Longer waits for breast cancer patients on Medicare

NEW YORK (Reuters Health) – Women with a new diagnosis of breast cancer who are covered by Medicare are waiting longer and longer to get treatment, according to a new nationwide study.

Researchers found that between 1992 and 2005, the average waiting time between being diagnosed and having surgery rose from 21 days to 32 days. The delay was especially long for black and Hispanic women, and for those living in large cities.

Still, the study team noted, it’s unclear how big a difference the extra week or two would make in women’s long-term health.

“I don’t believe the delays we’re seeing here are problematic, (but) we’re clearly going to need to keep any eye on it because if those delays keep increasing, they may become problematic,” said the study’s lead author, Dr. Richard Bleicher.

Bleicher, from Fox Chase Cancer Center in Philadelphia, and his colleagues analyzed cancer registry data and Medicare claims for 72,586 older adults diagnosed with breast cancer between 1992 and 2005, 99 percent of whom were women.

Over that period, both the time between a patient’s first breast cancer-related visit and her first biopsy increased, as did the time between biopsies and surgery, according to findings published this week in the Journal of Clinical Oncology.

When the researchers accounted for patient characteristics such as tumor stage, as well as number and type of pre-surgery visits and screenings, the relative delay shrank from 11 days to five days.

Whether the extra waiting in more recent years is “clinically meaningful” remains to be seen, according to Bleicher‘s team.

Another report published in the same journal found that for women with advanced cancer, waiting 60 days or more for treatment was tied to a greater likelihood of dying in the five years after diagnosis.

Shorter delays, however, weren’t associated with worse outcomes.

Among 1,786 North Carolina women on Medicaid, the average time between diagnosis and treatment – usually surgery – was 22 days between 2000 and 2002, Dr. Electra Paskett from The Ohio State University in Columbus and her team found.

The length of that interval didn’t seem to affect a woman’s chance of surviving early-stage breast cancer. But for those with late-stage cancer, women who waited 60 days or more between diagnosis and treatment were 66 percent more likely to die of any cause over the next five years and 85 percent more likely to die of breast cancer, in particular.

In Paskett’s study, one in 10 women waited at least 60 days for treatment.

She pointed out that people on Medicaid, like those in her study, may have more problems getting timely treatment compared to people with private insurance.

“It could be that they had problems finding a doctor who would accept them, because they’re low income, or (there were) scheduling problems with the clinic,” Paskett told Reuters Health.

She recommended health systems look into having “patient navigators” to guide low-income people and others who may need help through the treatment process.

Bleicher said doctors and health systems can start using the new data to figure out how to consolidate the biopsies, second opinions and other visits that often happen between diagnosis and treatment.

But for now, he told Reuters Health that women with breast cancer shouldn’t panic if it takes them a few weeks to coordinate their surgery.

“Getting to the operating room for treatment is not something that’s an emergency, even though it feels like one,” Bleicher said.

Up to 60 days, Paskett said, should be “plenty of time to get second opinions, plenty of time to get consults and things like that.”

SOURCE: http://bit.ly/10tpzc9 and http://bit.ly/10tpIMu Journal of Clinical Oncology, online November 19, 2012.

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Deere has downbeat 2013 outlook, and shares fall

MINNEAPOLIS (AP) — Tractor maker Deere & Co. is taking a cautious view of 2013, as drought and economic uncertainty hold back spending in some of the world’s biggest farm economies.

Also, its most recent quarterly profit missed analysts’ expectations. Deere shares fell $ 3.16, or 3.7 percent, to close at $ 82.83 Wednesday.

Deere is the world’s largest maker of agricultural equipment, like the bright green tractors and combines that prowl farm fields during planting and harvest seasons. Its fortunes rise and fall with those of farmers.

In recent years, that’s been a booming business as strong crop prices have put money in farmers’ pockets. But there were signs of a slowdown in farm spending in Deere’s outlook for the fiscal year that began this month.

And with the so-called “fiscal cliff” of potential tax increases and spending cuts looming in the U.S., Deere is cautious about big spending projects.

Deere expects agriculture sales in the U.S. and Canada to be flat for the year, as farmers continue to recover from a major drought in 2012. It predicted farmers will have $ 402.5 billion in cash receipts for 2013 — down by $ 2.5 billion from Deere’s August prediction — but still higher than in 2012 or 2011.

It also predicted that European sales would be flat to down 5 percent, and little changed in Asia. It expects 10 percent growth in South America. Overall Deere predicted that worldwide equipment sales will rise 5 percent for the year.

Labor expenses are rising, too. Deere hired 5,000 more people this year to support its growth. And it will have spent $ 480 million shoring up its pension plans in fiscal 2012 — $ 5 million more than it had expected — and will spend some $ 550 million in the current fiscal year.

Still, it predicted a fiscal 2013 profit of $ 3.2 billion, slightly above the expectations of analysts polled by FactSet. It said prices for its equipment will rise 3 percent for the year, on top of a 4 percent gain in the fourth quarter.

In the quarter that ended Oct. 31, Deere’s net income rose 2.7 percent to $ 687.6 million, or $ 1.75 per share. Revenue rose 14 percent to $ 9.79 billion. Analysts surveyed by FactSet expected earnings of $ 1.88 per share. A year ago Deere’s net income was $ 669.6 million, or $ 1.62 per share.

Equipment sales rose to $ 9.05 billion, topping analysts’ forecasts of $ 8.93 billion. Sales were strong in the U.S. and Canada, rising 26 percent for the quarter. Elsewhere, sales fell 2 percent. Sales of agriculture and turf equipment rose 16 percent, while construction and forestry equipment sales rose 7 percent.

In addition to farm equipment, Deere makes construction and forestry equipment such as backhoes, excavators, riding mowers and leaf blowers, making the company sensitive to movements in the global economy.

Deere is holding off on big spending projects as much as possible until January because of economic uncertainty, said Chief Financial Officer Rajesh Kalathur on a conference call.

“As the economics now become clearer, we may modify our plans. We will pull levers and cut down on investments if the scenario worsens, and we may accelerate our plans” if economies turn more positive, he said.

For the full fiscal year, Deere earned $ 3.07 billion, or $ 7.63 per share, up from $ 2.8 billion, or $ 6.63 per share, during the prior year. Revenue rose 13 percent to $ 36.16 billion for the year.

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AP Exclusive: Syrian rebels seize base, arms trove

BASE OF THE 46TH REGIMENT, Syria (AP) — After a nearly two-month siege, Syrian rebels overwhelmed a large military base in the north of the country and made off with tanks, armored vehicles and truckloads of munitions that rebel leaders say will give them a boost in the fight against President Bashar Assad‘s army.

The rebel capture of the base of the Syrian army’s 46th Regiment is a sharp blow to the government’s efforts to roll back rebels gains and shows a rising level of organization among opposition forces.

More important than the base’s fall, however, are the weapons the rebels found inside.

At a rebel base where the much of the haul was taken after the weekend victory, rebel fighters unloaded half a dozen large trucks piled high with green boxes full of mortars, artillery shells, rockets and rifles taken from the base. Parked nearby were five tanks, two armored vehicles, two rocket launchers and two heavy-caliber artillery cannons.

Around 20 Syrian soldiers captured in the battle were put to work carrying munitions boxes, barefoot and stripped to the waist. Rebels refused to let reporters talk to them or see where they were being held.

“There has never been a battle before with this much booty,” said Gen. Ahmad al-Faj of the rebels Joint Command, a grouping of rebel brigades that was involved in the siege. Speaking on Monday at the rebel base, set up in a former customs office at Syria’s Bab al-Hawa border crossing with Turkey, he said the haul would be distributed among the brigades.

For months, Syria’s rebels have gradually been destroying government checkpoints and taking over towns in the northern provinces of Idlib and Aleppo along the Turkish border.

Rebel fighters say that weapons seized in such battles have been essential to their transformation from ragtag brigades into forces capable of challenging Assad’s professional army. Cross-border arms smuggling from Turkey and Iraq has also played a role, although the most common complaint among rebel fighters is that they lack ammunition and heavy weapons, munitions and anti-aircraft weapons to fight Assad’s air force.

It is unclear how many government bases the rebels have overrun during the 20-month conflict, mostly because they rarely try to hold captured facilities. Staying in the captured bases would make them sitting ducks for regime airstrikes.

“Their strategy is to hit and run,” said Elias Hanna, a retired Lebanese army general and Beirut-based strategic analyst. “They’re trying to hurt the regime where it hurts by bisecting and compartmentalizing Syria in order to dilute the regime’s power.”

The 46th Regiment was a major pillar of the government’s force near the northern city of Aleppo, Syria’s economic hub, and its fall cuts a major supply line to the regime’s army, Hanna said. Government forces have been battling rebels for months over control of Aleppo.

“It’s a tactical turning point that may lead to a strategic shift,” he said.

At the 46th Regiment’s base, about 25 kilometers (15 miles) west of Aleppo, the main three-story command building showed signs of the battle — its walls punctured apparently from rebel rocket attacks. The smaller barracks buildings scattered around the compound, about 2.6 square kilometers (1 square mile) in size, had been looted, with mattresses overturned. A number of buildings had been torched.

Reporters from The Associated Press who visited the base late Monday saw no trace of the government troops who had been defending it — other than the dead bodies of seven soldiers.

Two of them, in camouflage uniforms, lay outside the command building. One of them was missing his head, apparently blown off in an explosion.

The rest were in a nearby clinic. Four dead soldiers were on stretchers set on the floor, one with a large gash in his arm, another with what appeared to be a large shrapnel hole in the back of his head. The last lay on a gurney in another room, his arms and legs bandaged, a bullet hole in his cheek and a splatter of blood on the wall and ceiling behind him as if he had been shot where he lay.

It could not be determined how or when the soldiers had been killed.

The final assault that took the base came after more than 50 days of siege that left the soldiers inside demoralized, according to fighters who took part.

Working together and communicating by radio, a number of different rebels groups divided up the area surrounding the base and each cut the regime’s supply lines, said Abdullah Qadi, a rebel field commander. Over the course of the siege, dozens of soldiers defected, some telling the rebels that those inside were short of food, Qadi said.

The rebels decided to attack Saturday afternoon when they felt the soldiers inside were weak and the rebels had enough ammunition to finish the battle, Qadi said. The battle was over by nightfall on Sunday. Seven rebel fighters were killed in the battle, said al-Faj of the rebels’ Joint Command. Other rebel leaders gave similar numbers.

It remains unclear how many soldiers remained in the base when the rebels launched their attack and what happened to them.

Al-Faj said all soldiers inside were either killed or captured. He said he didn’t know how many were killed, but that the rebels had taken about 50 prisoners, all of whom would be tried in a rebel court. Aside from the 20 prisoners seen at the rebel’s Bab al-Hawa base, the AP was unable to see any other captured soldiers.

The Syrian government does not respond to requests for comment on military affairs and said nothing about the base’s capture. It says the rebels are terrorists backed by foreign powers that seek to destroy the country.

Disorganization has plagued the Syrian opposition since the start of the anti-Assad uprising in March 2011, with exile groups pleading for international help even when they have no control over those fighting inside of Syria.

A newly formed Syrian opposition coalition received a boost Tuesday, when Britain officially recognized it as the sole representative of the Syrian people.

The National Coalition of the Syrian Revolutionary and Opposition Forces was formed in the Gulf nation of Qatar on Oct. 11 under pressure from the United States for a stronger, more united opposition body to serve as a counterweight to more extremist forces.

British Foreign Secretary William Hague said Tuesday the body’s members gave assurances to be a “moderate political force committed to democracy” and that the West must “support them and deny space to extremist groups.”

The United States and the European Union have both spoken well of the body but stopped short of offering it full recognition.

Key to the body’s success will be its ability to build ties with the disparate rebel groups fighting inside Syria. Many rebel leaders say they don’t recognize the new body, and a group of extremist Islamist factions on Monday rejected it, announcing that they had formed an “Islamic state” in Aleppo.

Anti-regime activists say nearly 40,000 people have been killed since Syria’s crisis started 20 months ago.

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Associated Press write Elizabeth Kennedy contributed reporting from Beirut, Lebanon.

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News Summary: India outrage over Facebook arrests

WHAT HAPPENED: As India‘s financial capital shut down for the weekend funeral of a powerful politician linked to waves of mob violence, a woman posted on Facebook that the closures in Mumbai were “due to fear, not due to respect.” A friend of hers hit the “like” button. For that, both women were arrested.

THE RATIONALE: The arrests were seen as a move by police to prevent any outbreak of violence by supporters of Bal Thackeray, a powerful Hindu fundamentalist politician who died Saturday.

THE REACTION: But analysts and the media are slamming the Maharashtra state government for what they said was a flagrant misuse of the law and an attempt to curb freedom of expression.

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Camembert to clocks: Dali’s genius on show in Paris

PARIS (Reuters) – The broadest-ever retrospective of Salvador Dali, opening in Paris this week, seeks to move beyond the shameless self-promotion that the 20th century Surrealist was often derided for and stress his indelible influence on artists today.

Once dubbed “Avida Dollars” for his love of money, Dali is regarded by some as little more than a marketing product, his Spanish home an obligatory tourist stop, his trademark melting watches the inspiration for money-spinning souvenirs.

But a new show at the Pompidou Centre lays bare the extent of his creative genius, exploring how his experiments with painting, cinema, advertising and installations influenced movements from Pop Art to today’s performance art.

The show, which runs from November 21 to March 25, is set to be a blockbuster of the Parisian art calendar. The last Dali retrospective at the Pompidou in 1979 remains the most visited exhibition in the museum’s history.

“There’s this vision we have of there being a good Dali, the Surrealist, and then the one who came after, who made money,” said exhibition curator Jean-Michel Bouhours.

“We needed to go beyond this distinction between the good and the bad and show how the experimental Dali was extraordinarily important in the history of art and the artistic models that developed in the 60s and 70s.”

The exhibition features some 200 works by the Spanish master, including the famous 1931 “The Persistence of Memory” with melting pocket watches, which Dali said was inspired by watching camembert cheese liquefying in the sun.

Also on show are dozens of works on paper, projects for stage and screen, photographs and films such as the 1929 “Un Chien Andalou“, written with Spanish director Luis Bunuel.

His designs for ballet, decorative arts and even a pavilion for the 1939 New York World Fair earned him the derision of fellow Surrealists such as Andre Breton.

But Dali saw mass media as a more efficient way than painting of getting across his “paranoid critique” of the world.

His 1935 installation, “Mae West’s Face Which May be Used As An Apartment” with its lip-shaped sofa showed an obsession with celebrity that would later influence the Pop Art of Andy Warhol.

Born Salvador Domingo Felipe Jacinto Dali in 1904 in the Catalan town of Figueres, Spain, Dali remains a controversial artist, loved for his creative genius but dismissed by some as a madman and hated for his at times grotesque artistic vision.

Although an anarchist in his youth and deeply attached to his native Catalonia, he was criticized for later declaring himself a monarchist, turning to religion and moving closer to the post-war authoritarian regime of Francisco Franco.

His love of show business and manic declarations such as “Surrealism is me”, alienated many. But he is cited as an influence for many artists such as Damien Hirst and Jeff Koons.

Dali died of heart failure in Figueres in 1989, seven years after the death of his wife and muse Gala.

(Reporting By Vicky Buffery, editing by Paul Casciato)

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FDA approves first-of-a-kind seasonal flu vaccine

WASHINGTON (AP) — The Food and Drug Administration says it has approved the first seasonal flu vaccine made using animal cell technology, rather than the half-century egg method.

The FDA approved Novartis‘ Flucelvax to prevent influenza in people 18 years and older.

The new method has been promoted by U.S. health officials because it is faster than egg-based production and could speed up manufacturing in the event of a pandemic.

In the older method, virus samples are injected into specialized chicken eggs and incubated. The egg fluids are later harvested, concentrated and purified into the vaccine.

With cell technology, small amounts of virus are put in fermenting tanks with nutrients and cells derived from mammals. The virus is then inactivated, purified and put into vaccine vials.

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Payday loan firms warned by OFT

20 November 2012 Last updated at 06:43 ET

David Fisher, Office of Fair Trading: “The industry as a whole certainly needs to raise its game”

The payday loan industry has been warned to improve the way it lends money and collects debts, or face fines or closures.

The Office of Fair Trading (OFT), in an interim report, says most of the 50 big firms it has been inspecting do not operate fully by its rules.

The OFT says it is worried by reckless lending and aggressive debt collection.

It has now begun formal investigations into several payday lenders over aggressive debt collection practices.

The OFT will publish its full report in the new year, when it has ended an investigation which it started in February 2012.

But David Fisher, the OFT’s director of consumer credit, said all 240 payday lenders have been put on notice to improve.

“What we are discovering is that right across the sector problems exist and the industry as a whole certainly needs to raise its game,” he told BBC News.

He added that recent estimates suggested that the industry was now lending £1.8bn a year, double the amount of a couple of years ago.

Updated rules

The OFT is worried about the “poor practices” which its enquiries have been uncovering, and which chime closely with many of the criticisms that consumer groups have been making of payday lenders.

Among the OFT’s concerns are that:

• lenders do not check properly if their borrowers can afford to repay the money they have borrowed


• too many loans are not repaid on time


• the loans are then extended too often


• lenders are too aggressive when borrowers fail to repay promptly

The regulator has become especially worried about the way payday loan firms use a type of repayment agreement called a continuous payment authority (CPA), using a credit or debit card to ensure they are repaid automatically.

The OFT has updated its rules for the industry to make it clear that if borrowers sign up for a CPA, it must be with their explicit agreement.

Borrowers must be told how a CPA works and how they can bring one to an end.

Lenders must not keep on trying to drain cash from their borrowers’ accounts if there is not enough money available to meet the debt.

Meggan Tile owes seven thousand pounds in payday loan debt and describes how the stress used to keep her awake at night

“Our report shows that a large number of payday loans are not repaid on time,” said Mr Fisher.

“Our revised guidance makes it absolutely clear to lenders what we expect from them when using continuous payment authority to recover debts and that we will not accept its misuse.”

The UK’s most high profile payday lender, Wonga, said it welcomed the OFT report and its recommendations, which add to a new industry code of practice that was announced in the summer and which comes into effect next week.

“Regarding continuous payment authority, which is also used by a broad range of businesses outside of consumer credit, we believe it is an important method of collection and we share the OFT’s concerns that it must not be misused,” said a Wonga spokeswoman.

‘Bad situation worse’

Joanna Elson, chief executive of the Money Advice Trust, welcomed the OFT’s interim report.

She said the experience of clients coming to the Trust for advice was that “payday loans have a habit of making a bad situation worse”.

“We have a lengthy list of concerns about the practices of many companies in the sector and we hope the OFT review will kickstart a more serious consideration of the problems payday loans create,” she said.

“Many thousands of people have come to us for help after having seen their debt problem made far more serious by taking out one or more payday loans,” she added.

The Financial Ombudsman Service (FOS) has found a small but increasing number of people complaining to it about payday loan firms.

A spokesman said the main reason for people complaining was that the loan had been unaffordable and should never have been granted in the first place.

“In the first half of this financial year – April to September 2012 – we received 271 new complaints; this compares to the 296 complaints brought to our service during the whole of last year (2011-12) – and we are currently upholding eight out of 10 cases in favour of the consumer,” said an FOS spokesman.

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Turbulence on Cuba-Italy flight leaves 30 bruised

ROME (AP) — An airliner flying from Havana to Milan abruptly plunged some 1,000 meters (3,300 feet) when it hit unusually strong turbulence over the Atlantic on Monday, terrifying passengers and leaving some 30 people aboard with bruises and scrapes, airline officials said.

The flight continued to Milan’s Malpensa airport after the plane’s captain determined that it suffered no structural damage and two passengers who are physicians found no serious injuries, Giulio Buzzi, head of the pilots division at Neos Air, told Sky TG24 TV.

The ANSA news agency quoted bruised passenger Edoardo De Lucchi as saying meals were being served when suddenly there was “10 seconds of terror.” He recounted how plates went flying and some passengers not wearing seatbelts bounced about.

Buzzi had said that the drop measured some 3,000 meters (10,000 feet) in a cloudless sky. But Milan daily’s Corriere della Sera’s web site, quoting Neos official Davide Martini, later reported that the plane first bounced up some 500 meters (1,650 feet), then dropped some 1,000 meters (3,300 feet) to some 500 meters (1,650 feet) below the original altitude.

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Charlie Chaplin’s bowler hat and cane fetch over $60,000 at auction

NEW YORK (Reuters) – One of Charlie Chaplin’s bowler hats and a cane, the staple of Hollywood silent-era comedy, were auctioned for $ 62,500 on Sunday, said auction house Bonhams.

Chaplin’s hat and cane, which fetched more than the initial estimate of $ 40,000-60,000, are synonymous with his “Little Tramp” character in films such as “City Lights” and “Modern Times.”

Bonhams memorabilia specialist Lucy Carr said earlier it is unknown how many of Chaplin’s bowlers and canes still exist. Those auctioned on Sunday are from a private collection but have a direct link to Chaplin, Carr said.

The waddling and bumbling “Little Tramp” character propelled Chaplin to global fame. The character, Hollywood legend says was created by accident on a rainy day at Keystone Studios, first appeared in 1914′s “Kid Auto Races at Venice” and lastly in 1936′s “Modern Times.”

Chaplin’s hat and cane are the highlights of an auction of popular culture artifacts that is still in progress. Other items include a handwritten letter from John Lennon in which the Beatle sketched himself and wife Yoko Ono nude. There is also an archive of Marilyn Monroe photographs, an early Charles Schulz “Peanuts” comic strip, and a wicker chair from Rick’s Cafe in “Casablanca.”

(Additional reporting by Eric Kelsey; editing by Christopher Wilson)

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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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