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The best defence in the east is about to meet the best defence in the west. But now is not the time to argue over who is No. 1 in the CFL.
“At this point, it doesn’t really matter,” said Blue Bombers defensive back Jovon Johnson, a big reason why Winnipeg‘s secondary was such a force this season and why the team is heading to Vancouver to play the B.C. Lions in the Grey Cup.
“We’re going into a game against them in the championship,” added Johnson. “Maybe they were the best defence in the west, we were the best defence in the east. Two great defences going against each other in a big game, that’s what we look forward to.”
For coach Paul LaPolice, who guided the Bombers to the playoffs after finishing 2010 at 4-14, the work ethic that got them to Vancouver is what really counts. And he isn’t terribly concerned that they are viewed as underdogs after beating Hamilton 19-3 in the East Final.
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“It doesn’t really matter,” LaPolice said Monday at the team offices next to Canad Inns Stadium, which saw it’s last CFL game Sunday. The Bombers move to their new facility on the grounds of the University of Manitoba next season.
“These guys … they’re going to be excited just to be playing in the game, whether they’re favourites or underdogs. Certainly B.C. being at home is going to put them in a position of a lot more comfort for them but we’ve certainly done well on the road this year.”
In fact, they already have one win in Vancouver this year and went on to beat the Lions in both their regular-season encounters.
The Bombers finished the regular season at 10-8 while the Lions were at 11-7, both atop their respective divisions.
One of the things LaPolice says he likes about the team is the lack of grumbling – publicly at least – as he moved players around this season to find the right mix.
There’s no question quarterback Buck Pierce is anxious to win the final game of the season in Vancouver, where he started his CFL career in 2005. He joined the Bombers after getting released by the Lions in 2009.
“Really, there’s no motivation needed right now,” said Pierce. “It’s one game away and one shot. We’re going out there with a purpose. It’s a business trip for us. We’re excited where we are but it’s not done yet.”
Win or lose on Sunday, the Bombers have gone through a major turnaround in one year. That can be seen in the demand for tickets as Winnipeg set a new all-time record for season sales as they prepare to move to their new, larger home.
The Bombers continue to surprise.
The most potent weapon fielded by the Winnipeg offence in their rout of Hamilton was running back Chris Garrett, who was released after training camp this season only to be picked up again and get real playing time after injuries sidelined top running back Fred Reid and backup Carl Volny.
“I don’t think that you could write a better story for me or for anyone for that matter,” said Garrett, who rated his 190-yard performance on 29 carries Sunday, plus one dramatic final touchdown on the last play of the game, as one of the best games of his career.
“To me it didn’t feel like 29 carries … I’m willing to do more, it was fun.”
PITTSBURGH – There were lofty expectations surrounding Sidney Crosby’s long-awaited return to NHL action, and the Pittsburgh Penguins captain delivered almost immediately with a goal fit for a superstar.
Crosby scored on his first shot of the season, opening the scoring of Pittsburgh’s game against the New York Islanders on Monday. He collected the puck near centre ice, carried it into the Islanders’ zone, muscled his way past Islanders defenceman Andrew MacDonald and flipped a backhand over goaltender Anders Nillson.
The goal, at 5:24 of the first period, came on Pittsburgh’s first shot of the game.
Crosby wasn’t done there. He scored on a backhand from a sharp angle in the third period, ringing the puck off the post and past Nillson, and added a pair of assists.
For the Stanley Cup champion and Olympic gold medallist, this was more proof that Crosby knows how to deal with the burden of great expectations.
He’s experienced the pressure to perform at an elite level since he was a 13-year-old whose immeasurable talent made him a household name throughout Canada. The same pressure he felt as an 18-year-old debuting in the NHL in 2005, and as a 22-year-old carrying the weight of an entire nation at the 2010 Vancouver Olympics.
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What figured to be the most routine of November regular-season games, a Monday night Islanders-Pittsburgh matchup, was transformed into perhaps the NHL’s most anticipated when the Penguins revealed Sunday that Crosby would play following a 10 months-plus concussion layoff.
Suddenly, tickets that were selling online for US$150 doubled and tripled in price.
“It’s been long,” Crosby said as dozens of reporters created a logjam around him after Monday’s morning skate. “I’ve never been away from hockey for that long, so I’m just excited to play again.”
Even with so little advance warning, TV crews and reporters from two countries poured into the Consol Energy Center on Monday, eager to hear every one of Crosby’s words, analyze each one of his shots and shifts. The ABCs of hockey – CBC, RDS, TSN, and ESPN, USA Today among them – all were there among many, many others.
The crowd roared as Crosby’s name was announced during the pre-game skate, and fans held up signs that read “Welcome back Sid.” A loud chant of “Crosby” lasted until just before the U.S. national anthem.
The Ringling Brothers circus appeared at Consol Energy Center only two weeks ago, but this was an even bigger attraction than that: the Sidney Crosby media circus.
Everyone wanted to see Crosby again. On the ice. For real, and not just in practice. Even the opposing team.
“It’s obvious we realize the magnitude of this,” said Islanders centre Josh Bailey. “It’s huge. It’s great for the game when you’re getting your best player back. It’s been a long time coming and you never like to see anyone go through what he’s gone through. We know how hard he’s worked to get back. It’s exciting for everyone.”
Make that a nervous excitement.
While the hockey world waited to again see the player who was dominating the NHL scoring race at this time last year – when Crosby was on a 25-game scoring streak – there also was a bit of anxious anticipation.
Everyone also wanted to see how he would respond to getting hit in or near the head.
“We’re all going to hold our breath the first time he gets hit,” Penguins forward Steve Sullivan said. “That’s without a doubt. Everyone is going to kind of wait. Everyone wants to see. Everyone wanted to wait to see (when he was coming) back, now it’s wait until he gets hit for the first time.”
Crosby has talked about what he went through during a layoff that began following successive hard hits to the head levelled by Washington’s David Steckel on Jan. 1 in the NHL Winter Classic and again four days later by the Lightning’s Victor Hedman. He played that Tampa Bay game because there was no indicated following the Washington game that he was concussed.
He returns to the game having made no equipment changes. And he’s ready to be bodychecked.
“I think anybody that has gone through this and missed this amount of time you’ve got to make sure you get involved early and get that first hit under your belt,” he said. “Maybe that means having to initiate that more myself in order to do that. But anybody that has gone through this realizes that, yeah, there is a feeling-out process to get back into it.”
Crosby said the concussion prevented him, for months, from watching TV or listening to music, and it affected his stability and ability to move freely in crowds. Most of all, it prevented him from playing the sport he loves, the sport he dominates like no other, the sport that needs him out front as a gate attraction and TV draw.
“I’ve tried not to think about how long it was going to be, but the months kept adding up,” Crosby said. “It’s all behind me now and I’m looking forward to getting started.”
While his Penguins teammates, until now, have been reluctant to explain what Crosby went through during the weeks and months in which he couldn’t play, Sullivan offered some candid insight.
“He could do everything on the ice, but mentally, in his head, he would get a little bit foggy,” said Sullivan. “But he could skate and work and do everything on the ice. How he felt afterwards was what was stopping him from coming back.”
Now, more than two months since training camp began and a month since he was cleared for contact during practice, Crosby is ready to play games again. It will be a busy week, too, with home games Wednesday (Blues) and Friday (Senators) and a Saturday night game in Montreal.
Not exactly the best way for Crosby to ease himself back, especially since he knows it will take some time for him to return to top speed, to totally regain what linemate Chris Kunitz calls his unmatched skill set.
Sullivan, who missed a season and a half with a back injury from 2007-09, has an idea what Crosby will be going through.
“The first couple of games are adrenaline, you get through it on adrenaline, and then there’s that little lull where the wear and tear of a regular season kicks in,” he said. “For him, (after) having that huge high of coming back, there’s going to be a dip. But he’s extremely strong mentally and prepares himself like no one other, so his play might not dip as far.”
When Mario Lemieux ended his 44-month retirement on Dec. 27, 2000, scoring in his first half-minute on the ice against Toronto in another highly anticipated game, the Maple Leafs talked afterwards of spending too much time standing and watching.
The Islanders, losers of 11 of 13, know they can’t do that against a player who has 18 goals and 62 points in 33 career games against them.
“If you’re not playing him hard, if you’re not finishing your check on him, he can make you look stupid,” Islanders forward Matt Moulson said.
And that might have been the smartest thing anyone in either dressing room said.
“It’s something I’ve thought about a lot over the last 10 months, so it’s pretty exciting,” Crosby said of his
much-anticipated return. “You don’t always get this anxious for games. This is one I can definitely say I’m anxious and excited for.”
The hard part? That’s all in the past, Crosby insisted. All those months of concussion testing, of doctors’ meetings, of working out, of dealing with setbacks and symptoms, of practising with no hope of playing that week or that night, are over.
“Now is the easy part. Now you just have to go play,” Crosby said.
NEW YORK – U.S. authorities declined to pursue a case against an “al-Qaida sympathizer” accused of plotting to bomb police stations and post offices in the New York area because they believed he was mentally unstable and incapable of pulling it off, two law enforcement officials said Monday.
New York Police Department investigators sought to get the FBI involved at least twice as their undercover investigation of Jose Pimentel unfolded, the officials said. Both times, the FBI concluded that he wasn’t a serious threat, they said.
The FBI concluded that the 27-year-old Pimentel “didn’t have the predisposition or the ability to do anything on his own,” one of the officials said.
The officials were not authorized to speak about the case and spoke on condition of anonymity. The FBI’s New York office declined to comment Monday.
New York authorities said Pimentel is an “al-Qaida sympathizer” motivated by terrorist propaganda and resentment of U.S. troops in Afghanistan and Iraq. Police Commissioner Raymond Kelly said police had to move quickly to arrest Pimentel on Saturday because he was ready to carry out his plan.
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“He was in fact putting this bomb together,” Kelly said. “He was drilling holes and it would have been not appropriate for us to let him walk out the door with that bomb.”
His lawyer Joseph Zablocki said his client’s behaviour leading up to the arrest was not that of a conspirator trying to conceal some violent scheme. Zablocki said Pimentel was public about his activities and was not trying to hide anything.
“I don’t believe that this case is nearly as strong as the people believe,” Zablocki said. “He (Pimentel) has this very public online profile. … This is not the way you go about committing a terrorist attack.”
Authorities characterized him in a different way. The unemployed U.S. citizen was born in the Dominican Republic and later converted to Islam. They said he was energized and motivated to carry out his plan by the Sept. 30 killing of al-Qaida’s U.S.-born cleric Anwar al-Awlaki.
“He decided to build the bomb August of this year, but clearly he jacked up his speed after the elimination of al-Awlaki,” Kelly said.
He plotted to bomb police patrol cars and postal facilities, targeted soldiers returning home from abroad, and also talked of bombing a police station in New Jersey, authorizes said.
New York police had him under surveillance for at least a year and were working with a confidential informant; no injury to anyone or damage to property is suspected, Kelly said. In addition, authorities have no evidence that Pimentel was working with anyone else.
“He appears to be a total lone wolf,” Mayor Michael Bloomberg said. “He was not part of a larger conspiracy emanating from abroad.”
Pimentel, also known as Muhammad Yusuf, was denied bail. The bearded, bespectacled man smiled at times during the proceeding. His mother and brother attended the arraignment, his lawyer said.
Pimentel was accused of having an explosive device Saturday when he was arrested, one he planned to use against others and property. The charges accuse him of conspiracy going back at least to October 2010 and include first-degree criminal possession of a weapon as a crime of terrorism, and soliciting support for a terrorist act.
Kelly said a confidential informant had numerous conversations with Pimentel on Sept. 7 in which he expressed interest in building small bombs and targeting banks, government and police buildings.
Pimentel also posted on his website trueislam1杭州夜网 and on blogs his support of al-Qaida and belief in jihad, and promoted an online magazine article that described in detail how to make a bomb, Kelly said.
Among his Internet postings, the commissioner said, was an article that states: “People have to understand that America and its allies are all legitimate targets in warfare.”
New York City remains a prime terrorist target a decade after the Sept. 11 attack. Bloomberg said there have been at least 14 foiled plots against the city, including the latest suspected scheme. The most serious threats came from Pakistani immigrant Faisal Shahzad who tried to detonate a car bomb in Times Square in 2010 and is now serving a life sentence, and Najibullah Zazi, who targeted the subway system a year earlier. Zazi pleaded guilty to federal terrorism charges and is awaiting sentencing.
Asked why federal authorities were not involved in the case, Manhattan District Attorney Cyrus R. Vance Jr. said there was communication with them but his office felt that given the timeline “it was appropriate to proceed under state charges.”
Alexis Smith, 22, who lives in an apartment in the same building as Pimentel, said she was shocked that he was a suspect in a terrorist plot. “He was always very courteous to us,” she said, adding that Pimentel helped her carry groceries and luggage into the building.
“It’s nice to know he was only working alone,” she said.
Associated Press writer Colleen Long, Jennifer Peltz, Tom McElroy and Samantha Gross AP video journalist David R. Martin contributed to this report from New York.
Women in Canada can be screened less frequently for breast cancer and doctors should stop performing routine breast examinations altogether in women without symptoms of the disease, according to new Canadian breast cancer screening recommendations.
The guidelines for average-risk women – updated for the first time in a decade – recommend no routine mammography screening for women aged 40 to 49 and lengthen the screening window for women ages 50 to 74 from every other year, to every two to three years.
Women have been told for years that regular mammograms save lives.
But in what could become a flash point in the debate about the benefits of the breast X-rays, the authors state that the absolute benefits of screening women aged 50 to 69 “remain small” and that a substantial portion will have false positive results – leading to “unnecessary and invasive investigation,” they said. In some cases it can lead to women having part or all of their breasts removed when, in fact, they do not have cancer.
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Women need to weigh the benefits and harms of mammography, the authors state, adding that women aged 50 to 69 “who do not place a high value on a small reduction in mortality and who are concerned about false-positive results, unnecessary diagnostic testing and potential over diagnosis of breast cancer are likely to decline screening.”
“We’re not trying to come across as saying that breast cancer screening with mammography is not useful,” said Dr. Marcello Tonelli, chair of The Canadian Task Force on Preventive Health Care and associate professor in the department of medicine at the University of Alberta in Edmonton.
“We think it is a potentially useful tool in the fight against cancer. But it’s important for women to be informed about the risks and benefits – to know that both are present, that it’s not all benefit and to realize, when they make that assessment, the magnitude of what they’re talking about.”
“If you look at the numbers, you are much more likely to have a false positive result than you are to have your life saved by screening,” Tonelli said. “It’s a real benefit, but compared with the risk of false positives, it’s relatively small.”
Appearing in this week’s issue of Canada’s top medical journal, the guidelines also recommend against doctors routinely performing breast examinations to screen for cancer – a change from the previous guidelines.
They also recommend against women checking their breasts monthly for signs of cancer, a hold over from the 2001 guidelines.
The authors state that no case can be made for screening all women for breast cancer beginning at age 40 – a controversial practice not followed in most of Canada but which had until recently been the recommendation in the U.S.
Only Prince Edward Island actively recruits women aged 40 to 49 for mammography screening. Overwhelmingly the provinces require a doctor’s referral for younger women.
In the 50 to 69 age group, the standard is screening every two years.
The new guidelines, published in this week’s issue of the Canadian Medical Association Journal, challenge the view that women who choose not to be screened are somehow “irresponsible,” according to a related commentary.
Dr. Peter Gotzsche, director of the Nordic Cochrane Centre in Copenhagen, Denmark says that any possible effect of screening on breast cancer deaths is “marginal” and that women have not been informed of the potential harms.
“There is massive over diagnosis,” he said in an interview with Postmedia News. “It is a disaster to be healthy one day and the next day become a breast-cancer patient.”
The tests can detect tumours that never would have threatened a woman’s life, he said, exposing women to unnecessary treatment that in itself can be life-shortening, as well as unnecessary lumpectomies or mastectomies.
Many women harbour harmless cell changes or cancers in their breast, Gotzsche said.
“If (mammography) had been a drug it would have been removed from the market immediately,” he said. “You cannot have a drug that harms the healthy population on such a grand scale and with a doubtful effect.”
The guidelines are intended for average-risk women – meaning women who do not have a previous history of the disease, who do not have a known genetic mutation or other risk factors for breast cancer.
According to the new guidelines, the absolute benefit of screening is lower among women aged 40 to 49, because of their lower risk of breast cancer to begin with. Screening about 2,100 women aged 40 to 49 once every two to three years for about 11 years would prevent a single death from breast cancer, the task force says. But about 690 women would have a false positive result, leading to unnecessary followup testing; 75 women would have an unnecessary biopsy of their breast.
For women aged 50 to 69, screening about 720 women once every two to three years for about 11 years would prevent one death from breast cancer, but it would also result in about 204 women having a false-positive result and 26 women undergoing a breast biopsy.
Tonelli said screening older women every three years “seems to preserve the benefits associated with screening more frequently” but might reduce the harms. He said the costs of testing did not influence the group’s recommendations.
Mammography can detect tumours when they’re smaller and more responsive to treatment, Tonelli said.
But some tumours are so aggressive that it makes no difference when they’ve been detected, he said. Others are so slow-growing they would not affect a woman’s health or life-expectancy.
No evidence was found to show that routine breast examinations by doctors in women who have no symptoms of disease prevent deaths from breast cancer. If anything, it can lead to unnecessary biopsies and procedures.
“When doctors examine the breasts of women who have no complaints, sometimes they find a mass – and more often than not those masses are benign,” Tonelli said.
His group also says doctors shouldn’t be teaching the kind of structured breast self-examination long taught to women. Large randomized trials show that it doesn’t reduce mortality from breast cancer and significantly increases the number of unnecessary interventions.
“If you go regularly looking (for breast cancer), most of those lumps and masses that are found are not cancer,” Tonelli said.
“We’re not saying that if a woman notices something with her breast that it should be ignored,” he stressed. A mass, lump, discharge or any change is reason to see a doctor.
Tonelli said individual women should discuss the risks and benefits of mammography screening with their doctors.
The College of Family Physicians of Canada has endorsed the guidelines.
Here are the key recommendations for breast cancer screening from the Canadian Task Force on Preventive Health Care:
– No routine mammography for women aged 40 to 49. The absolute benefit is lower for this age group than for older women because of their lower risk of cancer.
– For women aged 50 to 74, routine screening with mammography every two to three years.
– No screening of average-risk women using MRI.
– No routine clinical breast exams or breast self-exams to screen for breast cancer.
SPRING HILL, Tenn. – General Motors announced Monday it will start building the Chevrolet Equinox at its idled Tennessee plant and will also make midsized vehicles there in the future.
Monday’s announcement of a total US$244 million investment over two phases is projected to create nearly 1,900 jobs at the former Saturn plant outside Nashville.
The automaker said it initially will invest $61 million and create nearly about 700 jobs to begin making the Equinox by the second half of 2012. Sales of the crossover are up 45 per cent this year to more than 162,000, according to Autodata Corp.
An additional $183 million to make unspecified midsized vehicles for the 2015 model year is projected to create another 1,200 jobs. GM officials wouldn’t divulge more specifics.
“We don’t like to tip our hand to the competition,” said Cathy Clegg, GM’s vice-president for labour relations.
The company said the investment in the plant will place it among the world’s most flexible auto-making facilities, allowing GM to respond to changing demand for a variety of models.
“This flexibility will mean that customers who want our bestselling products won’t have to wait,” Clegg said.
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More than 2,000 workers were laid off after GM announced it would halt production of the Chevrolet Traverse at the plant in 2009.
Elected officials stressed the benefits to the local economy, while union leaders hailed Monday’s decision as a success for collective bargaining rights.
United Auto Workers members in Spring Hill voted in September to ratify a four-year contract with the General Motors Co. after company officials said they would once again start automobile production at the plant.
Under the new contract, GM can have as many entry-level, $15-an-hour workers as it wants, but after 2015 only 25 per cent of the factory workers can be paid the lower wage. UAW President Bob King said union members sacrificed wage and other demands to ensure jobs would be kept in the United States.
“These jobs in Spring Hill are symbolic of everything we did in these negotiations,” said UAW President Bob King.
Autoworkers cheered at Monday’s event as union and company officials pressed a button to ceremonially relaunch the line at the plant. They also booed and heckled U.S. Sen. Bob Corker, R-Tenn., who had opposed bailouts for the auto industry.
Retired autoworker Don Lockhart, 63, confronted Corker after the ceremony about the senator’s stance on organized labour. But Corker was dismissive of the criticism.
“You don’t know what you’re talking about,” Corker said.
NEW YORK, N.Y. – The mother of a “lone wolf” accused of plotting to attack police stations and post offices with homemade bombs apologized to New Yorkers on Monday, even as questions arose about why federal authorities – who typically handle terrorism cases – declined to get involved in what city officials called a serious threat.
The mother of Jose Pimentel spoke to reporters outside her upper Manhattan home the day after her son was arraigned in state court on terrorism-related charges.
“I didn’t raise my son in that way,” Carmen Sosa said.
Officials with the NYPD, which conducted the undercover investigation using a confidential informant and a bugged apartment, said the department had to move quickly because Pimentel was about to test a pipe bomb made out of match heads, nails and other ingredients bought at neighbourhood hardware and discount stores.
Federal authorities were aware of the probe, but under the circumstances, “it was appropriate to proceed under state charges,” District Attorney Cyrus Vance said in announcing the arrest late Sunday.
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Two law enforcement officials said Monday that the NYPD’s Intelligence Division had sought to get the FBI involved at least twice as the investigation unfolded. Both times, the FBI concluded that he wasn’t a serious threat, they said.
The FBI thought Pimentel “didn’t have the predisposition or the ability to do anything on his own,” one of the officials said.
The officials were not authorized to speak about the case and spoke on condition of anonymity. The FBI’s New York office and the U.S. attorney’s office in Manhattan both declined to comment on Monday.
Pimentel’s lawyer, Joseph Zablocki, said his client was never a true threat.
The arrest marked the second time this year that the police department took the unusual step of working with a state prosecutor to bring a terrorism case. In May, two men were indicted on charges they told an NYPD undercover detective about their desire to attack synagogues.
A grand jury declined to indict Ahmed Ferhani and Mohamed Mamdouh on the most serious charge initially brought against them – a high-level terror conspiracy count that carried the potential for life in prison without parole. They were, however, indicted on lesser state terrorism and hate crime charges, including one punishable by up to 32 years behind bars.
Attorneys for Ferhani said hate crime charges and a rarely used state terrorism law were misapplied to what they have called a case of police entrapment.
State prosecutors insist that there’s ample evidence that Pimentel went well beyond merely talking about terrorism – and that he was acting on his own initiative.
At an arraignment where Pimentel was ordered held without bail, prosecutors said investigators have “countless hours” of audio and video in this case. And in a criminal complaint, an intelligence division detective alleges Pimentel told him after the arrest that he was about an hour away from finishing the bomb and felt Islamic law obligates all Muslims to wage war against Americans to avenge U.S. military action in their homelands.
TORONTO – Most women age 40 to 49 should not have routine mammograms and those 50 to 69 can wait slightly longer between the tests than previously recommended, updated Canadian breast cancer screening guidelines advise.
And for the first time, the Canadian Task Force on Preventive Health Care that developed the guidelines says that women aged 70 to 74 should be getting mammograms on the same schedule as those 50 to 69.
The revamped guidelines, published Monday in the Canadian Medical Association Journal, apply to women with an average risk of developing the disease. They include those with no previous breast cancer, no history of the disease in a first-degree relative like a mother or sister, no known BRCA genetic mutation and no previous exposure to radiation of the chest wall.
In its previous set of guidelines penned in 2001, the expert panel made no recommendations for average-risk women in their 40s as to whether they should have routine screening or not.
But the task force now advises against the practice for that age group, saying the potential harms from false positives and unnecessary subsequent cancer treatment outweigh the possible benefit – a slight reduction in the number of deaths from the disease.
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“Before there was no recommendation for or against, and clinical practice followed that lead,” said task force chair Dr. Marcello Tonelli of the University of Alberta. “Most organized screening programs don’t recruit women aged 40 to 49 years as a result.
“The biggest change of all is probably in the way in which we frame all of our recommendations, that breast cancer screening has risks and it has benefits, and how women weigh those up will influence their personal decision to be screened or not.”
In the 2001 guidelines, women 50 to 69 with an average risk of breast cancer were advised to have mammography every two years. But the new guide extends that period, saying such tests can be done every two to three years.
The panel now suggests women age 70 to 74 should also have mammograms every two to three years.
“In routine practice, one of the challenges in producing guidance and then implementing it in real life is that patients don’t turn up for screening or any other service on the anniversary of their last test,” said Tonelli.
“So the intent here was to give a range so that someone who is appearing for screening at two years and a day is still falling within recommended practice (and) even after two years and six months,” he said from Edmonton.
“We also wanted to signal that since the last set of guidelines were produced, there has been some evidence produced that longer screening intervals, like every three years, might be just as good as every year.”
The new guidelines have grown out of an intensive review of international clinical trials, which looked at the risk of developing breast cancer in the various age groups and the potential harms inherent in the breast X-ray that can arise from misdiagnosis.
“Specifically, the harms could range from a woman being told she has an abnormality on a mammogram and being asked to repeat the mammogram, being asked to go for a biopsy of her breast, being asked to have part or all of her breast removed, and all the way up to surgery and radiation and chemotherapy.
“These are the spectrum of possible harms, so if you don’t have breast cancer, but you have your breast removed and have surgery, I think we’d all agree that’s a harm of screening.”
The task force determined that screening 2,100 women every two to three years for about 11 years would prevent just one death from breast cancer. However, it also would result in 690 women having false-positives that would lead to unnecessary followup testing, including 75 women having unnecessary breast biopsies.
“For every woman that had cancer found with mammography, there are many more that have had a false positive result or a scare,” Tonelli said.
While no primary studies looked at the risk of overdiagnosis specifically among women 40 to 49 years, “data from our systematic review show that for every 1,000 women aged 39 years and older who are screened using mammography, five will have an unnecessary lumpectomy or mastectomy,” the authors write.
“In addition to unnecessary intervention, false-positive results can lead to fear, anxiety and distress.”
Dr. Cornelia Baines, an epidemiologist at the University of Toronto and one of the world’s foremost experts on breast cancer screening, lauded the task force’s recommendations, calling them “completely warranted.”
“All in all, I think it’s a superb set of guidelines that really are very, very carefully drawn, carefully thought out and totally justified on the basis of existing evidence.”
Still, she predicted they will be greeted with the same indignation and criticism that occurred in 2009 when the U.S. Preventive Services Task Force presented similar recommendations, which also advised women to defer routine mammograms until age 50.
The switch from the previous recommendation that American women in their 40s have a mammogram every year or two like their older sisters caused a firestorm of controversy.
If Baines has any criticism about the revamped Canadian guidelines, it is that they could have been clearer in illustrating the potential harms arising from false-positive results, which could “serve as a disincentive to wanting screening.”
“They don’t say it in a way that really hits home,” she said, noting that for women age 40 to 49, there is a one in three chance of having a false-positive result, and one in every 200 will be falsely diagnosed with breast cancer and unnecessarily treated.
“I had breast cancer,” said Baines. “I can’t imagine how I would feel if I thought there was a major chance that all the emotional upheaval, all the miseries of treatment, all the misery of followup, all the misery of diagnostic labelling was all useless because I didn’t really have breast cancer.
“I do know for a fact that only a minority of women who get breast cancer die of it.”
This year in Canada, an estimated 23,600 women overall will be diagnosed with breast cancer and an estimated 5,100 will die of the disease.
The College of Family Physicians of Canada has endorsed the new guidelines, as has the Canadian Cancer Society.
Gillian Bromfield, director of cancer control policy for the Canadian Cancer Society, said they reinforce the organization’s own breast-screening recommendations, which suggest women 50 to 69 should have a mammogram every two years.
“For women age 50 to 69, all the major health organizations are quite consistent that this is the age group that should be getting screened on a regular basis,” she said. “When you get outside of that age range, that’s where you start to see a bit more inconsistency.”
Among women in their 40s, for example, the evidence isn’t particularly strong that routine mammograms help to save lives, Bromfield said. Even so, some women will still want screening and should talk to their doctors about the benefits and risks.
Indeed, that is the overriding advice of the guidelines, Tonelli stressed.
“They say: ‘Here is what you can expect to get in the way of benefits from screening and here’s what you might expect in the way of harms. And based on what you, yourself, feel about your trade-off of those risks and those benefits, you together with your doctor can make a decision that’s right for you.’”
In a related commentary, Dr. Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, calls the new guidelines “more balanced and more in accordance with the evidence than any previous recommendations.”
Gotzsche writes that scientific evidence does not support mammography screening and he argues that it could even be harmful because it can lead to unnecessary mastectomies.
“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening.”
Canadian Cancer Society: 杭州桑拿按摩论坛杭州夜生活cancer.ca
Note to readers: This is a corrected story. A previous version had an incorrect spelling for Bromfield
FLORHAM PARK, N.J. – Rex Ryan’s mouth really cost him this time.
The brash New York Jets coach will not appeal a US$75,000 fine issued by the NFL on Monday for using profanity while angrily responding to a fan at halftime of New York’s 37-16 loss to New England last Sunday. Ryan received an official notice from Commissioner Roger Goodell in the morning.
“The commissioner’s got a tough enough job,” Ryan said. “I’m an NFL lifer. I know I represent the NFL and I know I represent the Jets, so I’m accountable for my actions.”
Ryan spoke to Goodell a few days ago to discuss the matter, and to apologize to him.
“Quite honestly, the man’s made a decision, and if his decision is that I should be fined $75,000, then that’s the way it is,” Ryan said, when asked if the punishment was excessive. “I just want to get it behind me.”
A 49-second video shot by a fan at MetLife Stadium shows the Jets walking off the field and when Ryan appears, someone is heard yelling, “Hey, Rex, Belichick is better than you,” referring to Patriots coach Bill Belichick. Ryan looks up and tells the fan to “shut up” while also using an obscenity.
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Ryan apologized a day later for what he called “a mistake,” saying he “was full of emotion and just popped off.” Moments earlier, the Jets had just allowed the Patriots to take a 13-9 lead into halftime. He reiterated Monday that he has owned up to what he did since the incident became public last week.
It’s not the first time Ryan is in trouble because of his mouth, which likely contributed to the hefty punishment. He was fined $50,000 by the Jets in February 2010 after he was caught on a cellphone camera giving the middle finger to a fan during a mixed martial arts event in Florida.
“I know that to coach in the National Football League is an honour,” he said. “I don’t want to be the guy to put a black eye on this or whatever. I just want to get it behind me and move forward.”
The Jets will not further discipline Ryan for the latest incident, saying it was a game-related matter.
General manager Mike Tannenbaum said in a statement last week that he and Ryan discussed what happened and the coach “knows that his behaviour was not acceptable.”
OTTAWA – The Harper government appears to be getting a free pass from Canadians for backtracking on a key campaign promise to balance the federal budget by 2014.
The most recent survey by The Canadian Press-Harris Decima suggests that not only are Canadians not surprised the campaign pledge would not be fulfilled, most agree that it shouldn’t.
Overall, about 62 per cent of respondents to the survey taken earlier this month said they believed the government should not take extraordinary steps to try to meet the 2014 deadline.
The result is understandable given that Canadians are still largely divided on the issue of the most appropriate policy direction the government should take in the next year.
A slight majority of those surveyed – 53 per cent – said they believed Ottawa should control spending, while 43 per cent said the government should continue spending to create jobs. That’s almost a reverse of the results to an identical question asked in October.
“Canadians are clearly of two minds (on the issue),” said Doug Anderson, senior vice president of Harris Decima.
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“So, are they upset another year or two is being added to the balanced budget timeline? No. They are not saying don’t balance it, they are saying the idea of taking at least four years is most appropriate.”
The poll of 1,000 adult Canadians was conducted Nov. 10-13, and is considered accurate to within 3.1 points up or down, 19 times in 20.
The timing of the survey is significant because it comes a few days after Finance Minister Jim Flaherty released his fall economic update, warning that Canada faces a more sluggish recovery than previously thought, given the risks to the global outlook.
As a result, the update largely took a balanced budget in the fiscal year 2014-15 off the table, pencilling in 2015-16 as the new goal.
The extended timeline made headlines, but Canadians took the announcement in stride. According to the poll results, 87 per cent said they were not surprised by the change.
And 63 per cent agreed with Flaherty that “instability of the international economy” was more to blame for the missed deadline than any policies taken by the government. Even majorities among opposition NDP and Liberal supporters said the government is not primarily to blame.
“Canadians appear to agree that the global economic turmoil is a clear and valid reason for reducing the urgency of tackling the deficit, and their preferred timeline tends to match the one targeted by the federal government,” Anderson said.
Previous polling suggests that Canadians trust the Conservatives more than any other party to manage the economy during this period of uncertainty and elevated risk.
The survey did show a degree of partisan division in some of the questions, but not as strongly as might be supposed, noted Anderson.
On the question of stimulus versus cost-cutting, a clear majority of Conservatives said they favoured the spending-restraint option. But even so, NDP and Liberal supporters were not in radical disagreement.
Among New Democrats, 48 per cent said they favoured more spending as opposed to 47 per cent for restraints; while among Liberals, the split was 50 per cent to 44 per cent favouring stimulus measures.
NORWOOD, N.J. – Gregory Papalexis, whose Sabrett hot dogs have become a part of the New York City experience, has died. He was 86.
Papalexis was president, CEO and chairman of Englewood-based Marathon Enterprises, a supplier of hot dogs, buns, onion sauce and other products, and the owner of the Sabrett trademark.
He died Friday in Rockleigh, N.J., according to the Barrett Funeral Home in Tenafly, N.J., which is handling arrangements.
Sabrett hot dogs are sold nationwide. On the streets of New York, they are sold from stainless-steel pushcarts with instantly recognizable blue-and-yellow umbrellas. Marathon also supplies franks to Papaya King and Gray’s Papaya restaurants, and sells more than 35 million pounds of hot dogs a year.
His son-in-law, Mark Rosen, Marathon Enterprises’ vice-president of sales, told The Record of Bergen County that Papalexis was “the single biggest hot dog lover in the world.”
And Papalexis, who retired two years ago, practiced what he preached: He ate Sabrett hot dogs four or five days a week, relatives said. Mark Rosen said franks-and-beans casserole was part of the Papalexis family’s Christmas table each year.
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The son of a baker, Papalexis grew up next door to a hot dog factory in upper Manhattan. He earned a bachelor of science degree in industrial relations from New York University in 1948, and then entered the food business.
With a $2,500 G.I. loan, Papalexis bought his father’s bakery and sold rolls to clients throughout New York City, making deliveries in a Cadillac because it had the biggest trunk he could find.
He soon began selling hot dogs as well, manufacturing a pushcart brand called House O’ Weenies. He formed Marathon Enterprises in 1964 and acquired a series of competitors, including Sabrett Food Products in 1989.
His daughter, Nikki Rosen, also a company executive, said her father gave great detail to the buns his company sold, insisting they be “light, airy and fluffy,” she said. His reasoning was simple: If customers fill up on the bun, they won’t have room for a second hot dog.
The Sabrett company got its name in 1926 when its two co-founders wanted to call it the Sabre Meat Company, only to find that another firm was already using the name.
“So the two owners said, ‘We’re a small company, so we’ll call ourselves Sabre-ette, which soon became Sabrett,” said the company’s new president, Boyd Adelman.
The company’s facilities include two manufacturing plants and a distribution centre in the Bronx and a corporate office in Englewood, N.J.
Its customers include retail supermarkets, wholesale clubs, independent distributors, movie theatres, amusement parks, pushcart vendors, convention centres, ballparks and stadiums. In addition to hot dogs, the company also sells hot sausage, kielbasa, salami, pastrami, corned beef and garlic rings.
Information from: The Record, 杭州桑拿按摩论坛杭州夜生活northjersey杭州夜网