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CHICAGO (AP) -- Treating breast cancer almost always involves surgery, and for years the choice was just having the lump or the whole breast removed. Now, new approaches are dramatically changing the way these operations are done, giving women more options, faster treatment, smaller scars, fewer long-term side effects and better cosmetic results.

It has led to a new specialty - "oncoplastic" surgery - combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance.

"Cosmetics is very important" and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches.

More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer's spread, sparing women painful arm swelling for years afterward.

Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results.

Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There's even a "Goldilocks" mastectomy for large-breasted women - not too much or too little removed, and using excess skin to create a "just right" natural implant.

Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin.

"Breast surgery has become more minimalistic," said Dr. Shawna Willey of Georgetown's Lombardi Comprehensive Cancer Center.

"Women have more options. It's much more complex decision-making."

Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year.

Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence.

Many women don't want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring.

Here are some of the major trends:

IMMEDIATE RECONSTRUCTION

Doctors used to think it wasn't good to start reconstruction until cancer treatment had ended - surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast.

Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that's gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it.

The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation.

Nationally, about 25 to 30 percent of women get immediate reconstruction. At the Mayo Clinic, about half do, and at Georgetown, it's about 80 percent.

SPARING SKIN, NIPPLES

Doctors usually take the skin when they do a mastectomy to make sure they leave no cancer behind. But in the last decade they increasingly have left the skin in certain women with favorable tumor characteristics. Attai compares it to removing the inside of an orange while leaving the peel intact.

"We have learned over time that you can save skin" in many patients, Willey said. "Every single study has shown that it's safe."

Now they're going the next step: preserving the nipple, which is even more at risk of being involved in cancer than the skin is. Only about 5 percent of women get this now, but eligibility could be expanded if it proves safe. The breast surgery society has a registry on nipple-sparing mastectomies that will track such women for 10 years.

"You really have to pick patients carefully," because no one wants to compromise cancer control for cosmetic reasons, Attai said.

"The preliminary data are that nipple-sparing is quite good," but studies haven't been long enough to know for sure, Willey said. "It makes a huge difference in the cosmetic outcome. That makes the woman's breast recognizable to her."

Dr. Judy Boughey, a breast surgeon at the Mayo Clinic, said the new approach even has swayed patients' treatment choices.

"We're seeing women choosing the more invasive surgery, choosing the mastectomy," because of doctors' willingness to spare skin and nipples, she said.

It helped persuade Rose Ragona, a 51-year-old operations supervisor at O'Hare Airport in Chicago. She had both breasts removed on April 19 with the most modern approach: Immediate reconstruction, with preservation of her skin and nipples.

"To wake up and just see your breasts there helped me immensely," she said.

She chose to have both breasts removed to avoid radiation and future worry.

"I felt it was a safer road to go," she said. "I can't live the rest of my life in fear. Every time there's a lump I'm going to worry."

FREEZING TUMORS

Attai, the California breast surgeon, is one of the researchers in a national study testing cryoablation. The technique uses a probe cooled with liquid nitrogen that turns tumors into ice balls of dead tissue that's gradually absorbed by the body. This has been done since 2004 for benign breast tumors and the clinical trial is aimed at seeing if it's safe for cancer treatment.

"The technology is amazing. This is done in the office under local anesthesia, a little skin puncture," Attai said.

In the study, women still have surgery at some point after the freezing treatment to make sure all the cancer is destroyed. If it proves safe and effective, it could eliminate surgery for certain cancer patients.

"I'd love to see the day when we can offer women with small breast tumors a completely non-operative approach, and I do think that's coming soon," Attai said.

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Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP

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NEW ORLEANS (AP) — Video released early Monday by New Orleans police shows a possible suspect in the Mother's Day gunfire that wounded 19 people during a neighborhood parade.

The grainy surveillance video shows a crowd suddenly scattering in all directions, with some falling to the ground. They appear to be running from a man who turns and runs out of the picture. The person is wearing a white T-shirt and dark pants. The image isn't clear, but police say they hope someone will recognize him and notify investigators.

Police posted a series of still images from the video on YouTube.

Police believe more than one gun was fired in the burst of Sunday afternoon violence — the latest to flare up around a celebration this year — and they have vowed to swiftly track down those responsible. Detectives were conducting interviews, collecting any surveillance video they could find and gathering evidence from the scene. Cellphone video taken in the aftermath of the shooting shows victims lying on the ground, blood on the pavement and others bending over to comfort them.

Police also say the reward for information leading to arrests and indictments in the case is $10,000.

At least three of the victims were seriously wounded. Of the rest, many were grazed and authorities said that, overall, most wounds were not life threatening. No deaths were reported.

The victims included 10 men, seven women, a boy and a girl. The children, both 10 years old, were grazed and in good condition.

It's not the first time gunfire has shattered a festive mood in the city this year. Five people were wounded in January after a Martin Luther King Jr. Day parade, and four were wounded in a shooting in the French Quarter in the days leading up to Mardi Gras. Two teens were arrested in connection with the MLK shootings; three men were arrested and charged in the Mardi Gras shootings.

"The specialness of the day doesn't appear to interrupt the relentless drumbeat of violence," Mayor Mitch Landrieu said at a news conference outside a hospital where victims were being treated Sunday night.

Mary Beth Romig, a spokeswoman for the FBI in New Orleans, characterized the shooting as street violence.

As many as 400 people came out for the second-line procession — a boisterous New Orleans tradition — though only half that many were in the immediate vicinity of the shooting, Police Superintendent Ronal Serpas said. Officers were interspersed with the marchers, which is routine for such events.

Second-line parades are loose processions in which people dance down the street, often following behind a brass band. They can be planned events or impromptu offshoots of other celebrations. They trace their origins to the city's famous jazz funerals.

Police saw three suspects running from the scene. No arrests had been made as of late Sunday.

Outside the hospital Sunday night, Leonard Temple became teary as he talked about a friend who was in surgery after being shot three times during the parade. Temple was told the man was hit while trying to push his own daughter out of the way.

"People were just hanging out. We were just chilling. And this happened. Bad things always happen to good people," said Temple, who was at the parade but didn't see the shootings.

A social club called The Original Big 7 organized Sunday's event. The group was founded in 1996 at the Saint Bernard housing projects, according to its MySpace page.

The neighborhood where the shooting happened is a mix of low-income and middle-class row houses, some boarded up. As of last year, the 7th Ward's population was about 60 percent of its pre-Hurricane Katrina level.

The crime scene was about 1.5 miles from the heart of the French Quarter and near the Treme neighborhood, which has been the centerpiece for the HBO TV series "Treme."

Sunday's violence comes at a time when the city is struggling to pay for tens of millions of dollars required under federal consent decrees to reform the police department and the city jail. The mayor initially backed the police reform agreement and had sought a comprehensive civil rights investigation of the department when he took office in 2010. However, he is trying to put the brakes on the reform plans. In January, he said the city can't afford to spend millions required under the police reform agreement and the jail agreement reached separately between the Justice Department and Sheriff Marlin Gusman, who runs the city-funded jail.

The agreement to reform the police department came after a scathing Justice Department report in 2011 said the city's officers have often used deadly force without justification, made unconstitutional arrests and engaged in racial profiling. A series of criminal investigations focused on a string of police shootings in the aftermath of Hurricane Katrina in 2005.

Shootings at parades and neighborhood celebrations have become more common in recent years as the city has struggled with street crime, sometimes gang-related.

But police vowed to solve Sunday's shooting. Serpas said it wasn't clear if particular people in the second line were targeted, or if the shots were fired at random.

"We'll get them. We have good resources in this neighborhood," Serpas said.

___ Contributing to this report were Associated Press writers Michael Kunzelman and Kevin McGill in New Orleans and AP Radio reporter Jackie Quinn in Washington.

WASHINGTON (AP) — The top Democrat on the House Oversight panel said Monday that the authors of an independent investigation into the deadly assault in Benghazi, Libya, should answer questions about their work at a congressional hearing, not in a private deposition that the Republicans want.

"If our committee is truly interested in improving the security of American diplomatic personnel overseas, members of our committee and the American public should hear first-hand from the individuals who have done the most exhaustive review of these attacks," Rep. Elijah Cummings of Maryland wrote in a letter to Rep. Darrell Issa, R-Calif., the panel's chairman.

In a Sunday talk show appearance, Issa said he would seek sworn testimony from veteran diplomat Thomas Pickering and retired Adm. Mike Mullen, the former chairman of the Joint Chiefs of Staff. The two conducted an independent investigation of the Sept. 11 attack that killed Ambassador Chris Stevens and three other Americans.

Their report was highly critical of the State Department's handling of at the U.S. outpost. Pickering, who also appeared on the Sunday shows, defended his scathing assessment but absolved former Secretary of State Hillary Rodham Clinton.

"We knew where the responsibility rested," said Pickering, whose career working for Republican and Democratic administrations, spans four decades.

Issa said he wants to know with whom the pair spoke to reach their conclusions about Clinton. Cummings suggested that they testify in public before the committee on May 22.

"This is a failure, it needs to be investigated. Our committee can investigate. Now, Ambassador Pickering, his people and he refused to come before our committee," Issa said Sunday.

Pickering, sitting next to Issa during an appearance on one Sunday show, disputed the chairman's account and said that he was willing to testify before the committee.

"That is not true," said the former top diplomat, referring to Issa's claim that he refused to appear before the committee.

In a separate interview, Pickering said he asked, via the White House, to appear at last Wednesday's hearing by the House Oversight and Government Reform Committee in which three State Department officials testified. He said he could have answered many of the questions lawmakers raised, such as whether U.S. military forces could have saved Americans had they dispatched F-16 jet fighters to the consulate, some 1,600 miles away from the nearest likely launching point.

"Mike Mullen, who was part of this report and indeed worked very closely with all of us and shared many of the responsibilities directly with me, made it very clear that his view as a former chairman of the Joint Chiefs of Staff that there were nothing within range that could have made a difference," Pickering said.

Republicans and Gregory Hicks, the former deputy chief of mission in Libya, have questioned why the military couldn't move faster to stop the two nighttime attacks over several hours. Hicks, who testified before the House Oversight panel, said a show of U.S. military force might have prevented the second attack on the CIA annex that killed security officers Tyrone Woods and Glen Doherty.

Robert Gates, a former Defense secretary, defended the decisions made at the time, saying: "I think my decisions would have been just as theirs were," adding "getting somebody there in a timely way — would have been very difficult, if not impossible."

The Accountability Review Board, which Pickering headed with Mullen, did not question Clinton at length about the attacks but concluded last December that the decisions about the consulate were made well below the secretary's level.

In her last formal testimony as secretary of State, Clinton appeared before two congressional committees investigating the Benghazi attacks. She took responsibility for the department's missteps and failures leading up to the assault, but said that requests for more security at the diplomatic mission in Benghazi didn't reach her desk.

Pickering and Mullen's blistering report found that "systematic failures and leadership and management deficiencies at senior levels" of the State Department meant that security was "inadequate for Benghazi and grossly inadequate to deal with the attack that took place."

Issa spoke on NBC's "Meet the Press." Pickering spoke on CNN's "State of the Union," CBS' "Face the Nation" and NBC. Gates appeared on CBS.