remember we're not looking for electability. What's needed is credibility — to carry the colors without embarrassing the party.

That excludes one legislator who has expressed interest, Assemblyman Tim Donnelly of San Bernardino County. He's a former Minuteman who rails against illegal immigration and was placed on probation for trying to bring a loaded firearm onto an airplane. He called it an "honest mistake."

"He'd be a really horrible candidate, worse than no candidate," says Republican analyst Tony Quinn.

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Hathaway, Waltz win supporting-acting Oscars

LOS ANGELES (AP) — Anne Hathaway has gone from propping up leaden sidekick James Franco at the Academy Awards to hefting a golden statue of her own with a supporting-actress Oscar win as a doomed mother-turned-prostitute in the musical "Les Miserables."

Christoph Waltz won his second supporting-actor Oscar for a Tarantino film, this time as a genteel bounty hunter in the slave-revenge saga "Django Unchained."

Hathaway, whose perkiness helped carry her and the listless Franco through an ill-starred stint as Oscar hosts two years ago, is the third performer in a musical to win supporting actress during the genre's resurgence in the last decade.

"It came true," said Hathaway, who joins 2002 supporting-actress winner Catherine Zeta-Jones for "Chicago" and 2006 recipient Jennifer Hudson for "Dreamgirls." Hathaway had warm thanks for "Les Miz" co-star Hugh Jackman, with whom she once sang a duet at the Oscars when he was the show's host.

Hathaway's Oscar came for her role as noble but fallen Fantine in the big-screen adaptation of the Broadway smash that was based on Victor Hugo's epic novel of revolution, romance and redemption in 19th century France.

In a choked voice, Waltz offered thanks to his character and "to his creator and the creator of his awe-inspiring world, Quentin Tarantino."

Waltz also offered gracious thanks to his supporting-actor competitors, who included two-time Oscar winner Robert De Niro and Oscar recipient Tommy Lee Jones, who had been considered a slim favorite over Waltz for the prize.

A veteran performer in Germany and his native Austria, Waltz had been a virtual unknown in Hollywood when Tarantino cast him as a gleefully evil Nazi in 2009's "Inglourious Basterds," which won him his first Oscar.

Waltz has since done a handful of other Hollywood movies, but it's Tarantino who has given him his two choicest roles. Backstage, Waltz had a simple explanation for why the collaboration works.

"Quentin writes poetry, and I like poetry," Waltz said.

The foreign-language prize went to Austrian filmmaker Michael Haneke's old-age love story "Amour," which had been a major surprise with five nominations, including picture, director and original screenplay for Haneke and best actress for Emmanuelle Riva, who turned 86 on Sunday and would be the oldest acting winner ever.

The top prize winner at last year's Cannes Film Festival, "Amour" follows the agonizing story of an elderly man (Jean-Louis Trintignant) tending his wife (Riva) as she declines from age and illness.

Haneke thanked his own wife for supporting him in his work for 30 years.

"You are the center of my life," Haneke said.

The Scottish adventure "Brave," from Disney's Pixar Animation unit, was named best animated feature. Pixar films have won seven of the 12 Oscars since the category was added.

The story of an dauntless princess (voiced by Kelly Macdonald) who balks at her parents' attempts to marry her off, "Brave" won out over a strong field that included Disney's "Wreck-It Ralph" and "Frankenweenie."

"I just happen to be wearing the kilt," said "Brave" co-director Mark Andrews, who took the stage in his trademark Scottish garment.

The upbeat musical portrait "Searching for Sugar Man" took the documentary feature prize over a lineup of sober films that included the AIDS chronicle "How to Survive a Plague," the military-rape critique "The Invisible War" and the Israel-Palestine studies "5 Broken Cameras" and "The Gatekeepers."

"Searching for Sugar Man" follows the quest of two South African fans to discover the fate of acclaimed but obscure singer-songwriter Sixto Rodriguez, who dropped out of sight after two albums in the 1970s and was rumored to have died a bitter death.

"Thanks to one of the greatest singers ever, Rodriguez," said "Sugar Man" director Malik Bendjelloul.

There was a rare tie in one category, with the Osama bin Laden thriller "Zero Dark Thirty" and the James Bond tale "Skyfall" each winning for sound editing.

Oscar host Seth MacFarlane opened with a mildly edgy monologue that offered the usual polite jabs at the academy, the stars and the industry. He took a poke at academy voters over the snub of Ben Affleck, who missed out on a directing nomination for best-picture favorite "Argo," a thriller about the CIA's plot to rescue six Americans during the Iranian hostage crisis.

"The story was so top secret that the film's director is unknown to the academy," MacFarlane said. "They know they screwed up. Ben, it's not your fault."

William Shatner made a guest appearance as his "Star Trek" character Capt. James Kirk, appearing on a giant screen above the stage during MacFarlane's monologue, saying he came back in time to stop the host from ruining the Oscars.

"Your jokes are tasteless and inappropriate, and everyone ends up hating you," said Shatner, who revealed a headline supposedly from the next day's newspaper that read, "Seth MacFarlane worst Oscar host ever."

The performance-heavy Oscars also included an opening number featuring Charlize Theron and Channing Tatum, who did a classy dance while MacFarlane crooned "The Way You Look Tonight." Daniel Radcliffe and Joseph Gordon-Levitt then joined MacFarlane for an elegant musical rendition of "High Hopes."

Oscar producers Craig Zadan and Neil Meron lined up a top-notch cast of stars as presenters, including "The Avengers" co-stars Robert Downey Jr., Samuel L. Jackson, Chris Evans, Mark Ruffalo and Jeremy Renner. They presented two prizes that went to the shipwreck tale "Life of Pi," cinematography and visual effects.

"This movie was quite a beast to make," said cinematographer Claudio Miranda, who shot dazzling images for the story of a youth adrift on a lifeboat with a Bengal tiger.

Miranda's win marked another round of Oscar futility for revered cinematographer Roger Deakins, who was nominated for the James Bond adventure "Skyfall." Deakins has been nominated 10 times but has yet to win.

Halle Berry introduced a tribute to the James Bond franchise in which she has co-starred as the British super-spy celebrated his 50th anniversary on the big-screen last year with the latest adventure "Skyfall." Shirley Bassey sang her theme song to the 1960s Bond tale "Goldfinger."

A salute to the resurgence of movie musicals in the last decade included Oscar winners Zeta-Jones singing "All That Jazz" from "Chicago" and Hudson doing "And I Am Telling You I'm Not Going" from "Dreamgirls." Jackman and Hathaway joined cast mates of best-picture contender "Les Miserables" to sing songs from their musical.

Fans have pondered how far MacFarlane the impudent creator of "Family Guy," might push the normally prim and proper Oscars. Two hours into the show, the answer was, not that far. MacFarlane was generally polite and respectful, showcasing his charm, wit and vocal gifts.

MacFarlane did press his luck a bit on an Abraham Lincoln joke, noting that Raymond Massey preceded "Lincoln" star Daniel Day-Lewis as an Oscar nominee for 1940's "Abe Lincoln in Illinois."

"I would argue that the actor who really got inside Lincoln's head was John Wilkes Booth," MacFarlane wisecracked, earning some groans from the crowd. "A hundred and 50 years later, and it's still too soon?"

MacFarlane lent his voice to his foul-mouthed stuffed bear from last summer's blockbuster "Ted" to present some technical awards alongside the movie's star, Mark Wahlberg. Ted needled Wahlberg to tell him where the "big post-Oscars Hollywood orgy" would be. Wahlberg's answer: Jack Nicholson's house.

Affleck's "Argo" looks like it will be an uncommon film to claim best picture without a directing nomination, while "Lincoln" filmmaker Steven Spielberg and star Day-Lewis are favored to join exclusive lists of three-time Oscar winners.

Affleck was not counting on anything, though.

"We don't expect to depart with anything but our integrity," Affleck said on the Oscar red carpet before the show.

"Argo" has won winning practically every top prize at earlier honors. Hollywood was shocked that Affleck was snubbed for a directing nomination, possibly earning the film some sympathy votes, particularly from actors, who love it when one of their own succeeds behind the camera.

The story of how Hollywood, Canada and the CIA teamed up to rescue six Americans during the Iranian hostage crisis, "Argo" would become just the fourth film in 85 years to claim the top prize without a best-directing nomination and the first since 1989's "Driving Miss Daisy."

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Online: http://www.oscars.org

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AP writers Christy Lemire, Sandy Cohen, Beth Harris and Anthony McCartney contributed to this report.

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‘Bloodless’ Lung Transplants for Jehovah’s Witnesses

Eric Kayne for The New York Times

SHARING HOME AND FAITH A Houston couple hosted Gene and Rebecca Tomczak, center, in October so she could get care nearby.

HOUSTON — Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.

She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.

The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?

By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.

By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.

“At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”

Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

Ms. Tomczak had dismissed the prospect of a transplant for most of the two years she had struggled with sarcoidosis, a progressive condition of unknown cause that leads to scarring in the lungs. The illness forced her to quit a part-time job with Nielsen, the market research firm.

Then in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.

“I wanted to be around and be a part of their lives,” Ms. Tomczak recalled, dabbing at tears.

She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.

“I know,” she said, “that if I did anything that violates Jehovah’s law, I would not make it into the new system, where he’s going to make earth into a paradise. I know there are risks. But I think I am covered.”

Cutting Risks, and Costs

The approach Dr. Scheinin would use — originally called “bloodless medicine” but later re-branded as “patient blood management” — has been around for decades. His mentor at Methodist, Dr. Denton A. Cooley, the renowned cardiac pioneer, performed heart surgery on hundreds of Witnesses starting in the late 1950s. The first bloodless lung transplant, at Johns Hopkins, was in 1996.

But nearly 17 years later, the degree of difficulty for such procedures remains so high that Dr. Scheinin and his team are among the very few willing to attempt them.

In 2009, after analyzing Methodist’s own data, Dr. Scheinin became convinced that if he selected patients carefully, he could perform lung transplants without transfusions. Hospital administrators resisted at first, knowing that even small numbers of deaths could bring scrutiny from federal regulators.

“My job is to push risk away,” said Dr. A. Osama Gaber, the hospital’s director of transplantation, “so I wasn’t really excited about it. But the numbers were very convincing.”

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Athletes cash in on California's workers' comp

SACRAMENTO — In his seven-year career with the Denver Broncos, running back Terrell Davis, a former Super Bowl Most Valuable Player, dazzled fans with his speed and elusiveness.

At the end of his rookie year in 1995, he signed a $6.8-million, five-year contract. Off the field he endorsed Campbell's soup. And when he hung up his cleats, he reported for the National Football League Network and appeared in movies and TV shows.

So it may surprise Californians to find out that in 2011, Davis got a $199,000 injury settlement from a California workers' compensation court for injuries related to football. This came despite the fact Davis was employed by a Colorado team and played just nine times in California during an 88-game career, according to the NFL.

Davis was compensated for the lifelong effects of multiple injuries to the head, arms, trunk, legs and general body, according to California workers' compensation records.

He is not alone.

Over the last three decades, California's workers' compensation system has awarded millions of dollars in benefits for job-related injuries to thousands of professional athletes. The vast majority worked for out-of-state teams; some played as little as one game in the Golden State.

All states allow professional athletes to claim workers' compensation payments for specific job-related injuries — such as a busted knee, torn tendon or ruptured spinal disc — that happened within their borders. But California is one of the few that provides additional payments for the cumulative effect of injuries that occur over years of playing.

A growing roster of athletes are using this provision in California law to claim benefits. Since the early 1980s, an estimated $747 million has been paid out to about 4,500 players, according to an August study commissioned by major professional sports leagues. California taxpayers are not on the hook for these payments. Workers' compensation is an employer-funded program.

Now a major battle is brewing in Sacramento to make out-of-state players ineligible for these benefits, which are paid by the leagues and their insurers. They have hired consultants and lobbyists and expect to unveil legislation next week that would halt the practice.

"The system is completely out of whack right now," said Jeff Gewirtz, vice president of the Brooklyn Nets — formerly the New Jersey Nets — of the National Basketball Assn.

Major retired stars who scored six-figure California workers' compensation benefits include Moses Malone, a three-time NBA most valuable player with the Houston Rockets, Philadelphia 76ers and other teams. He was awarded $155,000. Pro Football Hall of Fame wide receiver Michael Irvin, formerly with the Dallas Cowboys, received $249,000. The benefits usually are calculated as lump-sum payments but sometimes are accompanied by open-ended agreements to provide lifetime medical services.

Players, their lawyers and their unions plan to mount a political offensive to protect these payouts.

Although the monster salaries of players such as Los Angeles Lakers guard Kobe Bryant and Denver Broncos quarterback Peyton Manning make headlines, few players bring in that kind of money. Most have very short careers. And some, particularly football players, end up with costly, debilitating injuries that haunt them for a lifetime but aren't sufficiently covered by league disability benefits.

Retired pros increasingly are turning to California, not only because of its cumulative benefits but also because there's a longer window to file a claim. The statute of limitations in some states expires in as little as a year or two.

"California is a last resort for a lot of these guys because they've already been cut off in the other states," said Mel Owens, a former Los Angeles Rams linebacker-turned-workers' compensation lawyer who has represented a number of ex-players.

To understand how it works, consider the career of Ernie Conwell. A former tight end for the St. Louis Rams and New Orleans Saints, he was paid $1.6 million for his last season in 2006.

Conwell said that during his 11-year career, he underwent about 18 surgeries, including 11 knee operations. Now 40, he works for the NFL players union and lives in Nashville.

Hobbled by injuries, he filed for workers' compensation in Louisiana and got $181,000 in benefits to cover his last, career-ending knee surgery in 2006, according to the Saints. The team said it also provided $195,000 in injury-related benefits as part of a collective-bargaining agreement with the players union.

But such workers' compensation benefits paid by Louisiana cover only specific injuries. So, to deal with what he expects to be the costs of ongoing health problems that he said affect his arms, legs, muscles, bones and head, Conwell filed for compensation in California and won.

Even though he played only about 20 times in the state over his professional career, he received a $160,000 award from a California workers' compensation judge plus future medical benefits, according to his lawyer. The Saints are appealing the judgment.

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