4B
Wednesday, June 26, 1996
NATION/WORLD
UNIVERSITY DAILY KANSAN
Cancer test avoided by potential victims
The Associated Press
CHICAGO — When Mary Jo was diag nosed with breast cancer, the 47-year-old mother of three was hardly surprised. After all, breast cancer had killed her mother and struck her sister.
But seven years later, Mary Jo, who asked that her last name not be used, has decided against being tested for a gene mutation that can trigger breast and ovarian cancer — even though the outcome could radically affect how her teen-age daughters see their future.
She is not alone in her decision. A new study found that fewer than half of the people with a family history of breast or ovarian cancer wanted to know whether they carried the mutated gene, called BRCA1.
"For some, knowledge is power. For some, knowledge is anxiety," Mary Joa said. She also worries that if she tested positive for the mutated gene, she and her family would be the targets of genetic discrimination.
That was a major worry of those who participated in the study, published June 19 in The Journal of the American Medical Association.
Researchers contacted 279 men and women from families who had been identified in previous studies as carrying the flawed BRCA1 gene. Of those people, 43 percent requested the results of their genetic tests. The participants had the option of receiving counseling before and after the tests.
A BRCA1 mutation is thought to be responsible for about half of all inherited
cases of ovarian and breast cancer.
Besides the possibility of discrimination in employment and insurance, one reason people might not want their test results is their fear of bad news, said Caryn Lerman, lead author of the study and director of bio-behavioral research at Georgetown University's Lombardi Cancer Center.
The benefits of testing include the relief that comes with a negative result, Lerman said. And even those who test positive can benefit from more aggressive cancer screening, she said.
About 5 percent to 10 percent of all breast or ovarian cancer cases are thought to come from inheriting a faulty gene.
Women with the mutated BRCA1 gene have an 80 percent to 90 percent chance of developing breast cancer in their lifetime, while the gene translates to a 40 percent to
65 percent risk of ovarian cancer, Lerman said.
Men were included in the study because they can pass the cancer susceptibility on to their daughters. There is also evidence male mutation carriers may run a higher risk of prostate and colon cancer, Lerman said.
Melody Cobleigh, director of the Comprehensive Breast Center of the Rush Cancer Institute in Chicago, praised the study, especially because it measured participants' emotional health.
After learning their results, non-carriers of BRCA1 mutations showed a significant drop in symptoms of depression compared with carriers and those who chose not to get their results. And BRCA1 carriers showed no increase in depression or ability to function after learning their
results.
"It looks like worrying whether you have the mutated gene leads to the same amount of depression as actually having it." Cobleigh said.
A drawback of the study was that all participants were white, all were from families with strong histories of cancer, 90 percent had completed high school, and 93 percent had health insurance, Cobleigh said.
"It tells us about the possible impact of this test on a rather affluent group of people," she said. "We don't have a clue as to how it might affect other ethnic groups."
In an accompanying editorial, Judy E. Garber and Deborah Schrag from the Dana-Farber Cancer Institute in Boston called for steps to be taken to assure BRCA1 testing is not misused.
Netanyahu ready for peace talks
Prime minister refuses to swap land for peace
The Associated Press
JERUSALEM — Israeli Prime Minister Benjamin Netanyahu says he is ready to resume peace talks with Palestinians and other Arabs but cannot be forced to swap land for diplomatic recognition.
Netanyahu said yesterday that negotiations should be held without prior conditions, but he also stressed that the terms for talks should force no side to change its position.
Netanyahu took the tough line after a meeting with Secretary of State Warren Christopher.
Christopher endorsed the prime minister's statement that negotiations should be unconditional, as well as Netanyahu's admonition that there could be no real peace with terrorism.
It was the first high-level meeting between Netanyahu's conservative government and the Clinton administration and was designed to set up the prime minister's July 9 meeting with President Clinton at the White House.
But clear disagreement arose about the cornerstone of U.S. Middle East policy: trading Israeli land to the Arabs for peace.
Netanyahu said Israel and the Arabs would be free to put any position on the bargaining table. But he gave no indication that he has lessened his resolve to hold on to the Golan Heights, a strategic border plateau that Syria demands to make peace with Israel.
This conflicts directly with the U.S. administration's view, although Christopher did not repeat the land-for-peace maxim in his joint news conference
with Netanvahu.
Afterward, U.S. spokesman Nicholas Burns said, "You can rest assured that is still our position. He did not come here to shy away from our positions."
The prime minister also reiterated his skepticism that Yasser Arafat's Palestinian Authority had kept its promise to deter terrorist attacks on Israelis.
But Netanyahu said, "We intend to resume negotiations with the Palestinian Authority."
The secretary of state will take that message directly to the Palestinian leader today. Christopher flies to Cairo to meet separately with Egyptian President Hosni Mubarak, then with Arafat.
Before yesterday's meeting, Christopher had said that he would ask Netanyahu to resume talks with the Palestinians and to implement last September's commitment by the late Prime Minister Yitzhak Rabin to limit Israeli troops in the volatile West Bank town of Hebron.
At the news conference, Netanyahu said Hebron posed complicated religious, security and historic questions that needed further study.
On another touchy issue, the prime minister reaffirmed his campaign position that there is a right of the Jewish people to settle Israel.
Netanyahu dismissed calls for dismantling settlements on the West Bank, in Gaza, and on the Golan Heights. Arab leaders at the summit conference in Cairo last weekend, insisted Jews quit East Jerusalem also. Israel took all those lands from the Arabs in the Six-Day War of 1967.
In Cairo, Egypt's foreign minister was not pleased with Netanyahu's performance. "Talk about resuming negotiations with no prior conditions points to Israel's ... skipping over the land-for-peace principle, which is basic," Moussa said.
He said it would be a key topic in today's Mubarak-Christopher talks.
AMA rejects doctor-assisted suicide
Association upholds policy of doctors' ethics to heal
The Associated Press
CHICAGO — A month after Dr. Jack Kevician's third courtroom victory, the American Medical Association yesterday affirmed its long-held stand against doctor-assisted suicide.
The 430 members of the AMA's policy-making House of Delegates supported their board of trustees in the belief that a doctor's responsibility is to heal, to relieve pain and to comfort, not to help people die.
"We here to treat patients, not to do away with them," Dennis Brown, a family practitioner from Schaumburg, Ill., said during the 10-minute debate.
It was the fourth time in two years the AMA rejected suggestions it change its policy on the matter, and the decision came in a virtually unanimous voice vote. The topic was debated more fully at a hearing Sunday.
The policy is not legally binding, but it guides the 296,000-member AMA in directing its considerable lobbying power and financial
resources toward influencing lawmakers, physicians and public opinion. Thirty-four states explicitly make it a crime to assist in a suicide, according to the AMA.
Nancy W. Dickey, a family doctor who chairs the board of trustees, said the vote reflects "a deeply felt ethical principle." The trustees cited explicit AMA policies dating to 1991 and a tradition extending back more than 2,000 years to the Hippocratic Oath.
The AMA reviewed the policy in light of two recent federal appeals court decisions favoring assisted suicide and an apparent increase in public support for the practice. They also were motivated by the continued failure of prosecutors to convict Kevorkian, who has assisted in 31 suicides since 1990. Kevorkian was acquitted in a total of five deaths in three trials.
Ulrich F. Danckers, a retired radiologist from River Forest, Ill., was the only physician to advocate any change in policy during Tuesday's debate. He wanted the AMA to declare itself neutral.
Dankers contended many physicians support assisted suicide but are afraid to say so publicly.
"It is intellectually dishonest for us to collectively get on our high moral horse by declaring
"We're here to treat patients,not to do away with them."
Dennis Brown family practioner
the practice unethical, and then look the other way when our members in ever larger numbers quietly endorse the practice at the bedside," Danckers said.
But Jo-Ellyn M. Ryall, a psychiatrist from St Louis, told the delegates, "There are many, many ways to commit suicide, and you do not need a physician to do this."
"My patients who talk to me about suicide want help and do not want to be killed," Ryall said. "So I recommend that if anyone comes to you, even if they're terminal and they're in pain and they're requesting suicide, that you evaluate them for the depression and anxiety that they probably have, and treat those illnesses."
Survivor relives massacre at site of mass grave
Muslims remember Serbian bus attack
Associated Press
SOKOLINA, Bosnia-Herzegovina — He was one of eight to survive.
Emir Mujik returned four years later to the same meadow where he and dozens of other Muslim men were herded into a rust-red bus by Serbs, who then methodically blew the bus apart with anti-tank rockets.
dead.
All that remains of the bus is a charred shell, a grisly memorial to the dead of Sokolina. Every window is missing, and rusting bullet holes riddle the metal sides.
Mujik, as a principal witness, guided diggers and forensic experts to the site Monday, when 47 bodies were exhumed from the June 14, 1992, massacre for autopsies and reburial by family members.
The exhumation was a sad homecoming for Mujkic, who last visited this field the day after the slaughter, leading residents of a nearby Muslim village there to bury the
As relatives of the victims wailed in the background, Mujkic relived an ordeal he said started when Serbs overran nearby Ahatovici, six miles north of Sarajevo, in May 1992.
After being held for weeks, he and 54 other Muslim men were loaded onto the bus and told they were on their way to a prisoner exchange.
Instead, he said the Serbs purposely destroyed the bus in a barrage, which included anti-tank rockets, near Sokolina, just southeast of Ahatovici.
"There were 55 of us lying down side by side, like sardines," Mujik said. "Then from all sides, shells, small-arms fire and hand grenades began to be fired at us."
Bullets and shrapnel pierced Mujik's hands, but the bodies of his friends and neighbors protected the rest of his body. He survived, buried under piles of bleeding flesh and body parts, he said.
The Serbs left without checking for survivors. Mujkic and seven others waited for nightfall to escape through woods to the
"There were 55 of us lying down side by side, like sardines."
Emir Mujkic mass grave survivor
nearby Muslim village of Vukasovici, whose residents buried the dead the next day.
Boston-based forensic scientist William Haglund was present at Monday's exhumation, representing the U.N. war crimes tribunal in The Hague, Netherlands.
Since the U.S.-brokered Dayton peace agreement took effect in December, human rights organizations and local authorities have uncovered a number of mass graves throughout Bosnia.
Although Bosnian Serbs began and conducted most of the ethnic cleansing, the practice of purging
ethnic groups through harassment and killing also was adopted by Bosnian Croats and Muslims.
Bosnian Serbs captured Ahatovici at the outset of the three-and-a-half-year war in May, as they took control of the hills surrounding the Bosnian capital. The village's prewar population of 2,200 was 49 percent Muslim.
A number of villagers were killed immediately. Those who failed to escape were captured and taken to makeshift concentration camps.
Bosnian Serbs relinquished control of the area around Ahatovici in March, but it took the Bosnian government until now to organize diggers, witnesses and forensic workers.
Halida Mesanovic, a 51-year-old Muslim woman, survived the Serb occupation but lost her twin sons. One was killed the day the Serbs overran Ahatovici, and the other died on the bus.
"I have been suffering for four years," Mesanovic told Associated Press Television at a commemoration marking the fourth anniversary of the massacre. "I wish many mass graves on whoever invented this."
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