Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

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Senate Passes Russian Trade Bill, With a Human Rights Caveat

WASHINGTON — The Senate voted on Thursday to finally eliminate cold war-era trade restrictions on Russia, but at the same time it condemned Moscow for human rights abuses, threatening to further strain an already delicate relationship with the Kremlin.

The Senate bill, which passed the House last month, now goes to President Obama, who has opposed using United States trade policy to make a statement about the Russian government’s treatment of its people.

But with such overwhelming support in Congress — the measure passed the Senate 92 to 4 and the House 365 to 43 — the White House has had little leverage to press its case.

And President Obama has shown little desire to pick a fight in which he would appear to be siding with the Russians on such an issue.

In a statement issued after the Senate vote, the White House mentioned the human rights component of the bill only in passing, instead emphasizing that the president was looking forward to signing a measure that would level the playing field for American workers.

The most immediate effect of the bill would be to formally normalize trade relations with Russia after nearly 40 years. Since the 1970s, commerce between Russia and the United States has been subject to restrictions that were intended to punish Communist nations that kept their citizens from emigrating freely.

While presidents have waived the restrictions since the cold war ended — allowing them to remain on the books as a symbolic sore point with the Russians — the issue took on new urgency this summer after Russia joined the World Trade Organization. As part of its pact with the trade group, Russia lowered tariffs for other member countries, but only those that granted it normal trade status.

By some estimates, American exports to Russia are expected to double after its trade status is revised.

But another effect of the bill — and one that has Russian officials furious with Washington — will be to require that the federal government freeze the assets of Russians implicated in human rights abuses and deny them visas.

Lawmakers on Capitol Hill were inspired to attach those provisions to the trade legislation because of the case of Sergei L. Magnitsky, a Russian lawyer who sustained serious injuries and died in a Moscow detention center in 2009 after he accused government officials of a tax fraud scheme.

During the Senate debate, it was Mr. Magnitsky’s case, and not Russia’s trade status, that occupied most of the time.

One by one, Democratic and Republican senators alike rose to denounce Russian officials for their disregard for basic freedoms.

“This culture of impunity in Russia has been growing worse and worse,” said Senator John McCain, Republican of Arizona. “There are still many people who look at the Magnitsky Act as anti-Russia. I disagree,” he added. “Ultimately passing this legislation will place the United States squarely on the side of the Russian people and the right side of Russian history, which appears to be approaching a crossroads.”

In Moscow, the denunciation was swift, and legislators promised retaliation with a proposal of their own that would freeze the bank accounts of American human rights violators.

“This initiative is intended to restrict the rights of Russian citizens, which we consider completely unjust and baseless,” said Konstantin Dolgov, the Russian foreign ministry’s human rights envoy, in comments to the Interfax news agency in Brussels. “This is an attempt to interfere in our internal affairs, in the authority of Russia’s investigative and judicial organs, which continue to investigate the Magnitsky case.”

Russian officials have said that Mr. Magnitsky is not the hero his supporters make him out to be, and they have pursued posthumous tax evasion charges against him. And lately the case has taken some more unusual turns. One witness was recently found dead in Britain.

Initially the Senate faced some pressure to pass a bill that punished human rights violators from all nations, not just those who are Russian. But the House bill applied only to Russia. And the Senate followed suit, as supporters of the bill wanted something that would pass quickly and not require a complicated back-and-forth with the House.

But Senator Ben Cardin, a Democrat from Maryland who wrote the bill that would apply internationally to all nations, said the United States position on human rights abusers was unambiguous. “This bill is our standard,” he said. “The world is on notice.”

Ellen Barry contributed reporting from Moscow.

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Typhoon Bopha Kills Hundreds in Philippines

Bullit Marquez/Associated Press

A resident hung clothing amid fallen trees and debris on Wednesday, a day after Typhoon Bopha made landfall in the village of Andap, in southern Philippines. More Photos »

MANILA — With many roads and bridges washed away, rescue teams struggled Wednesday to reach isolated villages in the southern Philippines after a powerful out-of-season typhoon tore through the region, leaving more than 270 people dead and hundreds more missing, officials said.

Typhoon Bopha packed winds of up to 100 miles per hour when it struck Tuesday, bringing torrential rains that washed away villages and left thousands homeless.

The deaths were concentrated in the province of Compostela Valley, a mountainous gold mining area, and the neighboring province of Davao Oriental, on the eastern coast of the southern Philippine island of Mindanao, Lt. Col. Lyndon Paniza, a military spokesman, said in a telephone interview late Wednesday afternoon.

A national disaster official, Benito Ramos, said at a news conference on Wednesday afternoon that 274 people had died, 339 were injured and 279 were missing. Those figures were likely to rise, he suggested, since rescue workers had not yet reached several villages in the hardest-hit areas and the casualties there were not known.

Most of the dead appeared to have drowned or been hit by falling trees or flying debris, officials said.

“There is debris in the road, so our soldiers are moving by foot,” Colonel Paniza said. “They are crossing rivers and landslides. I don’t want to speculate, but we don’t know what they will find when they reach those cut off areas.”

Three soldiers are known to have died, and eight are missing, he said. Some of the soldiers died when a landslide washed out their patrol base, and others disappeared while on search-and-rescue operations.

Local television crews broadcast grisly footage of mud-covered bodies being loaded into trucks in villages that appeared flattened by the storm. In some areas, not a single structure could be seen standing.

In areas where roads were washed out, the government sent seagoing vessels to take relief goods to remote coastal areas from the provincial capital of Davao Oriental, Mati.

“I have thus authorized the local government of Mati, its mayor and the provincial governor to use their calamity funds to hire all available large, local fishing boats for an immediate sea-lift transfer of goods to the affected areas,” Manuel Roxas, the interior secretary, said in a statement.

The eastern coast of Mindanao, which was the area hardest hit by the storm, is a remote, impoverished agricultural area. Mr. Roxas told reporters on Wednesday that during his visit to the area, he had seen tens of thousands of fallen coconut trees and many acres of destroyed banana plantations.

In New Bataan, the town hit hardest by the storm, Virgilia Babaag had been waiting nervously in her home before dawn on Tuesday as hard rain from the approaching typhoon pounded her small village.

“My neighbors started yelling, ‘The water is coming fast! Run! Run!’ ” she said Wednesday by telephone.

Ms. Babaag gathered up her three young nieces staying with her and ran through the night toward high ground. There she stayed with dozens of others as winds ripped through the town.

“When I came back, my roof was gone,” she said from her devastated home. “The houses around my place are destroyed. There are so many who have died here. The soldiers are still finding more.”

The Philippines is hit by as many as 20 powerful tropical storms each year, but this one struck remote communities south of the usual typhoon path.

“This is the first time that the people in this area have experienced a storm like this,” Colonel Paniza said. “They aren’t accustomed to big storms.”

Last December, Tropical Storm Washi — another out-of-season storm that hit south of the usual Philippine typhoon belt — killed more than 1,200 people and left hundreds of thousands homeless.

This year, officials put out strong warnings days in advance and carried out mandatory early evacuations of vulnerable communities.

President Benigno S. Aquino III, stung by criticism last year that the national government had not done enough to prepare for Tropical Storm Washi, went on television the day before the storm hit and pleaded with people to follow the instructions of local government officials.

“I am facing you now because the incoming storm is no laughing matter,” Mr. Aquino said, adding later, “We expect the cooperation of everyone so that nobody gets in harm’s way.”

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Microsoft #DroidRage Tweet Shows How Malware Has Moved Past Windows

“Do you have an Android malware horror story?” Microsoft asks through its @windowsphone Twitter account, in what may be one of the most ironic tweets of the year.

After all, it wasn’t that long ago that “virus” and “worm” stories made headlines on a regular basis, all of them about “computer viruses” which were really Windows viruses. Just a few years ago, Apple advertised the fact that a Mac “Doesn’t get PC viruses” as a reason to buy one.

But this year, 600,000 Macs were infected by the Flashback trojan, an epidemic which exceeded the scale of history’s single largest Windows infection. And now ​Microsoft​ is implying that its phones don’t get malware, as a way to advertise them. How did things get to be this way, and what will malware and virus authors do next?

​When virii attack

For years, Microsoft’s DOS and Windows operating systems were the biggest targets for virus and malware authors simply because they were the least secure. Today’s PC security best practices had yet to be built into them, and trying to bolt features on to ancient programming code was a half-baked solution at best. HugeWindows malware epidemics spread as the malware programs were able to install themselves without explicit permission and operate without user intervention.

​Network effects

One reason Microsoft Windows dominated the computing world for years and years was simply because it was dominant. More people using Windows meant more profits for Windows app developers, which meant more games and apps for Windows, which meant more people buying Windows PCs so they could use Windows games and apps.

Like with apps, malware is a business that makes money for the people who write it. And while it was theoretically possible to infect a computer running a more secure operating system, like OS X (used on Macs) or Ubuntu (powered by Linux), it was considered impossible to get it to spread far enough to be profitable. Whereas on Windows it was (and still is) possible to infect vast numbers of PCs, even chaining them into zombified “botnets” which act as supercomputers-for-hire.

​How the mighty have fallen?

OS X’s more secure design makes it extremely hard to infect with malware — normally. The Flashback trojan sneaked in this year using the Java web browser plugin, which is bundled with the Mac’s Safari web browser and was poorly maintained.

Plugins like Java and Flash open up new ways to infect a computer, which was one reason why Apple stopped including the Flash plugin (already absent on its iPhone and iPad) by default. Apple created a fix for the problem, but not before over half a million Macs were infected.

​What about on smartphones?

Unlike Apple and Microsoft’s app stores, the Google Play store allows anyone to submit anything with no review. It’s up to Android smartphone and tablet users to look at the “permissions” each game or app requests, as well as the reputation of their developers, and decide whether or not to install them.

While some consider this approach more “trustworthy” and respectful of users, it’s also helped lead to a comparatively enormous number of malware infections on Android, including “The Mother of All Android Malware,” which completely took over tens of thousands of phones last year.

​Are you #DroidRage-ing yet?

Microsoft’s tweet says “we may have a get-well present” for people who send it their best or worst stories of Android malware. Even if all the apps in the Windows Store are virus-free, however, there are still far fewer of them than there are for Android.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.
Social Media News Headlines – Yahoo! News

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Still Jets' starter, Sanchez out to prove himself

FLORHAM PARK, N.J. (AP) — Mark Sanchez spent a few days after his miserable performance wondering what was next.

The New York Jets quarterback had been benched, his coach tired of his mistakes, and there was no guarantee Rex Ryan would give him his job back anytime soon.

"I knew at some point before I died, I'd start at quarterback again," Sanchez said Wednesday. "I'm glad it's this week."

Ryan gathered his three quarterbacks Wednesday morning and told them he made up his mind: He's sticking with Sanchez.

For this week, at least.

Ryan weighed his options after pulling Sanchez for Greg McElroy last Sunday against Arizona, talking to many people within the organization before settling on his quarterback.

"I have to get this decision right," Ryan said, "and I believe I have."

So it will be Sanchez and not McElroy or Tim Tebow on Sunday when the Jets take on the Jaguars in Jacksonville.

"I'm pleased with coach's decision," Sanchez said. "Now it's my job to go make him right."

Sanchez was removed late in the third quarter against Arizona, and McElroy came in and led the Jets to the only touchdown of the game on his first NFL drive, helping New York to a 7-6 victory. Sanchez was 10 of 21 for 97 and three interceptions, while McElroy was 5 of 7 for 29 yards and the score, and appeared to spark the team.

Including, the Jets hope, Sanchez.

"When I looked at everything, the biggest thing I kept coming back to is, who gives us the best opportunity to win?" Ryan said. "When I kept coming back to that, I believe the correct answer was Mark Sanchez."

It was perhaps the biggest call in Ryan's nearly four years as coach, considering the sensitivity of the situation and the possible ramifications. He acknowledged there were differing opinions among those he spoke to, but said he received no pressure from owner Woody Johnson and added that Johnson was "absolutely" OK with the decision.

"From the day Mr. Johnson hired me," Ryan said, "he said it's 100 percent my decision who plays."

Sanchez, whose confidence was shaken with Sunday's performance, gets a chance to bounce back from the first benching of his NFL career and to regain the trust of his teammates. He has struggled recently, with two touchdowns and five interceptions in his last four games.

"It was probably the worst and best experience of my life," Sanchez said. "Hopefully, you learn from it and move on and never look back. It was definitely was the worst, but it could turn around and be one of the best things that's ever happened."

He said he had never been benched, except for maybe on his fifth-grade basketball team.

"I think (Ryan) was, more or less, sending a message and it's well-received," Sanchez said. "I know. I got it."

He'll likely be on a short leash against Jacksonville — with Tebow the No. 2 if healthy, and McElroy also ready to go — but Ryan acknowledged it might not be a quick hook if he struggles. Ryan also referenced the team's color-coded system which determined how much risk Sanchez can take with each pass, saying the quarterback is now back in the "red light" area — meaning he must be extremely cautious.

"If he throws one interception, it doesn't mean he's going to get benched, necessarily," Ryan said.

It's still uncertain if Tebow will be active against his hometown Jaguars while he recovers from two broken ribs. Despite being medically cleared by team doctors to play, Ryan chose to keep him active but not play against New England on Thanksgiving night, and then made him inactive against Arizona.

If Ryan went with McElroy, a seventh-round pick in 2011 out of Alabama, it would have been a clear indication the franchise is moving on from Sanchez.

"I'm just disappointed because I let a lot of people down," Sanchez said. "You let a lot of teammates down when you play like that. That never feels good. It just doesn't, not the way I prepare, not with the skill set I've been blessed to have."

Money might have played a role in the decision, too, with Sanchez owed $8.25 million next year in guarantees. But Ryan adamantly denied that factored into things.

"Absolutely zero," he said without hesitating.

Still, the Jets are likely stuck with Sanchez and his contract, so they need to see if he can rebound after the lowest point of his career.

"I believe in Mark," Ryan said.

It didn't appear Tebow was much of a factor in Ryan's decision. Ryan said all three quarterbacks would be in the mix, but didn't speculate whether he would have pulled Sanchez in favor of Tebow last Sunday if he were active.

"I'm not too worried about it," Tebow said. "Just trying to get better and trying to heal up."

Tebow was expected to have a major role in the offense, but instead has been a spare part averaging about seven offensive snaps per game. He has been listed as the No. 2 quarterback on the depth chart, but if the Jets turned to McElroy, it would have meant the No. 3 guy leapfrogged Tebow to start for the Jets.

McElroy said he has had a "normal" week so far, taking his usual number of snaps along with practicing with the scout team.

"You're not guaranteed anything, not at all," McElroy said. "You do your best to make the most of your opportunity and do your best to help the team."

The fact the next two games are on the road should also help Sanchez. He was booed mercilessly by the MetLife Stadium crowd last Sunday, particularly after each interception, and chants for McElroy were heard throughout the game. McElroy was cheered as he warmed up late in the third quarter, and there was growing sentiment among some fans and media that he earned a start after lifting the team.

"This is my opinion," Ryan said, "and I believe that sometimes you don't need to sit a guy for 'X' amount of games."

Now, Ryan has sent the message to Sanchez: perform or else. And Sanchez gets another shot to save his job this season — and his status as the Jets' franchise quarterback.

"This kind of thing affects people's lives and careers," Sanchez said. "It's not just, 'Oh, man. Bummer.' It's not like that. This is serious."

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand name version of tamoxifen.

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Ransomware Is Expanding in the United States

CULVER CITY, Calif. — Kidnappers used to make ransom notes with letters cut out of magazines. Now, notes simply pop up on your computer screen, except the hostage is your PC.

Michal Czerwonka for The New York Times

Security researchers Eric Chien, left, and Vikram Thakur at Symantec, where Mr. Chien has been tracking ransomware schemes.

Sometimes victims get a message, ostensibly from the F.B.I., accusing them of breaking the law and demanding a fine.

In the past year, hundreds of thousands of people across the world have switched on their computers to find distressing messages alerting them that they no longer have access to their PCs or any of the files on them.

The messages claim to be from the Federal Bureau of Investigation, 20 other law enforcement agencies across the globe or, most recently, Anonymous, a shadowy group of hackers. The computer users are told that the only way to get their machines back is to pay a steep fine.

And, curiously, it’s working. The scheme is making more than $5 million a year, according to computer security experts who are tracking them.

The scourge dates to 2009 in Eastern Europe. Three years later, with business booming, the perpetrators have moved west. Security experts say that there are now more than 16 gangs of sophisticated criminals extorting millions from victims across Europe.

The threat, known as ransomware, recently hit the United States. Some gangs have abandoned previously lucrative schemes, like fake antivirus scams and banking trojans, to focus on ransomware full time.

Essentially online extortion, ransomware involves infecting a user’s computer with a virus that locks it. The attackers demand money before the computer will be unlocked, but once the money is paid, they rarely unlock it.

In the vast majority of cases, victims do not regain access to their computer unless they hire a computer technician to remove the virus manually. And even then, they risk losing all files and data because the best way to remove the virus is to wipe the computer clean.

It may be hard to fathom why anyone would agree to fork over hundreds of dollars to a demanding stranger, but security researchers estimate that 2.9 percent of compromised computer owners take the bait and pay. That, they say, is an extremely conservative estimate. In some countries, the payout rate has been as high as 20 percent.

That people do fall for it is a testament to criminals’ increasingly targeted and inventive methods. Early variations of ransomware locked computers, displayed images of pornography and, in Russian, demanded a fee — often more than $400 — to have it removed. Current variants are more targeted and toy with victims’ consciences.

Researchers say criminals now use victims’ Internet addresses to customize ransom notes in their native tongue. Instead of pornographic images, criminals flash messages from local law enforcement agencies accusing them of visiting illegal pornography, gambling or piracy sites and demand they pay a fine to unlock their computer.

Victims in the United States see messages in English purporting to be from the F.B.I. or Justice Department. In the Netherlands, people get a similar message, in Dutch, from the local police. (Some Irish variations even demand money in Gaelic.) The latest variants speak to victims through recorded audio messages that tell users that if they do not pay within 48 hours, they will face criminal charges. Some even show footage from a computer’s webcam to give the illusion that law enforcement is watching.

The messages often demand that victims buy a preloaded debit card that can be purchased at a local drugstore — and enter the PIN. That way it’s impossible for victims to cancel the transaction once it becomes clear that criminals have no intention of unlocking their PC.

The hunt is on to find these gangs. Researchers at Symantec said they had identified 16 ransomware gangs. They tracked one gang that tried to infect more than 500,000 PCs over an 18-day period. But even if researchers can track their Internet addresses, catching and convicting those responsible can be difficult. It requires cooperation among global law enforcement, and such criminals are skilled at destroying evidence.

Charlie Hurel, an independent security researcher based in France, was able to hack into one group’s computers to discover just how gullible their victims could be. On one day last month, the criminals’ accounting showed that they were able to infect 18,941 computers, 93 percent of all attempts. Of those who received a ransom message that day, 15 percent paid. In most cases, Mr. Hurel said, hackers demanded 100 euros, making their haul for one day’s work more than $400,000.

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Bret Bielema leaves Wisconsin for Arkansas

FAYETTEVILLE, Ark. (AP) — Bret Bielema is taking his brand of power football to Arkansas, leaving Wisconsin after seven seasons.

Arkansas released a statement Tuesday saying Bielema has agreed to a deal to take over the program reeling following the firing of former coach Bobby Petrino.

A person familiar with the situation, who spoke on the condition of anonymity because the information hasn't been released publicly, says the deal is for six years and $3.2 million annually.

The Razorbacks were 4-8 this year, and Long announced after the season that interim coach John L. Smith would not return.

Bielema was 68-24 with the Badgers, including a 17-14 win over Arkansas in the 2007 Capital One Bowl.

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Clinton Warns Syria Against Using Chemical Weapons

Narciso Contreras/Associated Press

 A kitchen in a home in Aleppo, Syria showed signs of heavy fighting Sunday.

WASHINGTON — President Obama warned Syria’s government on Monday that it would be “totally unacceptable” to use chemical weapons against its own people and vowed to hold accountable anyone who did, as American intelligence officials picked up signs that such arms might be deployed in the ongoing insurgency.

The White House said that some recent actions by the government of President Bashar al-Assad were indicators that Syrian forces were preparing to use such weapons, following earlier reports that intelligence agencies had noticed signs of activity at chemical weapons sites. Mr. Obama’s spokesman said the administration had “an increased concern” of possible use of chemical weapons.

In a speech later in the day that echoed earlier comments by Secretary of State Hillary Rodham Clinton, Mr. Obama sternly asserted again that he would punish Syria for using chemical weapons, although he did not say how. The administration has been preparing contingency plans that include the dispatch of tens of thousands of troops to secure such weapons, although it is not clear whether Mr. Obama would go that far.

“Today I want to make it absolutely clear to Assad and those under his command: The world is watching,” Mr. Obama said in a speech at the National Defense University in Washington. “The use of chemical weapons is and would be totally unacceptable. If you make the tragic mistake of using these weapons, there will be consequences and you will be held accountable.”

During an earlier briefing at the White House, Jay Carney, the president’s press secretary, hinted at possible military action in response, although he declined to specify what options Mr. Obama would consider. “We think it is important to prepare for all scenarios,” Mr. Carney said. “Contingency planning is the responsible thing to do.”

The president’s statements on Syria amplified similar warnings issued by Mrs. Clinton earlier in the day in Prague, the Czech capital, where she was stopping on her way to meetings in Brussels.

“This is a red line for the United States,” Mrs. Clinton said, using the same language that the White House later would use. “I am not going to telegraph in any specifics what we would do in the event of credible evidence that the Assad regime has resorted to using chemical weapons against their own people. But suffice it to say we are certainly planning to take action if that eventuality were to occur.”

There have been signs in recent days of heightened activity at some of Syria’s chemical weapons sites, according to American and Israeli officials familiar with intelligence reports. Mrs. Clinton did not confirm the intelligence reports or say what sort of activity was occurring.

The Syrian Foreign Ministry, in a swift response, said the government “would not use chemical weapons, if it had them, against its own people under any circumstances.” The statement was reported on Syrian state television and on the Lebanese channel LBC.

The crisis has been worsening in Syria, where about 40,000 people have been killed in 20 months of conflict that has also spilled into neighboring countries. The warning from the White House came as developments elsewhere suggested the political terrain could be shifting.

The spokesman for Syria’s foreign ministry, Jihad Makdissi, was reported by the Hezbollah-run television station, Al Manar, as having been fired, although Lebanese news Web sites reported the departure as a defection. Mr. Makdissi, one of the highest ranking Christians to defect, had been one of the most accessible Syrian officials for foreign journalists. Al Manar reported that he was fired for making statements that did not reflect the government’s point of view, though it was unclear what those statements might have been.

But in recent months he had not taken phone calls and had not made public statements, leading some to speculate that he had either fallen out of favor or had doubts about the government. A security source said Mr. Makdissi flew to London from Beirut on Monday morning with his family.

Michael R. Gordon reported from Brussels. Reporting contributed by Anne Barnard from Beirut, Lebanon, and Sebnem Arsu from Istanbul.

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Four Things Google’s Nexus 4 Has in Common with the iPhone 4

Besides being each company’s flagship smartphone (and having the number 4 in their names), Google‘s new Nexus 4 and the 2010 iPhone 4 have a fair bit in common with each other.

This could be a good thing, if you remember just how popular the iPhone 4 was. Unfortunately, in this case it’s more of a bad thing, and hearkens back to “Antennagate” and the iPhone 4′s other problems. Do any of these features remind you of anything?

​A glass back

With the iPhone 5, Apple finally moved from a crack- and scratch-prone glass backplate to a solid, aluminum unibody construction. Google doesn’t seem to have gotten the memo that the former may have been a bad idea, however, and the Nexus 4 has a sparkly glass back surface.

While sparkly things obviously have their fans, the Nexus 4′s chassis also seems to lean towards the brittle side. Joshua Topolsky, who reviewed the Nexus 4 for The Verge, managed to crack the glass when he accidentally knocked his phone off the table. Meanwhile, Droid-Life’s Kellex found that setting the phone on a stone countertop caused its glass back to fracture in two.

​No 4G

Even Topolsky’s glowing review of the Nexus 4 said “It feels slow,” and “There’s simply no way to ignore this deficit.” That’s because, like the iPhone 4, the Nexus 4 lacks a 4G radio (even though it has the chip to support one if it had it).

The iPhone 4, however, was released in 2010, when 4G was still a new thing and the Android “superphones” which supported it had enormous screens and horrible battery life. Today, even the iPhone has 4G. Possibly because of bad blood between Google and the wireless carriers, which appear to resent Google’s selling phones unsubsidized and sans “customizations,” the Nexus 4 does not.

​Selling out fast

Every one of Apple’s iPhone models has sold out faster, and more dramatically, than the one before. Google’s Android devices, in contrast, haven’t tended to do so … although the new Nexus smartphones and tablets are starting to have this problem.

How bad is it? After Google finally got a new wave of Nexus 4s up for sale, they sold out in about a half-hour. Google claims that it hasn’t actually sold out, but even if you spotted the Nexus 4 on Google Play, chances are you ran into technical glitches which kept it out of your shopping cart. Tipster “Syko Pompos” told the Android Police blog how to get around this and place your order, but expect to wait months to receive it.

​Public relations nightmares

It hasn’t quite reached Antennagate levels yet, perhaps partly because the Nexus brand isn’t as well-known as the iPhone (the iPhone 4′s antenna problems were actually shared by many smartphones). But most of the press coverage of the Nexus 4 lately has been about how you can’t get one. Or else, how if you want one you’ll have to either buy it on contract or pay a lot more to get it unsubsidized from T-Mobile.

On the plus side (for the Nexus), this problem is only partly caused by the Google Play store’s technical errors. The biggest reason it’s taking so long to get out to people is, like with the iPhone 4, simply how popular it is.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

Linux/Open Source News Headlines – Yahoo! News

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