Retooling Pap test to spot more kinds of cancer

WASHINGTON (AP) — For years, doctors have lamented that there's no Pap test for deadly ovarian cancer. Wednesday, scientists reported encouraging signs that one day, there might be.

Researchers are trying to retool the Pap, a test for cervical cancer that millions of women get, so that it could spot early signs of other gynecologic cancers, too.

How? It turns out that cells can flake off of tumors in the ovaries or the lining of the uterus, and float down to rest in the cervix, where Pap tests are performed. These cells are too rare to recognize under the microscope. But researchers from Johns Hopkins University used some sophisticated DNA testing on the Pap samples to uncover the evidence — gene mutations that show cancer is present.

In a pilot study, they analyzed Pap smears from 46 women who already were diagnosed with either ovarian or endometrial cancer. The new technique found all the endometrial cancers and 41 percent of the ovarian tumors, the team reported Wednesday in the journal Science Translational Medicine.

This is very early-stage research, and women shouldn't expect any change in their routine Paps. It will take years of additional testing to prove if the so-called PapGene technique really could work as a screening tool, used to spot cancer in women who thought they were healthy.

"Now the hard work begins," said Hopkins oncologist Dr. Luis Diaz, whose team is collecting hundreds of additional Pap samples for more study and is exploring ways to enhance the detection of ovarian cancer.

But if it ultimately pans out, "the neat part about this is, the patient won't feel anything different," and the Pap wouldn't be performed differently, Diaz added. The extra work would come in a lab.

The gene-based technique marks a new approach toward cancer screening, and specialists are watching closely.

"This is very encouraging, and it shows great potential," said American Cancer Society genetics expert Michael Melner.

"We are a long way from being able to see any impact on our patients," cautioned Dr. Shannon Westin of the University of Texas MD Anderson Cancer Center. She reviewed the research in an accompanying editorial, and said the ovarian cancer detection would need improvement if the test is to work.

But she noted that ovarian cancer has poor survival rates because it's rarely caught early. "If this screening test could identify ovarian cancer at an early stage, there would be a profound impact on patient outcomes and mortality," Westin said.

More than 22,000 U.S. women are diagnosed with ovarian cancer each year, and more than 15,000 die. Symptoms such as pain and bloating seldom are obvious until the cancer is more advanced, and numerous attempts at screening tests have failed.

Endometrial cancer affects about 47,000 women a year, and kills about 8,000. There is no screening test for it either, but most women are diagnosed early because of postmenopausal bleeding.

The Hopkins research piggybacks on one of the most successful cancer screening tools, the Pap, and a newer technology used along with it. With a standard Pap, a little brush scrapes off cells from the cervix, which are stored in a vial to examine for signs of cervical cancer. Today, many women's Paps undergo an additional DNA-based test to see if they harbor the HPV virus, which can spur cervical cancer.

So the Hopkins team, funded largely by cancer advocacy groups, decided to look for DNA evidence of other gynecologic tumors. It developed a method to rapidly screen the Pap samples for those mutations using standard genetics equipment that Diaz said wouldn't add much to the cost of a Pap-plus-HPV test. He said the technique could detect both early-stage and more advanced tumors. Importantly, tests of Paps from 14 healthy women turned up no false alarms.

The endometrial cancers may have been easier to find because cells from those tumors don't have as far to travel as ovarian cancer cells, Diaz said. Researchers will study whether inserting the Pap brush deeper, testing during different times of the menstrual cycle, or other factors might improve detection of ovarian cancer.

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Holmes Played Childish Games After Aurora Carnage

As police confronted the movie theater carnage and a massive booby trap left behind by accused Aurora gunman James Holmes, the suspect loopily played with hand puppets, tried to stick a metal staple in an electrical socket and clamly flipped a styrofoam cup, according to court testimony today.

Holmes, 25, displayed the bizarre behavior once he was in custody and taken to Aurora police headquarters after the shooting that left 12 people dead and dozens injured, the lead investigator in the case testified today.

While being cross examined by Colorado public defender Daniel King, Police Detective Craig Appel was asked about the observations of two Aurora officers assigned to watch over Holmes in an interrogation room.

Appel said that to preserve possible gunshot residue, police had placed paper bags over Holmes' hands. One officer, King said, noted in a report that Holmes began moving his hands "in a talking puppet motion."

Click here for full coverage of the Aurora movie theater shooting.

King asked if Appel was also aware that the officer "observed Holmes take a staple out of the table and tried to stick it in an electrical socket?" Appel confirmed Holmes' actions.

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The officers also noted that they watched as Holmes began playing with an empty styrofoam cup, trying to "flip it" on the table.

While Holmes was carrying out his childish antics, police were puzzling over a complex booby trap Holmes had left behind in his apartment, according to testimony.

A gasoline-soaked carpet, loud music and a remote control car were part of Holmes' plan to trick someone into triggering a blast that would destroy his apartment and lure police to the explosion while he shot up a movie theater in Aurora, Colo., according to court testimony.

FBI agent Garrett Gumbinner told the court that he interviewed Holmes on July 20, hours after he killed 12 and wounded 58 during the midnight showing of "The Dark Knight Rises."

"He said he rigged the apartment to explode to get law enforcement to send resources to his apartment instead of the theater," Gumbinner said.

His plan failed to prompt someone into triggering the bombs.

Gumbinner said Holmes had created two traps that would have set off the blast.

The apartment was rigged with a tripwire at the front door connected to a mixture of chemicals that would create heat, sparks and flame. Holmes had soaked the carpet with a gasoline mixture that was designed to be ignited by the tripwire, Gumbinner said.

"It would have caused fire and sparks," the agent said, and "would have made the entire apartment explode or catch fire."

Holmes had set his computer to play 25 minutes of silence followed by loud music that he hoped would cause a disturbance loud enough that someone would call police, who would then respond and set off the explosion by entering the apartment.

Gumbinner said Holmes also told him he rigged a fuse between three glass jars that would explode. He filled the jars with a deadly homemade chemical mixture that would burn so hot it could not be extinguished with water.

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Venezuela postpones inauguration for cancer-stricken Chavez

CARACAS (Reuters) - Venezuela will postpone the inauguration of President Hugo Chavez for a new term due to health problems, the government said on Tuesday, another sign the socialist leader's cancer may be bringing an end to his 14 years in power.

The 58-year-old former soldier who has dominated the South American OPEC nation since 1999 has not been heard from since surgery on December 11 in Cuba - his fourth operation since he was diagnosed with an undisclosed type of cancer in June 2011.

The announcement outraged opposition leaders who insist that Chavez must be sworn in before the National Assembly on January 10 as laid out in the constitution, or temporarily step aside and leave an ally in power.

"The commander president wants us to inform that, based on his medical team's recommendations, the post-operative recovery should extend past January 10," said Vice President Nicolas Maduro, Chavez's chosen successor, in a letter read to the legislature.

"As a result, he will not be able to be present at the National Assembly on that date."

The letter said authorities would seek another date for the inauguration ceremony but did not say when it would take place or give a time frame for Chavez's return from Havana.

Rather than being sworn in by the legislature, he would take his oath at a later date before the Supreme Court, the letter said, as allowed by the constitution.

Government leaders insist Chavez is completely fulfilling his duties as head of state, even though official medical bulletins say he has a severe pulmonary infection and has had trouble breathing.

The government has called for a massive rally outside the presidential palace on Thursday, and allied presidents including Uruguay's Jose Mujica and Bolivia's Evo Morales have confirmed they will visit Venezuela this week despite Chavez's absence.

Argentine President Cristina Fernandez has announced plans to visit Chavez in Havana on Friday.

But the unprecedented silence by the president - famous for regularly speaking for hours in meandering broadcasts - has left many convinced he could be in his last days.

His resignation or death would upend politics in the oil-rich nation, where he enjoys a deity-like status among poor supporters thankful for his social largesse.

His critics call him a fledgling dictator who has squandered billions of dollars from crude sales while dashing the independence of state institutions.

CONSTITUTION DISPUTE

The constitution does not specify what happens if the president does not take office on January 10.

The Supreme Court, controlled by Chavez allies, called a news conference for Wednesday. It is widely expected to announce an interpretation of the constitution that will give Chavez leeway to take office when he is fit to do so.

If he dies or steps aside, new elections would be called within 30 days. Before leaving for Havana in December, the president instructed his supporters to back Maduro in that vote if he were unable to continue.

Opposition leaders argue that Congress chief and Chavez ally Diosdado Cabello should take over, as mandated by the constitution if the president's absence is formally declared.

Cabello has ruled that out, saying the president continues to be in charge.

"Who could have believed the opposition would be screaming for Diosdado Cabello to be given the presidency of the republic?" he said during a rambunctious session of Congress. "That's crazy, the opposition is losing it."

Meanwhile opposition deputies accused the Socialist Party of failing to follow Chavez's instructions - a scene that would have been unimaginable before Chavez's prolonged absence.

"President Chavez is the only one among you who has spoken clearly," said opposition leader Julio Borges.

He was drowned out by pro-Chavez deputies clapping and chanting the socialist leader's name and rebuffed by Cabello, who had long been considered a potential successor to Chavez until he was passed over for Maduro.

"It's not my fault you weren't chosen, don't take your frustration out on me," Borges quipped.

Another opposition deputy complained that during the debate a copy of the constitution was thrown across the chamber from the direction of the Socialist Party's deputies.

Chavez's supporters have held near-daily vigils for his recovery, while opposition activists accuse the president's allies of a Cuban-inspired manipulation of the situation.

Maduro has taken over the day-to-day running of the government and looks set to continue in the role past Thursday.

The mustachioed former bus driver lacks Chavez's charisma, but he has sought to imitate the president's style with vituperative attacks on the opposition and televised ribbon-cutting ceremonies.

With the micro-managing Chavez away, major policy decisions in Venezuela, such as a widely expected devaluation of the bolivar currency, appear to be on hold.

Venezuelan bond prices, which had soared in recent weeks on Chavez's health woes, dipped on Monday and Tuesday as investors' expectations of a quick government change apparently dimmed.

"The 'regime change' euphoria seems excessive taking into account the unclear legal transition and perhaps, more importantly, the risk that regime change does not allow for policy change," New York-based Jefferies' managing director Siobhan Morden said in a note on the bonds.

(Editing by Daniel Wallis and Eric Beech)

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Hate speech case: MIM MLA Akbaruddin Owaisi sent to 14- day judicial custody

HYDERABAD: Majlis-e-Ittehadul Muslimeen MLA Akbaruddin Owaisi, facing multiple cases for his alleged " hate speech", was today remanded to 14-day judicial custody by a magistrate in Nirmal town of Adilabad district.

Akbaruddin was reportedly questioned and produced before the magistrate at 5:30am, after which he was sent to judicial custody.

The Magistrate also asked the police to produce the MLA before the court later today at 10:30 am.

Owaisi has been taken to the Nirmal town police station, and his petition is expected to be listed at the Andhra Pradesh high court today.

Owaisi was arrested yesterday, a day after he returned from London and was admitted to a hospital for a medical check up, before being taken into custody.

Following the arrest of the MIM leader, the state government has imposed a prohibitory orders in the town to maintain law and order.

Additional security forces have been deployed in Hyderabad and Adilabad as a precautionary measure.

Owaisi, the floor leader of his party in the Andhra Pradesh Assembly, is facing a case against him in Adilabad for alleged provocative speeches regarding the disputed Bhagyalakshmi shrine in the Charminar area.

Complaints have been filed against him in regard to the same speeches in various police stations in Hyderabad and other parts of the state.

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Report: Death rates from cancer still inching down

WASHINGTON (AP) — Death rates from cancer are continuing to inch down, researchers reported Monday.

Now the question is how to hold onto those gains, and do even better, even as the population gets older and fatter, both risks for developing cancer.

"There has been clear progress," said Dr. Otis Brawley of the American Cancer Society, which compiled the annual cancer report with government and cancer advocacy groups.

But bad diets, lack of physical activity and obesity together wield "incredible forces against this decline in mortality," Brawley said. He warned that over the next decade, that trio could surpass tobacco as the leading cause of cancer in the U.S.

Overall, deaths from cancer began slowly dropping in the 1990s, and Monday's report shows the trend holding. Among men, cancer death rates dropped by 1.8 percent a year between 2000 and 2009, and by 1.4 percent a year among women. The drops are thanks mostly to gains against some of the leading types — lung, colorectal, breast and prostate cancers — because of treatment advances and better screening.

The news isn't all good. Deaths still are rising for certain cancer types including liver, pancreatic and, among men, melanoma, the most serious kind of skin cancer.

Preventing cancer is better than treating it, but when it comes to new cases of cancer, the picture is more complicated.

Cancer incidence is dropping slightly among men, by just over half a percent a year, said the report published by the Journal of the National Cancer Institute. Prostate, lung and colorectal cancers all saw declines.

But for women, earlier drops have leveled off, the report found. That may be due in part to breast cancer. There were decreases in new breast cancer cases about a decade ago, as many women quit using hormone therapy after menopause. Since then, overall breast cancer incidence has plateaued, and rates have increased among black women.

Another problem area: Oral and anal cancers caused by HPV, the sexually transmitted human papillomavirus, are on the rise among both genders. HPV is better known for causing cervical cancer, and a protective vaccine is available. Government figures show just 32 percent of teen girls have received all three doses, fewer than in Canada, Britain and Australia. The vaccine was recommended for U.S. boys about a year ago.

Among children, overall cancer death rates are dropping by 1.8 percent a year, but incidence is continuing to increase by just over half a percent a year. Brawley said it's not clear why.

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Poisoned Lottery Winner's Body to Be Exhumed

The body of a $1 million lottery jackpot winner will likely be exhumed from Rosehill Cemetery in Chicago, according to the Cook County medical examiner, who determined that the winner died of cyanide poisoning.

Last June Urooj Khan, 46, won $1 million in a scratch-off lottery game, or $425,000 after taxes, but he died unexpectedly on July 20. Since there were no signs of foul play or any cause for suspicion, his death was attributed to arteriosclerotic cardiovascular disease, which covers heart attacks, stroke or ruptured aneurysm.

But a few days after the death certificate was issued, a family member called the medical examiner's office and asked that the death be investigated, said Dr. Stephen Cina, Cook County's chief medical examiner. Cina said he could not disclose the identity of the family member because of the ongoing investigation.

"We are in discussion with the state attorney about whether we are going to do an exhumation. Right now, we are leaning in that direction. We have a cause and matter of death on the books, and we're comfortable with that," Cina told ABCNews.com. "If or when this goes to court, it would be nice to have all the data possible."

Illinois Lottery/AP Photo

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Cina said the final toxicology results came back in late November showing a lethal level of cyanide, which led to the homicide investigation. Melissa Stratton, a spokeswoman for the Chicago Police Department, confirmed a murder investigation had been "under way," and that the police department had been working closely with the medical examiner's office.

Khan is survived by his wife, Shabana Ansari, 32, and teenage daughter. The family owned three dry-cleaning businesses in Chicago.

Ansari told the Chicago Tribune that Khan was "the best husband on the entire planet" and "extraordinary, nice, kind and lovable."

Ansari could not be reached by ABC News for comment.

The police are not confirming whether Khan's lottery winnings played a part in the homicide.

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When asked why cyanide, a chemical asphyxiant that binds to red blood cells and prevents the entry of oxygen, was not found in the initial examination of Khan's body, Cina said, "Quite frankly, it's unusual as a cause of death, so it's not at the top of your mind."

He said about 50 percent of people can smell cyanide, but it is more noticeable when the body is opened up.

Sometimes the coloring of blood changes with cyanide poisoning after death, becoming "more reddish than purple," he said.

"In this case that wasn't particularly striking," Cina said, describing the first examination of Khan's body.

"It strangles your red blood cells at a biochemical level," he said.

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Ex-governor in North Korea with Google chief; seeks American's release

SEOUL (Reuters) - Former New Mexico Governor Bill Richardson and Google Executive Chairman Eric Schmidt began a controversial private mission to North Korea on Monday that will include an effort to secure the release of an imprisoned American.

The trip comes after North Korea carried out a long-range rocket test last month and as, according to satellite imagery, the reclusive state continues work on its nuclear testing facilities, potentially paving the way for a third nuclear bomb test.

Footage from North Korean state television showed Richardson and Schmidt at the Pyongyang airport on Monday evening.

"We are going to ask about the American who's been detained. A humanitarian private visit." Richardson said.

Richardson's efforts to seek the release of Kenneth Bae, a Korean-American tour guide who was detained last year will mark the latest in a series of high-profile visits over the years to free Americans detained by Pyongyang.

The delegation comprised Schmidt, his daughter, Richardson and Google executive Jared Cohen, according to South Korean news media and it arrived in Pyongyang on a flight from the Chinese capital, Beijing.

The mission has been criticized by the United States due to the sensitivity of the timing. The United States does not have diplomatic relations with North Korea and the isolated and impoverished state remains technically at war with U.S. ally South Korea.

"We continue to think the trip is ill-advised," U.S. State Department spokeswoman Victoria Nuland said in Washington. Last week she said the main U.S. objection was that the trip came so soon after North Korea's much-criticized December 12 rocket launch.

South Korea is in the midst of a transition to a new president who will take office in February, while Japan, another major U.S. ally in the region, has a new prime minister.

A U.S. official said the trip's timing was particularly bad from the Obama administration's point of view because it comes as the U.N. Security Council ponders how to respond to the North Korean missile launch.

"We are in kind of a classical provocation period with North Korea. Usually, their missile launches are followed by nuclear tests," said the official, who spoke on condition of anonymity.

"During these periods, it's very important that the international community come together, certainly at the level of the U.N. Security Council, to demonstrate to North Korea that they pay a price for not living up to their obligations."

Richardson, a former ambassador to the United Nations, has made numerous trips to North Korea in the past that have included efforts to free detained Americans. The reasons for Schmidt's involvement in the trip are not clear, though Google characterized it as "personal" travel.

Schmidt did not respond to requests for comment.

Richardson told CBS television last Friday that he had been contacted by Bae's family and that he would raise the issue while in North Korea.

Pyongyang's most notable success was securing a visit from former President Bill Clinton in 2009 to win the release of two American journalists.

Last year, Jared and Schmidt met defectors from North Korea, a state that ranks bottom in an annual survey of Internet and press freedom by Reporters Without Borders.

Media reports and think tanks say that officials from the North Korean government went to Google's headquarters in 2011, something the U.S. technology giant declined to comment on.

(Additional reporting by Cho Meeyoung and WASHINGTON Bureau; Editing by Michael Perry, Ron Popeski and David Brunnstrom)

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Hagel draws fire as Obama's Pentagon pick

WASHINGTON: US President Barack Obama named Chuck Hagel on Monday to lead the Pentagon, setting up an ugly confirmation battle as Republican opponents said he was too hard on Israel and too soft on Iran.

Obama's choice of John Brennan to replace scandal-tainted David Petraeus as CIA chief was seen as more straightforward despite the counter-terrorism czar's defense of "enhanced interrogation techniques" and the US drone war.

The second term revamp of the president's national security team was expected to win ultimate approval but several leading Republicans signaled they would make it tough for Hagel even though he is one of their own.

Obama paid particular tribute to retiring Pentagon chief Leon Panetta before giving ringing endorsements to the "outstanding" Hagel and Brennan and urging the Senate not to dally in confirming their important appointments.

"Chuck Hagel is the leader that our troops deserve. He is an American patriot," the president said, heaping praise on a war hero who was awarded two Purple Heart medals for his bravery as a soldier in Vietnam.

"When Chuck was hit by shrapnel, his brother saved him. When his brother was injured by a mine, Chuck risked his life to pull him to safety. To this day, Chuck bears the scars -- and the shrapnel -- from the battles he fought in our name," Obama said.

Some Republicans have never forgiven him for his outspoken criticism of ex-president George W. Bush's handling of the Iraq war, and his closeness to the Democratic president sees him regarded by others as a traitor.

But Obama, who wants to be remembered as a leader who ended wars abroad to set about the tricky task of nation-building at home following a crippling recession, described Hagel as someone perfectly fitted to that mold.

"Maybe most importantly, Chuck knows that war is not an abstraction. He understands that sending young Americans to fight and bleed in the dirt and mud, that's something we only do when it's absolutely necessary," he said.

Administration appointments are often tense affairs in the United States as confirmation hearings provide senators with opportunities to turn away unwanted candidates or score cheap political points, or both.

Hagel, 66, known for a fiercely independent streak and a tendency to speak bluntly, is expected to get particularly rough treatment due to his criticism of America's "Jewish lobby" and opposition to some Iran sanctions.

Republican Senator Lindsey Graham said Hagel would be "the most antagonistic defense secretary towards the state of Israel in our nation's history."

Another Republican senator, John Cornyn of Texas, said he would oppose the nomination, charging it would be the "worst possible message we could send to our friend Israel and the rest of our allies in the Middle East."

But in an interview with The Lincoln Journal Star, a newspaper in his home state of Nebraska, Hagel hit back at his critics.

There is "not one shred of evidence that I'm anti-Israeli, not one vote (of mine) that matters that hurt Israel," he said.

If confirmed by the Senate, Hagel will have to manage major cuts to military spending while wrapping up the US war effort in Afghanistan and preparing for worst-case scenarios in Iran or Syria.

Serving as an enlisted man who never joined the officer ranks, Hagel carries a particular empathy for the unheralded infantry "grunts" in the field.

As he grapples with budget pressures, the former sergeant will likely try to shield frontline troops from the effect of spending cuts.

In his typical straight-shooting fashion, Hagel has called the Defense Department "bloated" and said that "the Pentagon needs to be pared down."

Obama, smarting from watching Susan Rice -- reportedly his first choice to succeed Hillary Clinton as secretary of state -- fold her bid in the face of Republican opposition, pressed hard for the Senate to approve Hagel.

"He would be the first person of enlisted rank to serve as secretary of defense. One of the few secretaries who had been wounded in war and the first Vietnam veteran to lead the department," Obama said, calling his appointment "historic."

Brennan, 57, may get an easier ride but is sure to face questions over his support for the use of certain "enhanced interrogation techniques" under the Bush administration and for his staunch defense of the US drone program.

The 25-year Central Intelligence Agency veteran, an Arabic-speaking Middle East expert, replaces Petraeus, who resigned in November after confessing to an extramarital affair with his biographer Paula Broadwell.

Obama highlighted what he called Brennan's incredible work ethic, saying "John is legendary even in the White House" and reminding everyone of a now-famous quote from August 2010.

Asked if he got any down time or was all work and no play, Brennan replied: "I don't do down time."

In a moment of levity at the White House event, the avuncular 74-year-old Panetta drew loud laughs when he said he would be retiring to his walnut farm and "dealing with a different set of nuts."

- AFP/ac

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Better drive safe, wife's watching

NEW DELHI: Drivers of Andhra Pradesh's 23,000 public transport buses are a lot more responsible now, a transformation that has happened in the past six months. That's because buses they're assigned to have photographs of their children and wife stuck on the dashboard. This step coupled with random mandatory breath analyser tests, have had a salutary effect and accidents are significantly down.

Also, the December 16 Delhi gang rape has spurred the Andhra Pradesh State Transport Corporation (APSRTC) to make state bus travel safer for women. It has started martial arts training for its 7,000-odd women conductors so that they can help prevent attacks on passengers.

On Monday, APSRTC that ferries at least 1.4 crore passengers every year, received a trophy for its impressive accident-control record from highways minister CP Joshi. In the last two years, the corporation has recorded only 0.13 and 0.11 accidents per 1lakh km. "Ever since we started the two recent initiatives to put brake on accidents, our record has improved to 0.09," APSRTC vice- chairman and managing director A K Khan, an IPS officer, said.

The idea of putting a driver's family photograph on the dashboard was implemented last July in view of the psychological impact it has on the man behind the wheel. "Every driver leaves home promising his family that he will return home safe. A soft reminder of his family motivates him to be alert. This has gone down well with the drivers," Khan said.

Booze test for Andhra drivers must

To ensure drivers aren't drunk, the Andhra Pradesh State Transport Corporation (APSRTC) has procured 300 advanced breath analyzers and tests are mandatory.

Last July, 25 drivers were sacked after they were found drunk.

"This strong message of zero tolerance to drink driving has worked," APSRTC vice-chairman and managing director A K Khan said.

APSRTC transports at least 1.2 crore passengers per day and covers 82 lakh km. It won the trophy in the mofussil category. "Over 1.47 lakh state transport undertaking buses carry about 7 crore passengers across the country. They need to ensure high levels of passenger safety," said executive director of association of STRUs U Sudhakara Rao.

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Report: Death rates from cancer still inching down

WASHINGTON (AP) — Death rates from cancer are continuing to inch down, researchers reported Monday.

Now the question is how to hold onto those gains, and do even better, even as the population gets older and fatter, both risks for developing cancer.

"There has been clear progress," said Dr. Otis Brawley of the American Cancer Society, which compiled the annual cancer report with government and cancer advocacy groups.

But bad diets, lack of physical activity and obesity together wield "incredible forces against this decline in mortality," Brawley said. He warned that over the next decade, that trio could surpass tobacco as the leading cause of cancer in the U.S.

Overall, deaths from cancer began slowly dropping in the 1990s, and Monday's report shows the trend holding. Among men, cancer death rates dropped by 1.8 percent a year between 2000 and 2009, and by 1.4 percent a year among women. The drops are thanks mostly to gains against some of the leading types — lung, colorectal, breast and prostate cancers — because of treatment advances and better screening.

The news isn't all good. Deaths still are rising for certain cancer types including liver, pancreatic and, among men, melanoma, the most serious kind of skin cancer.

Preventing cancer is better than treating it, but when it comes to new cases of cancer, the picture is more complicated.

Cancer incidence is dropping slightly among men, by just over half a percent a year, said the report published by the Journal of the National Cancer Institute. Prostate, lung and colorectal cancers all saw declines.

But for women, earlier drops have leveled off, the report found. That may be due in part to breast cancer. There were decreases in new breast cancer cases about a decade ago, as many women quit using hormone therapy after menopause. Since then, overall breast cancer incidence has plateaued, and rates have increased among black women.

Another problem area: Oral and anal cancers caused by HPV, the sexually transmitted human papillomavirus, are on the rise among both genders. HPV is better known for causing cervical cancer, and a protective vaccine is available. Government figures show just 32 percent of teen girls have received all three doses, fewer than in Canada, Britain and Australia. The vaccine was recommended for U.S. boys about a year ago.

Among children, overall cancer death rates are dropping by 1.8 percent a year, but incidence is continuing to increase by just over half a percent a year. Brawley said it's not clear why.

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