Amazon Kindle Fire HD 8.9 is Good, But No iPad Killer [REVIEW]

Unboxing the Kindle Fire HD 8.9

Click here to view this gallery.

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Amazon expands its tablet sights with the bigger, more powerful Kindle Fire HD 8.9. Can it compete against Apple‘s iPad?

If there’s one company that deserves credit for reigniting the iPad competitor market, it’s Amazon. Despite some bugs and an overall blah design, its 7-inch Kindle Fire was the first Android tablet that made sense to consumers who gobbled it up to help the Fire grab 50% of the Android tablet market in just 6 months.

[More from Mashable: 9 Black Friday Deals For iPhone Owners]

That tablet essentially opened the flood gates for a new set of ever-more-powerful 7-inchers from, notably, Barnes & Noble and Google. All three companies have already updated their 7-inch offerings to more powerful components and higher-resolutions screens. They’re all still running Android, though Amazon and Barnes & Noble choose to hide the Google OS behind smarter and much more consumer-friendly interfaces.

All this led Apple to finally enter the mid-sized tablet space with the iPad Mini. It’s easily the best-looking tablet of the bunch, but also $ 120 more expensive than its nearest competitor.

The more interesting development, though, is Amazon‘s (and Barnes & Noble‘s) decision to go toe-to-toe with Apple’s full-size iPad and launch the Amazon Kindle Fire HD 8.9 (in 4G LTE and WiFi-only). The move is akin to a middle weight boxer putting on the pounds to take on the Heavyweight world champion. Amazon’s Kindle Fire HD is slightly smaller (the iPad is 9.7-inches), lighter (567g vs. 625g), cheaper ($ 369 for 32 GB model vs. $ 599 for the iPad 4th Gen — Amazon subsidizes with sleep-state ads, that I do not mind) and overall somewhat less powerful. In order to win the battle, the 8.9-inch Kindle Fire HD better be pretty nimble on its feet, while able to throw that all important knockout punch.

Short version of this story: the Kindle Fire HD 8.9 does some serious damage, but the iPad 4th Gen gets the decision and retains the tablet leader title.

The Kindle Fire HD 8.9 is by no means a failure. In many ways, it’s as good as the smaller Kindle Fire HD, but throughout my tests I noticed odd bugs and glitches (which should all be fixable by software) and a somewhat disturbing lack of power that’s especially obvious when you put the Fire HD 8.9 next to the iPad 4th Gen

What It Is

If you’ve never seen an iPad and someone handed you the Kindle Fire HD .9, you’d likely say its jet-black, soft-to-the-touch plastic body felt good in your hands and was more than effective at all the core tasks (reading, game playing, e-mail, web browsing).

Design-wise, the 8.9 device looks exactly like the 7-inch model, complete with the too-hard to find volume and power buttons. There are no other physical buttons on this device, but Amazon chooses to hide the few it has by making them the exact same color as the chassis and flush with the body. Every time I use the tablet I do the “where’s the damn button” dance, rotating the Kindle Fire HD round and round until I feel the buttons (since I can barely see them).

I have applauded Barnes & Noble for putting the physical “N” home button right on the face of their Nook HD. Bravo for having the guts to do this. Amazon apparently looks at Apple’s iPad home button and thinks to have anything similar would be seen as “copying” the Cupertino hardware giant, when instead they should realize that it works, consumers like it and tablets without it are at a distinct disadvantage.

Amazon’s interface has you make do with a virtual, slide-out home button that is always available. Problem is, I found times when it wasn’t available. When I played Spider-Man and Asphalt 7, the tiny little left-had bar would disappear and I couldn’t exit the game unless I hit the sleep/power button.

The rest of the Kindle Fire HD 8.9′s body is solid and unremarkable (if you read my Kindle fire HD 7 review, then you know exactly what to expect.). Like the iPad 4th Gen, the Kindle Fire HD 8.9 has a front-facing 720p-capable camera. It’s useful for capturing video, snapping 1 Megapixel images and, probably most important, Skype video chats. Skype has built a fairly sharp-looing Kindle Fire app, though the design doesn’t fully fit the larger 8.9-inch screen. Skype just updated its Android app for better tablet viewing and hopefully, we’ll see this update hit the Kindle Fire HD 8.9 as well.

The iPad also has an HD rear-facing camera. The Kindle fire HD 8.9 does not (Barnes & Noble leave out cameras altogether)

Not Packing a Punch

As a large-screen high-resolution tablet (though iPad’s 2048×1536 retina display beats it), the Kindle Fire HD 8.9 offers plenty of attractive screen real estate for web browsing, book and magazine reading and games. But the results can be mixed. Silk, Amazon‘s custom web browser, was occasionally less than responsive and games, though, they ran well, never looked half as good as they do on the considerably more expensive iPad 4.

Granted, you can’t always find the same high-quality immersive action games on both Android and iOS, but Asphalt 7 Heat is a notable exception and it throws the performance differences between the two tablets into stark contrast. Game play is equally responsive on both platforms: the Kindle Fire HD 8.9’s accelerometer reads my moves just as well as the iPad.

The graphics on the Kindle Fire HD, however, are reduced to blobs and blocks (palm trees without distinct leaves, buildings without discernible windows) . The iPad’s quad-core graphics simply overmatch the Kindle Fire. I have never, for example, seen an iPad draw the game as I was playing, as I did when I tried out The Amazing Spider-Man.

Additionally, I experienced more than my share of crashes with games and even magazine apps like Vanity Fair.

The Good

Not everyone, however, will compare the Kindle Fire HD 8.9 to the iPad. Some will see the $ 299 entry-level price point (for the 16 GB model) and appreciate the power, flexibility and utility of this device. Like all Fire’s before it, the Kindle Fire HD 8.9 makes it easy to consume mass quantities of content. Nearly every menu option: Games, Apps, Books, Music, Videos, Newsstand, puts you just one click away from shopping for fresh content. If you have an Amazon account (and who doesn’t) your desired book, music or movie is just a click away. Plus, you can still easily store any of it locally, and worry about running out of storage space, or in the cloud, and never worry about space or accessibility—you can get to that purchased Kindle content from any Kindle app or registered Amazon device.

Watching movies on the tablet is a pleasure. I streamed a couple through Amazon Prime; they looked good on the 1920 x 1200 screen and the Dolby Stereo speakers produced sharp, loud, almost room-filling sound—an impressive feat not even the iPad can match.

The Kindle Fire HD 8.9 also includes a mini-HDMI-out port, which prompted me to connect the tablet to my 47-inch LED HDTV so we could watch Disney’s Brave. Yes, I had to get up and tap on the Kindle screen each time I wanted to pause and restart the move, but otherwise, I was pretty impressed with how the Kindle handled the task.

Obviously I yearn for an Apple Airplay-like feature on Android tablets (rumor has it one is coming), but this is the next, best thing.

There isn’t a lot to say about the Kindle Fire HD 8.9-inch interface that I did not say in the Kindle Fire HD 7 review. I will note, however, that the increased real estate makes the trademark task carousel seem almost too big. Icons for everything from your recently played Spider-Man game to magazine apps, books and Web sites all sit side-by-side-by side. Some, like book covers, look gorgeous.

Others like a broken web-page link look stupid. Worse yet, none of them have labels, which can occasionally make it hard to identify which app or task you’re looking at. I’m just not sure this interface metaphor is sustainable.

Personally I prefer either the clean consistent look of iOS, or the uber-user friendly, family-oriented Nook HD profile-based one. Amazon may want to take a hard look at those and start over.

Staying Connected

The Kindle Fire HD 8.9 is also Amazon’s first cellular-based tablet. That fact puts it even more squarely in competition with the iPad (which obviously has always had 3G models and now offers blazing fast 4G LTE ones as well on all major carriers).

Amazon’s mobile broadband plans are a little more conservative, with just the AT&T 4G LTE option (the 32 GB 4G model that I tested lists for $ 499, which is still $ 224 less than a comparable iPad 4th Gen).

In my experience, the connectivity is superfast and fairly ubiquitous. Amazon‘s $ 49 (a year) flat fee plan is attractive, but with a cap of 250MB per month of data, it’s unlikely it will satisfy the most data-hungry users. If you do need more data, users can also get 3GB and 5GB data plans directly from AT&T on the device.

At press time, Amazon had not enabled streaming video over LTE. Having it sounds nice, but even with the most generous data plans, streaming video would eat it up faster than you can say, “I’m streaming Back to the Future in HD over 4G LTE on my Kindle fire HD!”

The reality for most users is that WiFi is plentiful and you’ll be hard pressed to find a spot where you can’t connect for free or a small one-off fee. It’s the reason Barnes & Noble’s line of HD Nooks do not include a cellular option.

Review continues after FreeTime Gallery

FreeTime

Kindle HD FreeTime Start

Click here to view this gallery.

Perhaps the best new addition to the Kindle Fire family is not a piece of hardware or new component, but the new FreeTime app. Amazon put a lot of loving care into this parental control interface, but almost mucks the whole thing up by hiding the tool under an app that you have to scroll down to (or search) to find. By contrast profiles and age and content controls are baked into the Barnes & Noble Nook HD in a way that makes them impossible to ignore.

Even so, once you do access FreeTime, I think you’ll be pleased with the level of control it gives you. I added test profiles for my two children and then hand-picked every app and piece of content they could access. I was also able to block broadband mobile and even set time limits for access to content and overall screen viewing time (on a per profile basis). The set-up is a bit wonky and it bizarrely switches between landscape and profile screens, but I still applaud the effort. It would make sense for Amazon to move FreeTime into a device set-up screen. If the user has no additional family members or kids using the device, they can easily skip it.

To Buy or Not to Buy

Amazon’s expansive content and shopping ecosystem has always been a strong draw and it’s just as good in this large screen tablet as it was in the very first Kindle Fire. Still, you have to compare it with the equally strong iOS ecosystem, which is no slouch in the content shopping department. Apple doesn’t connect you as seamlessly to physical products, but there’s nothing difficult about shopping on Amazon.com via your iPad. It’s also notable that tablet competitor Barnes & Noble has added movie and TV viewing, rental and purchase.

Ultimately, all of these tablets are offering more and more of the same content options, apps, and features. The decision will likely come down to price, app selection, interface and overall ease of use. The Amazon Kindle fire HD 8.9 scores well on all of these, but does not always lead.

For the price, it’s a great value, but I want Amazon to focus on hardware and interface design for the next big update. Then, they may get my full endorsement.

This story originally published on Mashable here.

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Study finds mammograms lead to unneeded treatment

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Sandy victims cheered by NYC's Thanksgiving parade

NEW YORK (AP) — Victims of Superstorm Sandy in New York and elsewhere in the Northeast were comforted Thursday by kinder weather, free holiday meals and — for some — front row seats to the annual Macy's Thanksgiving Day Parade.

"It means a lot," said Karen Panetta, of the hard-hit Broad Channel section of Queens, as she sat in a special viewing section set aside for New Yorkers displaced by the storm.

"We're thankful to be here and actually be a family and to feel like life's a little normal today," she said.

The popular Macy's parade, attended by more than 3 million people and watched by 50 million on TV, included such giant balloons as Elf on a Shelf and Papa Smurf, a new version of Hello Kitty, Buzz Lightyear, Sailor Mickey Mouse and the Pillsbury Doughboy. Real-life stars included singer Carly Rae Jepsen and Rachel Crow of "The X Factor."

The young, and the young at heart, were delighted by the sight and sound of marching bands, performers and, of course, the giant balloons. The sunny weather quickly surpassed 50 degrees.

Alan Batt and his 11-year-old twins, Kyto and Elina, took in the parade at the end of the route, well away from the crowd and seemingly too far away for a good view. But they had an advantage: Two tall stepladders they hauled over from their apartment eight blocks away — one for each twin.

"We're New Yorkers," the 65-year-old Batt said. "We know what we're doing."

With the height advantage, "I get to see everything!" Kyto said.

At nearby Greeley Square, social worker Lowell Herschberger, 40, of Brooklyn, sought in vain to tear his sons, 8-year-old Logan and 6-year-old Liam, from a foosball table set up in the tiny park as the balloons crept by on the near horizon.

"Hey, guys — there's Charlie Brown," he said, pointing at the old standby balloon.

The boys didn't look up.

"I guess they're over it," the father said with a shrug.

Mayor Michael Bloomberg was reflective Thursday as he praised police, firefighters, armed services personnel, sanitation workers and volunteers involved in the storm response. His office was coordinating the distribution of 26,500 meals at 30 sites in neighborhoods affected by Sandy, and other organizations also were pitching in.

The disaster zones on Staten Island were flooded — this time with food and volunteers from Glen Rock, N.J., organized using social media.

"We had three carloads of food," volunteer Beth Fernandez said. "The whole town of Glen Rock pitched in. ... It's really cool. It's my best, my favorite Thanksgiving ever."

On Long Island, the Long Beach nonprofit Surf For All hosted a Thanksgiving event that fed 1,200 people. Carol Gross, 72, a Long Beach native, said she went to volunteer but was turned away because of a surplus of helpers.

"A lot of people like me, old-timers, we've never seen anything like this horror," she said, recalling the destruction.

Gross' brother, Jerry, who moved to Arizona in the 1960s, was stunned by what he saw when he returned for Thanksgiving.

"To come back and see the boardwalk all devastated like it is, it's like going to Manhattan and finding Times Square gone," he said.

George Alvarez, whose Toms River, N.J., home suffered moderate damage when Sandy hit the coast, said his family usually does "the traditional big dinner" on Thanksgiving. But this year, they chose to attend a community dinner held at an area church.

"This storm not only impacted us, it impacted a lot of our friends, our community, our psyche," Alvarez said shortly before his family headed out for their meal. "We could have had our usual dinner here at home, but this year it felt like we should be with others who are experiencing the same concerns we are. We made it through this devastating storm, and that's something to celebrate."

Across the country, other cities offered a mix of holiday cheer and acts of charity.

Thousands of people made the most of the mild, sunny fall weather to watch Detroit's Thanksgiving parade, hours ahead of the Lions' annual home game.

Floats and marching bands poured down Woodward Avenue on Thursday morning, with many spectators forgoing the cold-weather gear of past parades. Detroit's temperature hit 52 degrees at 11 a.m., with a warm wind blowing from the south.

Parade participants included NASCAR driver Brad Keselowski, a 28-year-old Rochester Hills native and the first Michigan-born driver to win the Sprint Cup Series.

In San Francisco, lines of the homeless and less fortunate began forming late Wednesday outside a church in the city's tough Tenderloin district that expected to serve more than 5,000 meals, said the Rev. Cecil Williams.

"We must make sure people can overcome all adversities," Williams said. "You can, you will and you must."

On New York City's Rockaway Peninsula, convenience store owner Mohamed Razack said he was able to open again Wednesday for the first time since the storm.

"At first, I was very depressed, but now, I'm proud," said Mohamed Razack, 50. "We are the first store to open around here."

___

AP radio correspondent Julie Walker, AP video journalist Ted Shaffrey and Associated Press writers Kiley Armstrong and Karen Matthews in New York, Alison Barnwell on Long Island, Bruce Shipkowski in New Jersey and Terry Collins in San Francisco contributed to this report.

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Deaths of 5 runaways prompt soul search in China

BEIJING (AP) — On the day China unveiled its new leadership in Beijing with promises of a better life for all, five runaway boys died in a garbage bin where they had sought shelter and warmth on a cold, damp night in the south.

The boys were all brothers or cousins aged 9 to 13. Surnamed Tao, they were the sons of three brothers — two of whom are migrant workers with jobs far from home — and most of them lived largely unsupervised in the care of their blind grandmother.

They had been missing for more than a week when, police say, they lit a fire to stay warm on the night of Nov. 15 in the southern city of Bijie and died from carbon monoxide poisoning.

As details of the tragedy emerged this week, it touched off the country's latest soul-searching about social responsibility. It renewed concern over the "left-behind" rural children who often stay with grandparents while parents seek work in thriving coastal cities, and the failure of the country's social services to adequately care for them.

"Though you departed from us in a garbage bin, you are not garbage," children's book author Zheng Yuanjie wrote in his microblog, adding that the fault lies with "adults who failed their responsibilities."

Questions have been raised about how the children — found about 25 kilometers (15 miles) from their home village of Caqiangyan — could have gone missing for 10 days without more of an effort launched to find them. Six local officials, including two school principals, were sacked on Tuesday.

"We have failed in our management work," said Tang Guangxing, a spokesman for Bijie city, where the boys' bodies were found Friday. "Our work was not attentive enough."

State media outlets, giving the deaths broad coverage, have joined in the hand-wringing.

"This is a shame that cannot be washed away by a civilized society," the Beijing Youth Daily wrote in an editorial.

The official Xinhua News Agency said the boys had poor grades at school and had essentially dropped out of their classes. It faulted China's education system for putting too much stress on academic excellence at the expense of caring for less successful students.

"Please do not forget the mission of compulsory education. Please spread love and responsibility like sunshine," Xinhua wrote in an editorial. "This is also a tragedy of 'left-behind children,' which is a sign of the time and requires introspection from family, society and government."

Many critics in China have fretted over decaying public morality as the country's economy rapidly grows and its people enjoy unprecedented wealth. A similar outcry erupted last year when a toddler in Guangzhou was run over by two vehicles and then ignored by at least 18 passers-by.

The latest incident has focused concern on the plight of families in impoverished rural areas. An estimated 58 million children countrywide lack sufficient supervision or stay in the care of grandparents when their parents seek work in China's booming cities.

Some details of the boys' home life remain unclear. Their relatives lack telephones and could not be contacted, though some were quoted by Chinese media outlets who sent journalists to the extremely poor, mountainous region of mud huts where farmers earn about 3,000 yuan ($475) a year.

The boys — Zhongjin, Zhonghong, Zhonglin, Chong and Bo — were found in a 1.5-meter-by-1.3-meter (5 foot-by-4 foot) garbage container in Bijie after a night of drizzling rain when temperatures were about 4 Celsius (40 Fahrenheit).

Two of the fathers, ironically, are garbage collectors in the boom city of Shenzhen near Hong Kong, according to a Xinhua report. One of the mothers lives in Shenzhen and another reportedly left the family. The third brother and his wife are farmers in the Bijie area, though they apparently often left the boys to fend for themselves, Xinhua said.

Former journalist and Bijie resident Li Yuanlong posted online that the children had been spotted living in a temporary shelter with plastic cloth, bricks and plywood at a nearby demolition site.

Li, who broke the story on the deaths in an online posting, told The Associated Press on Wednesday that local officials in Bijie were not pleased with the coverage and that police escorted him out of the city and told him to stay away for four or five days.

Some observers have faulted the family for not keeping closer watch over their children.

"How could grandparents take care of your child when you are away?" asked Beijing parking attendant Liang Hongjin, a migrant worker from Henan province.

However, much of the criticism has been directed at the government and educational system.

The family reported the boys missing Nov. 5. Beijing lawyer Li Fangping said the failure of local officials to launch a proper search was "horrific."

The boys died hours after Xi Jinping gave his first speech as China's new leader in Beijing's Great Hall of the People. Xi underlined the Communist Party's mission to improve the country's education, employment, social security, housing and health care.

"Our people have an ardent love for life," Xi said in the speech. "They want their children to have sound growth, have good jobs and lead a more enjoyable life."

The boys' deaths reflect a systematic failure of children services, Beijing Normal University social welfare expert Wang Zhenyao said on state-run China Central Television. The system lacks shelters, social workers and volunteers, and there is poor communication with those in need, he said.

"That's a blank in China," he said.

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Study finds mammograms lead to unneeded treatment

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Silent skies over Gaza after cease-fire

The rockets and missiles fell silent over Gaza for the first time in eight days today, but gunfire erupted in the crowded streets of the Palestinian enclave to celebrate the announcement of a ceasefire in the bloody conflict between Israel and Hamas.

The two sides fired final salvos at one another up until the final moments before the 2 p.m. ET cease-fire deadline. At least one Israeli missile landed at 1:57 p.m. ET in Gaza, and four rockets were launched toward the Israeli province of Beer Sheva at 1:59 p.m. ET.

After 2 p.m. ET, however, the sky was finally empty of munitions.

The eight days of fighting left 130 Palestinans and five Israelis dead, and badly damaged many of Gaza's buildings. A bomb that exploded on a bus in Tel Aviv earlier today left an additional 10 Israelis wounded.

FULL COVERAGE: Israel-Gaza Conflict

The fighting came to an end after a meeting between Egyptian President Mohammed Morsi and U.S. Secretary of State Hillary Clinton.

"This is a critical moment for the region," Clinton said after the meeting, standing next to Egyptian Foreign Minister Mohamed Kamel Amr to announce the deal.

"The people of this region deserve a chance to live free of fear and violence and today's agreement is a step" in that direction, Clinton said. "Now we have to focus on reaching a durable outcome."

PHOTOS: Israel, Hamas Fight Over Gaza

Clinton said that Egypt and the U.S. would help support the peace process going forward.

"Ultimately every step must move us toward a comprehensive peace for people of the region," she said.

Israeli Prime Minister Benjamin Netanyahu confirmed the cease-fire from Tel Aviv after Clinton's announcement.

"I agree that that it was a good idea to give an opportunity to the cease-fire... in order to enable Israeli citizens to return to their day to day lives," Netanyahu said.

He reiterated that it was vital to Israel's security to "prevent smuggling of arms to terrorist organizations" in the future.

An Israeli official told ABC News that the ceasefire would mean a "quiet for quiet" deal, in which both sides stop shooting and "wait and see what happens."

"Who knows if the ceasefire will even last two minutes," the official said. The official said that any possible agreement on borders and blockades on the Gaza/Israel border would come only after a period of quiet.

INFOGRAPHIC: Strike Point: Israel, Hamas, and the Unwinnable Conflict

Clinton and Morsi met for three hours in Cairo today to discuss an end to the violence. The secretary of state met with Netanyahu Tuesday night for more than two hours, saying she sought to "de-escalate the situation in Gaza."

The fighting dragged on Tuesday night and Wednesday morning despite Hamas officials declaring publicly Tuesday afternoon that they expected a cease-fire would be announced Tuesday night, after Clinton and Netanyahu's talks.

The airstrikes by the Israeli Defense Forces overnight hit government ministries, underground tunnels, a banker's empty villa and a Hamas-linked media office. At least four strikes within seconds of each other pulverized a complex of government ministries the size of a city block, rattling nearby buildings and shattering windows.

Hours later, clouds of acrid dust still hung over the area and smoke still rose from the rubble. Gaza health officials said there were no deaths or injuries.

On Wednesday morning, the IDF said they had destroyed 50 underground rocket launching sites in Gaza. They also said that Israel's "Iron Dome" missile shield intercepted two rockets from Gaza into Israel overnight as well.

Around 12 p.m. in Israel, however, a bomb exploded on a public bus near the nation's military headquarters in Tel Aviv, in one of the city's busiest areas. Israel police said the explosion was a terrorist attack, the first in Israel since 2006.

Upon landing in Cairo to meet with Morsi, Clinton released a statement condemning the attack.

"The United States strongly condemns this terrorist attack and our thoughts and prayers are with the victims and the people of Israel. As I arrive in Cairo, I am closely monitoring reports from Tel Aviv, and we will stay in close contact with Prime Minister Netanyahu's team. The United States stands ready to provide any assistance that Israel requires," she said.

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Afghan revolving door: 5 US generals, 5 years

KABUL, Afghanistan (AP) — For former CIA director David Petraeus, it was a one-year stint as top U.S. commander in Afghanistan. His replacement is scheduled to leave next year after 18 months in the job.

And now the sex scandal that draws them together — Petraeus' career toppled and Marine Gen. John Allen's possibly on hold — also has placed greater attention to the quick turnover of American battlefield chiefs in the 11-year war.

Nearly two dozen generals have commanded troops from the United States and the NATO-led International Security Assistance Force, or ISAF, since the American invasion in late 2001 — with five U.S. generals running both commands in the past five years alone.

There is no firm evidence the Pentagon's revolving door in Afghanistan has posed any significant obstacles for U.S. troops, but some military analysts suggest the frequent changes at the top create potential breaks in continuity in the critical cooperation with the Afghan political leadership and security officials.

"The learning curve is pretty steep," said retired Lt. Gen. David Barno, who commanded U.S. forces in Afghanistan in 2003 and 2004. "One of the critical coins of the realm in being effective in this kind of environment is relationships among your allies, relationships with the host nation, and with the Afghans."

Iraq also had regular command changes, including Petraeus in charge during the U.S. troop "surge" in 2007 that helped dislodge insurgent control from key areas. But the war strategy in Afghanistan has, at many times, been even more complex as fronts shift and Taliban fighters regain strength.

"Rotating top commanders on an annual basis makes no management sense," Thomas E. Ricks, a senior fellow at the Center for a New American Security, wrote in an opinion piece published recently in The New York Times.

"Imagine trying to run a corporation by swapping the senior executives every year," he continued. "Or imagine if, at the beginning of 1944, six months before D-Day, Gen. George C. Marshall, the Army chief of staff, told Gen. Dwight D. Eisenhower, the supreme allied commander, that it was time to give someone else a chance to lead."

Petraeus, a four-star general, took over the Afghan command in July 2010 to fill a void after Gen. Stanley A. McChrystal was fired because of scathing remarks about America's civilian leadership. McChrystal's predecessor, Gen. David McKiernan, was ousted on May 11, 2009, a year before his term as commander was set to end because newly elected President Barack Obama wanted a new war policy. He had succeeded Gen. Dan McNeill, who served in 2007-08.

Petraeus completed a one-year term and retired to become CIA director in September 2011.

He resigned Nov. 9 after he had an extramarital affair with his biographer. Allen, who also has four stars, is under investigation following revelations that he exchanged thousands of emails with a Florida socialite also involved in the Petraeus case, including a few which were found to be of a questionable nature.

Some analysts and former military officers say that rotating generals so quickly creates a disconnect between the commanders and their Afghan allies, including the mercurial President Hamid Karzai. Commanders also have to deal with billions of dollars in funds and the complexities of handing over security to the Afghans by the end of 2014, including building an army and police of 352,000 almost from scratch.

Gen. Mohammad Zahir Azimi, a spokesman for the Afghan Ministry of Defense, said the longer a NATO commander stays in the job, the more chance he has to really understand Afghanistan.

"For us, an Afghan army corps commander should stay in his position for at least three years," he said.

Jawed Kohistani, military analyst in Kabul, said he thinks a constant changeover of senior NATO commanders or Afghan military leaders hampers coordination of the two forces. Staying longer, he believes, allows a commander to know insurgents and their weaknesses.

"It gives an opportunity for the enemy to use this gap — the time between the leaving of one commander and the arrival of another — to their advantage," Kohistani said. "There should be enough time for a NATO commander to get to know the Afghan president, vice presidents, security ministers and assess the situation. If he doesn't have enough time to do all these things, it has a negative effect on the security situation."

Obama sped up the confirmation hearing last week for Gen. Joseph Dunford to become the 15th ISAF commander and replace Allen, who was to leave in the spring after 18 months at the helm for a new job as U.S. European Command chief and NATO supreme allied commander. But Allen's confirmation has been postponed until an investigation into his role is concluded.

There have also been about a half-dozen U.S. generals who only commanded American combat troops in the first years of the conflict.

By comparison, the command tours of generals in Iraq "averaged almost twice as long as ISAF's," said Stephen Biddle, a professor of political science and international affairs at George Washington University.

Given the huge funds involved in the war effort, running the Afghan campaign has been as complicated as managing a multibillion dollar corporation.

Anthony Cordesman, a national security expert at the Center for Strategic and International Studies, said the lack of continuity includes both the military and civilian presence in Afghanistan, including the State Department and other agencies.

"What the Afghans see is constant change at every level," he said. "They constantly see people come and go. They have no reason to establish lasting relationships. People leave at the point where they're becoming most effective."

He added that "this constant rotation is a problem everybody recognizes, but no one has really been willing to address."

The Pentagon also has a number of senior leaders — ranging from the chairman of the joint chiefs of staff and defense secretary to the commander of U.S. Central Command — who also play key roles in the war strategy and provide some continuity.

"There is no doubt that the frequent changeover is tough. There is a learning curve each time a new man takes the helm,"

"The good aspect to this is that it brings a fresh set of eyes," said Michael O'Hanlon, a fellow at the Brookings Institution in Washington. "It's not realistic to have commanders serve a whole lot longer than, say, Gen. Allen ... as these folks get tired."

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Baldor reported from Washington. Associated Press writers Rahim Faiez and Deb Riechmann in Kabul contributed to this report.

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Clinton’s high-profile swan song

Secretary of State Hillary Rodham Clinton at a meeting with President Barack Obama, second from left, and Japan's …Secretary of State Hillary Rodham Clinton was supposed to be heading for the exit, even as the fight over who should succeed her escalated. Instead, America's top diplomat sped Tuesday to the Middle East on an urgent mission to douse flaring violence between Israel and Hamas, the Islamist Palestinian group that controls Gaza.

Amid early, disputed reports of a possible truce, Clinton had several major goals: Ease the violence, bolster Egyptian President Mohammed Morsi, and avoid an appearance of giving Hamas any sort of legitimacy on the world stage. The U.S. regards Hamas as a terrorist group and deals only with the Palestinian Authority of President Mahmoud Abbas, which controls the West Bank but has been relegated to the sidelines of the latest deadly clashes.

As Clinton winged her way to the troubled region, President Barack Obama—en route to Washington from a trip to Asia—spoke by telephone to Morsi from Air Force One, their third such conversation in 24 hours.

Obama "commended President Morsi's efforts to pursue a de-escalation," Deputy National Security Adviser Ben Rhodes told reporters aboard the presidential plane. "And he also underscored that President Morsi's efforts reinforce the important role that President Morsi and Egypt play on behalf of regional security and the pursuit of broader peace between the Palestinians and Israelis."

Morsi, whose country shares a peace accord with Israel and a border with Gaza, is thought to have sway with Hamas.

Clinton was to stop in Jerusalem for talks with Israeli Prime Minister Benjamin Netanyahu, in Ramallah to meet with Abbas and in Cairo for discussions with Morsi. State Department spokeswoman Victoria Nuland said Clinton aimed for a "de-escalation of violence and a durable outcome that ends the rocket attacks on Israeli cities and towns and restores a broader calm."

American officials have been leery of using the term "cease-fire," preferring variations on "de-escalation" of the conflict.

Clinton's visit came as the political battle over the Sept. 11 terrorist attack on the American compound in Benghazi, Libya, clouded the debate over who will succeed her.

Republicans have accused the Obama administration of covering up the role of suspected extremists in the assault, and questioned whether Clinton's State Department correctly handled requests for more security at the site. The president's foes have targeted Susan Rice, the U.S. ambassador to the United Nations, who at the request of the White House in several television interviews incorrectly tied the attack to protests sparked by an Internet video that ridiculed Islam.

The Benghazi strike claimed the lives of Ambassador Chris Stevens and three other Americans. It has also highlighted the uncertain fate of so-called Arab spring countries—like Egypt—where popular movements swept aside decades-old authoritarian regimes.

Ahead of Clinton's visit, the White House renewed its support for Israel's military operations but hinted at disapproval of a possible ground offensive. Netanyahu's government has called up thousands of troops in what could be preparations for such an onslaught.

Rhodes told reporters the U.S. would prefer to see the Israelis work "diplomatically and peacefully" to resolve the crisis, noting both Palestinian and Israeli civilians would be at risk in the event of a ground assault.

Clinton's stop in Ramallah underscored a diplomatic peculiarity of her trip: Top U.S. officials regard the Palestinian Authority as such minor players in the current crisis, neither Obama nor Clinton have spoken to Abbas since the violence escalated nearly a week ago.

While Clinton by Monday had reached out to leaders—including Jordan's King Abdullah; the foreign ministers of Israel, Egypt, France and Turkey; Egypt's prime minister; and U.N. Secretary-General Ban Ki-moon—she had not spoken to Abbas.

By refusing to deal directly with Hamas and reaching out to the Palestinian Authority instead, Clinton appeared to be trying to resolve the conflict without involving one of the key participants.

Rhodes on Tuesday reiterated U.S. conditions for dealing directly with Hamas: The group must renounce terrorism and recognize Israel's right to exist.

He also defended Clinton's trip to Ramallah, calling it a worthwhile investment "both as it relates to what's happening in Gaza and our efforts going forward to improve the situation in Gaza, but also in terms of our broader efforts to pursue peace between the Israelis and Palestinians."

Rhodes's message was implicit but unmistakable:  If the Palestinians want a lasting peace deal, they should align with the Palestinian Authority and not with Hamas or other extremist groups.

The U.S. has for years been steadfast in its posture toward Hamas. Massachusetts Sen. John Kerry, a top contender for Clinton's job, did not talk to Hamas when he made a surprise visit to Gaza in January 2009.

Clinton headed to the Middle East after traveling to Asia with Obama on what aides to both expected would be their final joint trip overseas, including a history-making stop in Myanmar.

Aboard Air Force One on a flight between Rangoon and Cambodia, the one-time political rivals sat in Obama's private office sharing memories of their work together.

"As the president said, it wasn't just the last four years; they have been through a lot together over the last five or six years," Rhodes said. "But right now there is urgent business to be done."

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Aussie fake-bomb plotter sentenced to 13½ years

SYDNEY (AP) — An Australian investment banker who admitted chaining a fake bomb to a Sydney teenager as part of a bizarre extortion plot was sentenced to 13 years and six months jail Tuesday.

Madeleine Pulver, then 18, was studying at home alone in her family's mansion in August 2011 when Paul Douglas Peters walked in wearing a rainbow-striped ski mask and carrying a baseball bat. He tethered a bomb-like device to her neck along with a ransom note and then slipped away, leaving the panicked teen alone. It took a bomb squad 10 hours to remove the device, which contained no explosives.

At the sentencing, Judge Peter Zahra said Peters intended to put the fear into the young victim that she would be killed.

"The terror instilled can only be described as unimaginable," the judge said.

Pulver hugged relatives after the sentence was read. Her father, Bill Pulver, wiped away tears.

The judge gave Peters less than the maximum sentence of 20 years, acknowledging he'd pleaded guilty and was likely depressed at the time.

After attaching the device to the teen, Peters, 52, fled to the U.S., but police used an email address he left on the ransom note to track him down. Authorities arrested him two weeks later at his ex-wife's home in Louisville, Kentucky, and extradited him to Australia. He pleaded guilty in March to aggravated break and enter and committing a serious indictable offense.

Defense attorneys had argued that Peters was depressed, drinking heavily and exhibiting wild mood swings before committing the crime. He had recently split from his wife, was separated from his children and had become obsessed with a book he was writing about a villain out for revenge, his lawyer Tim Game said during earlier sentencing hearings. A psychiatrist for the defense testified that Peters may have tried to become the evil protagonist in his book. Peters said he had no memory of the crime.

But prosecutors said there was a much simpler explanation for Peters' bizarre actions: money.

Prosecutor Margaret Cunneen said during an earlier hearing that Pulver was never the intended target of Peters' crime. The investment banker was having financial problems and originally traveled to Mosman — the wealthy Sydney suburb where the Pulvers live — to hunt down the beneficiary of a multimillion-dollar trust fund he had learned about, she said. When he arrived in Mosman, he bumped into a neighbor of the Pulvers whom he had met while doing business in Hong Kong. That man then became Peters' new target, Cunneen said.

But on the day of the attack, Peters walked into the wrong house. Madeleine Pulver was, in the end, just the unwitting victim of Peters' incompetence, the prosecutor said.

Embarrassed by his bungled extortion bid, Peters concocted a story about being delusional and not remembering the crime to save face, Cunneen said.

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New push for most in US to get at least 1 HIV test

WASHINGTON (AP) — There's a new push to make testing for the AIDS virus as common as cholesterol checks.

Americans ages 15 to 64 should get an HIV test at least once — not just people considered at high risk for the virus, an independent panel that sets screening guidelines proposed Monday.

The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a check-up, something a doctor can order with as little fuss as a cholesterol test or a mammogram. Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening.

Yet not nearly enough people have heeded that call: Of the more than 1.1 million Americans living with HIV, nearly 1 in 5 — almost 240,000 people — don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.

The updated guidelines will bring this long-simmering issue before doctors and their patients again — emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.

"It allows you to say, 'This is a recommended test that we believe everybody should have. We're not singling you out in any way,'" said task force member Dr. Douglas Owens, of Stanford University and the Veterans Affairs Palo Alto Health Care System.

And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV — which includes gay and bisexual men and injecting drug users — were eligible for that no-copay screening.

There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.

Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.

Monday's proposal also recommends:

—Testing people older and younger than 15-64 if they are at increased risk of HIV infection,

—People at very high risk for HIV infection should be tested at least annually.

—It's not clear how often to retest people at somewhat increased risk, but perhaps every three to five years.

—Women should be tested during each pregnancy, something the task force has long recommended.

The draft guidelines are open for public comment through Dec. 17.

Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.

"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.

The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.

"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said — the reason making it routine during any health care encounter could help.

But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 percent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 percent of ER patients known to be at increased risk were tested while there.

Mermin calls that "a tragedy. It's a missed opportunity."

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Online:

Task force recommendation: http://www.uspreventiveservicestaskforce.org

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