Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

____

Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

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Stock futures little changed as market awaits Bernanke, data

NEW YORK (Reuters) - Stock index futures were little changed on Wednesday as investors awaited a second round of testimony in Congress by Federal Reserve Chairman Ben Bernanke for signs of whether the Fed will continue its economic stimulus program.

Economic data was also in focus with U.S. durables goods and homes data due out at 8:30 a.m. ET (1330) GMT and 10:00 a.m. ET (1500 GMT), respectively.

Bernanke will make his second appearance before the Financial Services Committee at 10:00 a.m. ET (1500 GMT).

"Of course, Bernanke is in the spotlight again but I don't expect him to vary from his comments from yesterday," said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

A day earlier, Bernanke strongly defended the Fed's monetary stimulus efforts before Congress, easing financial market worries over an early retreat from the Fed's bond buying program, which had been triggered by minutes of the Fed's January meeting released a week ago.

His remarks, along with data showing sales of new homes hit a 4 1/2-year high, helped U.S. stocks rebound Tuesday from their worst decline since November.

Despite the bounce, the S&P 500 was unable to move back above 1,500, a closely watched level that had been technical support until recently, but may now prove a resistance point.

The benchmark S&P 500, up 6 percent for the year, was within reach of record highs a week ago before the minutes from the Fed's January meeting were released. Since then, the index has shed 1 percent as the minutes raised questions about the longevity of the Fed's economy-stimulating measures.

S&P 500 futures rose 2.1 points and were in line with fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures fell 1 points while Nasdaq 100 futures added 4 points.

In earnings news, Target Corp posted a lower quarterly profit as sales of food and value-priced items only partially mitigated weakness in holiday spending. The stock fell 1.7 percent to $62.99 in premarket trading.

Dollar Tree Inc reported a higher quarterly profit as the chain controlled costs and as consumer spending improved. The stock rose 4.5 percent to $42.91 in premarket trading.

In Europe, shares rose, steadying after the previous session's sharp losses, though jitters over the euro zone kept a lid on gains.

Italy's 10-year debt costs rose more than half a percentage point at the first longer-term auction since an inconclusive parliamentary election, although they remained below the psychologically important level of 5 percent.

(Editing by Bernadette Baum)

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British Media to Challenge Secrecy Bid in Litvinenko Case

The British Broadcasting Corporation said it and other news organizations would oppose an effort on Tuesday by the British government to limit information disclosed to the planned inquest into the death of Alexander V. Litvinenko, a former officer in the KGB who died of radiation poisoning in London more than six years ago.

The BBC reported that the government had planned to apply for a so-called Public Interest Immunity certificate, usually issued on the grounds of national security that would prevent the inquest from hearing information on topics which have not been made public.

The authorities’ resistance to full disclosure may force a postponement in the scheduled May 1 start date for the inquest, which would be the first — and likely the only — forum for sworn testimony about the killing, according to a lawyer for Mr. Litvinenko’s widow, Marina Litvinenko.

The lawyer, Ben Emmerson, complained on Tuesday that the preparations for the inquest were becoming “bogged down” by “the government’s attempt to keep a lid on the truth.”

“It is the government’s secret files that are delaying this inquest,” he said, according to the Press Association news agency, which also quoted the coroner, Sir Robert Owen, as saying on Tuesday that “due to the complexity of the investigation which necessarily precedes the hearings” the schedule for the inquest to begin on May 1 “may be a timetable to which it may not be possible to adhere.”

The Guardian newspaper, which is also opposing the government’s effort to restrict evidence, said that it would argue that “the public and media are faced with a situation where a public inquest into a death may have large amounts of highly relevant evidence excluded from consideration by the inquest. Such a prospect is deeply troubling.”

But the Foreign Office said the authorities had made their application in line with their “duty to protect national security and the coroner would rule according to “the overall public interest.”

The case has strained ties between Britain and Russia, reviving memories of the cold war.

Mr. Litvinenko, who styled himself a whistle-blower and foe of the Kremlin, died in November, 2006, weeks after he secured British citizenship. He had fled from Russia to Britain in 2000.

Britain’s Crown Prosecution is seeking the extradition from Russia of Andrei K. Lugovoi, another former KGB officer, to face trial on murder charges. Mr. Lugovoi denies the accusation and Russia says its constitution forbids it from sending its citizens to other countries to face trial.

At a hearing in December in advance of the inquest, which is to start on May 1, Mr. Emmerson, the lawyer representing Marina Litvinenko, said that Mr. Litvinenko was a “registered and paid agent and employee of MI6, with a dedicated handler whose pseudonym was Martin.”

Mr. Litvinenko also worked for the Spanish intelligence service, Mr. Emmerson said, and both the British and Spanish spy agencies made payments into a joint account with his wife. The lawyer added that the inquest should consider whether MI6 failed in its duty to protect him against a “real and immediate risk to life.”

The BBC said Marina Litvinenko would also oppose the British government’s effort to limit information about its knowledge of her husband’s death.

The coroner has said in previous hearings that he will examine what was known about threats to Mr. Litvinenko and would also seek to determine whether the Russian state bore responsibility. In a deathbed statement, Mr. Litvinenko directly blamed President Vladimir V. Putin, who dismissed the accusation.

Russian state prosecutors are expected to be represented at the inquest. Moscow has denied British suggestions that it may have been involved in killing Mr. Litvinenko, who died after ingesting polonium 210 — a rare radioactive isotope — at the Pine Bar of the Millennium Hotel in central London.

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Charlize Theron & Channing Tatum's Oscars Dance - No Practice Makes Perfect!

By Oliver Jones and Tim Nudd

02/26/2013 at 08:35 AM EST

Channing Tatum and Charlize Theron

Getty

Who knew Charlize Theron could dance? Or that Channing Tatum could do so with his clothes on?

Together they wowed the Academy Awards on Sunday, performing a challenging ballroom dance in front of 40 million viewers – each counting on their background in dance to make up for a frightening lack of rehearsal time.

"They were going to cram and rehearse constantly over two days [right before the Oscars]. But then they both simultaneously got the flu," producer Neil Meron tells PEOPLE.

"We were going, 'Oh my God.' Literally at the last minute they got to rehearse and miraculously got up there and they killed."

It helped that both know a little something about dance.

Theron, 37, studied at the Joffrey Ballet School in New York before embarking on her Oscar-winning acting career. "We reached out to Charlize first, and there was no hesitation. She absolutely jumped on board," says Meron.

Tatum, 32, was less sure of himself, despite loads of dance experience in movies like Step Up and Magic Mike, the latter loosely based on his own experiences as a male stripper.

"Chan said to us, 'Look, I have danced in all these movies, but I have never really done honest-to-God choreography. I don't know that I can do that,' " Meron says. "We told him, 'We believe you are a great dancer, and that you will be able to do it.' He said he would give it a try."

In the end, they dazzled with a Fred Astaire and Ginger Rogers style number choreographed by Rob Ashford.

And Chan even kept his tux on.

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Koop, who transformed surgeon general post, dies

With his striking beard and starched uniform, former Surgeon General Dr. C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.

His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.

Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.

Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.

An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.

Dr. Richard Carmona, who served as surgeon general a decade ago under President George W. Bush, said Koop was a mentor to him and preached the importance of staying true to the science even if it made politicians uncomfortable.

"He set the bar high for all who followed in his footsteps," Carmona said.

Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."

A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.

Chris Collins, a vice president of amFAR, the Foundation for AIDS Research, said many people don't realize what an important role Koop played in the beginning of the AIDS epidemic.

"At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," Collins said.

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.

In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.

He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

Koop maintained his personal opposition to abortion, however. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day, but Reagan would not interfere.

Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was born in the New York City borough of Brooklyn, the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats.

He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

Koop received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it.

In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children, one of whom died in a mountain climbing accident when he was 20.

Koop was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine.

He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was by far the best-known surgeon general and for decades afterward was still a recognized personality.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."

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Ring reported from Montpelier, Vt. Cass reported from Washington. AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.

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Futures rise in rebound after steep losses on Italy vote

NEW YORK (Reuters) - U.S. stock index futures rose on Tuesday, indicating equities would partially rebound from a steep drop over Italian election results as investors saw opportunities to buy beaten-down shares.

Market participants speculated a coalition government would eventually emerge in Italy and ease worries about a new euro zone debt crisis.

Groups in Italy opposed to economic reforms posted a strong showing, resulting in a political deadlock with a comedian's protest party leading the poll and no group securing a clear majority in parliament.

"We've gone to an environment of political stability to instability, and until we get some type of clarity over who is in charge, which could take days, the market will have renewed concerns," said Art Hogan, managing director of Lazard Capital Markets in New York.

"Investors are taking advantage of the drop, and once some kind of coalition government is formed most of our concerns will be put to rest," Hogan said.

S&P 500 futures rose 3.9 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures added 38 points and Nasdaq 100 futures rose 5.75 points.

Major indexes fell more than 1 percent on Monday, with the S&P 500 having its biggest daily drop since November as investors fretted that if Italy does not undertake reforms, that could once again destabilize the euro zone. European equities <.fteu3>, which closed before the results on Monday, fell 1.1 percent.

Investors will pay close attention to the first of two days of congressional testimony by Federal Reserve Chairman Ben Bernanke for insight into the central bank's view of the economy, as well as the outlook for its bond buying program. Last week, equities fell on concerns the program might end sooner than had been anticipated.

Bernanke appears before the Senate Banking Committee at 10 a.m. (1500 GMT).

Economic data will include the CaseShiller report on December home prices at 9 a.m. (1400 GMT). Analysts expect a 0.5 percent rise. January consumer confidence is scheduled for 10 a.m. and is seen rising to 61.0 from 58.6 in the previous month. New-home sales for January also are due at 10 a.m.

The rise in U.S. futures suggests that a recent trend of investors buying on dips will continue. Last week, concerns the Fed might roll back its stimulus policy earlier than expected prompted a sharp two-day decline, though equities recovered most of the lost ground by the end of the week.

Financial shares may be among the most volatile, as the group is closely tied to the pace of global economic growth. Morgan Stanley was one of the top percentage losers on the S&P on Monday, dropping more than 6 percent on concerns about the company's exposure to European debt. It rose 0.8 percent to $22.20 in premarket trading on Tuesday.

Dow component Home Depot Inc , the world's largest home improvement retailer, reported adjusted earnings and sales that beat expectations. Its stock rose 1.5 percent to $64.90 in premarket trading.

For the benchmark S&P 500 index, 1,500 will be watched as a key level after the index closed below it on Monday for the first time since February 4, with selling accelerating after falling below it. An inability to break back above it could portend further losses.

The S&P remains 4.3 percent higher on the year. With 83 percent of the S&P 500 having reported so far, 69 percent beat profit expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data. Fourth-quarter S&P earnings are seen having risen 6 percent, above a 1.9 percent forecast at the start of the earnings season.

(Editing by Chizu Nomiyama and Kenneth Barry)

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India Ink: Laliji, the Octogenarian from Bihar

Why do millions of people, from entire Indian villages to urbane middle managers to foreign tourists, brave the crowds at the Kumbh Mela? During this year’s 55-day pilgrimage, to Allahabad, Uttar Pradesh, an estimated 100 million Hindus and others are expected to take a holy dip in the Ganges River to wash away their sins. India Ink interviewed some of them.

Laliji, 80, from Chhapra, Bihar, was one among them. This is what she had to say.

Why did you come to the Kumbh Mela this year? Is it your first time?

I have come to the Kumbh before, but this is the first time my son brought me here. It was his way of showing his gratitude.

How have you found it so far?

I like it, especially since all my friends and fellow-villagers are here. We are celebrating it. The dip was memorable, though the water was cold. But I am enjoying.

Describe your journey to the Kumbh. Did you travel alone? How long did it take?

We took a bus from our house to the district headquarters, from where the village leaders had promised to arrange transport for us. But that seemed to be a crowded option, hence we decided to take another bus and come here.

Do you consider yourself a religious person?

I am very religious, and have brought up my eight sons that way. We are God-fearing people. We think twice before we can hurt anyone or anything. It’s not for nothing that we are respected in our village.

Who do you think is going to win the 2014 election?

I don’t understand politics. Last year, someone paid us to vote for them — we did.

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Anne Hathaway's Oscar Dress Had You Talking

By Maggie Coughlan

02/25/2013 at 08:30 AM EST

The Oscars may honor the best in film, but they'd be nothing without the fashion.

When Anne Hathaway stepped on to the red carpet in a light pink backless Prada gown at Sunday's 85th Annual Academy Awards, she made quite the fashion statement.

While the gown seemed simple from the front, at second glance, an open back and thigh-high slit gave it a sexy edge. Hathaway, 30, told Kristin Chenoweth on ABC's red carpet that her mom called the dress "business in front, party in the back."

Viewers had their own opinions on the dress – which seemed to emphasize Hathaway's bust – which later inspired its own parody Twitter account.

But the dress may have served as a lucky charm for Hathaway, who took home the Oscar for Best Supporting Actress for her role in Les Misérables.

"It came true. Thank you so much to the Academy for this and for nominating me with Helen Hunt, Jacki Weaver, Amy Adams and Sally Field. I look up to you all so much and it's just been such an honor. Thank you," Hathaway said upon receiving her Oscar.

She continued, "There are so many people whose generosity and support is the reason I'm standing here right now. I must thank Hugh Jackman. Hugh, you're the best. The cast, the crew, especially Simon Hayes and the sound wizards. Congratulations on tonight, you guys."

Hathaway continued thanking the cast and the crew before giving a romantic shout out to her husband, Adam Shulman.

"By far and away, the greatest moment of my life is the one when you walked into it. I love you so much. And thank you for this. Here's hoping that someday in the not too distant future the misfortunes of Fantine will only be found in stories and never in real life. Thank you."

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FDA approves new targeted breast cancer drug

WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.

The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.

Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.

"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."

Cobleigh helped conduct the key studies of the drug at the Chicago facility.

The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.

The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.

Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.

FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.

Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.

FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer

Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.

Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.

Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.

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Stock futures point to higher open, Barnes & Noble rallies

NEW YORK (Reuters) - U.S. stock index futures pointed to a higher open on Monday, suggesting the equity rally was intact despite concerns that the Federal Reserve could curtail its stimulus for the economy sooner than many expected.

Stocks have been strong performers so far this year, with the S&P 500 jumping 6.2 percent in 2013 to hover around its highest levels since 2007. That has prompted many to predict a pullback, but so far declines have been neutralized as investors use any dip as a buying opportunity.

Barnes & Noble Inc will be in focus after the Wall Street Journal reported that Chairman Leonard Riggio was considering a bid for the company's bookstore business. The stock jumped 13 percent to $15.25 in premarket trading.

While the S&P fell last week, the decline was a slight 0.3 percent and was the first weekly drop after a seven-week string of gains, suggesting many may still be looking for a consolidation.

"People are cautious about investing near five-year highs, especially given the pace at which we got here, but there's still room to grow and any pullback should be shallow," said Robert Pavlik, chief market strategist at Banyan Partners LLC in New York.

S&P 500 futures rose 7 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures added 57 points and Nasdaq 100 futures rose 18.25 points.

The gains have come on strong corporate earnings. With 83 percent of the S&P 500 having reported results, 69 percent of beat profit expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data.

In addition, the market has risen against a backdrop of stimulus from the Federal Reserve. Last week stocks faltered when some Fed officials seemed to suggest the stimulus may be curtailed earlier than many expected, though subsequent comments seemed to allay those concerns.

Another test for equities will come with the looming debate over massive U.S. government budget cuts that will take effect on Friday if lawmakers fail to reach an agreement over spending and taxes. The White House issued warnings about the harm the cuts. referred to as sequester are likely to inflict on the economy if enacted.

"Right now we're looking past the sequester, but as we go forward we may see more anxiety if it doesn't look like our leaders can get anything together," Pavlik said.

More government-related uncertainty came from Italy, where a close election left questions about how the country would handle its three-year debt crisis. Last year, inconclusive Greek elections sparked a protracted selloff and a period of uncertainty in U.S. equity markets as well.

Still, European shares <.fteu3> were higher on Monday, rising 0.4 percent after a smooth Italian debt auction.

Lowe's Cos Inc reported earnings that beat expectations, helped by rebuilding efforts after Hurricane Sandy in the United States. Shares rose 0.6 percent to $37.90 before the bell.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 6 percent, according to Thomson Reuters data, above a 1.9 percent forecast at the start of the earnings season.

Dow component Johnson & Johnson forecast a negative impact to its first-quarter earnings as a result of a Venezuelan currency devaluation, though the charge wouldn't impact its full-year guidance.

Dynavax Technologies Inc shares plunged 27 percent to $2.18 before the bell after the Food and Drug Administration denied approval for the company's adult hepatitis B vaccine and sought additional data for evaluate its safety.

U.S. stocks closed higher on Friday, boosted by strong results from Hewlett-Packard Co , as well as allayed concerns over Fed policy.

(Editing by Chizu Nomiyama and Kenneth Barry)

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