Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast-cancer data and a professor of biostatistics at the University of Texas’ M.D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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DealBook: Wall Street Pay Rises, for Those Who Still Have a Job

It’s nice work – if you can get it.

Wall Street has cut thousands of jobs over the last year or so. On Tuesday, JPMorgan Chase, one of the country’s biggest banks, announced that it was eliminating 4,000 more jobs through layoffs and attrition, adding its name to a string of large banks that continue to cut jobs to reduce expenses.

The good news? For the employees who remain, pay is up, according to a report released Tuesday by the New York State comptroller.

This may seem surprising given the outcry over high compensation during the financial crisis. In recent years, however, faced with greater regulation, a slow economic recovery and the loss of once big moneymaking businesses like selling products tied to mortgages, the banks have tried instead to cut people rather than pay, which they argue is needed to retain talent that might otherwise leave for better paying jobs at hedge funds or elsewhere.

The average cash bonus for people employed in New York City in the financial industry rose by roughly 9 percent, to $121,900, in 2012 and cash bonuses in total are forecast to increase by roughly 8 percent to $20 billion this year, said Thomas P. DiNapoli, the state’s comptroller.

In recent years, some firms have deferred cash payments to employees, and Mr. DiNapoli said part of the increase in 2012 was cash promised in recent years but actually paid out last year. He said that it was “tough” to break out what percentage of the total were deferrals, but he believed that it was still a small part of the total.

All told, the average pay package for securities industry employees in New York was $362,900 in 2011, the last year for which data is available, almost unchanged from 2010.

Wall Street jobs are harder to get than they were just a few years ago, but for those who can get their foot in the door, finance remains the best paying sector in New York City, Mr. DiNapoli told reporters during a conference call

“Profits and bonuses rebounded in 2012, but the industry is still restructuring. Despite its smaller size, the securities industry is still a very important part of the New York City and New York State economies,” he said.

The current economic recovery, he said, is being driven by industries other than Wall Street, which he said has regained only 30 percent of the jobs lost during the downturn. The securities industry in New York City lost 28,300 jobs during the financial crisis and has added only 8,500 since, a net loss of 19,800 jobs. New York City financial industry employment totaled 169,700 at the end of 2012.

Before the start of the financial crisis, business and personal income tax collections from Wall Street related activities accounted for up to 20 percent of New York State tax revenue. In 2012, that contribution fell to 14 percent.

“Wall Street is still in transition, but it is very slowly adjusting to changes in its economic and regulatory environment,” he said.

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Oscars 2013: An 'Argo' night at Academy Awards

For the second straight year, the movie business fell for itself.

"Argo" — in which a Hollywood producer and makeup artist help engineer the rescue of six Americans from Iran — won the top prize at the 85th Academy Awards, one year after the silent film story "The Artist" took the best picture Oscar.

"I never thought I'd be back here. And I am," producer-director Ben Affleck said in accepting the best picture trophy Sunday night, 15 years after he won an original screenplay Oscar for "Good Will Hunting" and then saw his career fall into a tailspin that included "Gigli" and "Daredevil."

FULL COVERAGE: Oscars 2013 | Winners

"It doesn't matter how you get knocked down in life. That's going to happen," said Affleck, who wasn't nominated for directing "Argo," one of nine films in the best picture race. "All that matters is that you've got to get up."

"Argo," which became the first movie to win best picture without its director being nominated since 1989's "Driving Miss Daisy," collected two other Academy Awards, for editing and adapted screenplay. But it was not the evening's most recognized film: That honor went to Ang Lee's "Life of Pi," which won four Oscars — for directing, visual effects, cinematography and score.

"Thank you, movie god," said Lee, whose movie came into the evening with 11 nominations, one behind Steven Spielberg's "Lincoln." The film about the 16th president helped Daniel Day-Lewis make movie history, as he became the only man to ever win three lead actor statuettes. "Lincoln" won one other prize, for production design.

The song-and-dance heavy ceremony, hosted by Seth MacFarlane, hewed closely to a traditional awards show script, but there were several surprises. First Lady Michelle Obama, who joined the ABC telecast from the White House, announced "Argo" as the best picture. And the ceremony featured only the sixth tie in Oscar history and the first since 1994, with the sound editing award split between "Zero Dark Thirty" and "Skyfall." For the first time in Oscar history, six best picture nominees were $100-million blockbusters.

The ceremony was billed as a tribute to music in film, and boasted a number of extravagant musical numbers — including a medley of songs from movie musicals and an appearance by Barbra Streisand, who sang "The Way We Were." The telecast also paid homage to the long running James Bond series, with Adele singing the theme from "Skyfall" and Dame Shirley Bassey performing the theme from 1964's "Goldfinger."

Oscars 2013: Nominee list | Red carpet | Highlights

Jennifer Lawrence, 22, nabbed the lead actress prize for her role as an emotionally unstable widow in "Silver Linings Playbook" — and promptly tripped over her long dress walking up the stairs to accept her statuette. The crowd quickly gave her a standing ovation. "You guys are just standing up because you feel bad that I fell and that's embarrassing," Lawrence said to the applauding crowd at the Dolby Theatre.

The evening's very first award — for supporting actor — was a shocker, with long shot Christoph Waltz winning for his role as bounty hunter Dr. King Schultz in Quentin Tarantino's "Django Unchained" over favored contenders Robert De Niro ("Silver Linings Playbook") and Tommy Lee Jones ("Lincoln"). Waltz, who won the same award three years ago for Tarantino's "Inglourious Basterds," dedicated his prize to his writer-director, who also won the Oscar for original screenplay. "We participated in a hero's journey — the hero being Quentin," Waltz said.

Tarantino pulled off a mild surprise with the screenplay triumph for his slave-revenge tale. He dedicated his award to his eclectic cast of actors. "I actually think if people know my movies 30-50 years from now it's because of the characters I create," Tarantino said.

Anne Hathaway's supporting actress win for her emotionally raw portrayal of a doomed seamstress in "Les Misérables" was hardly as startling. The 30-year-old had been the odds-on favorite to win since the film first screened for members of the Motion Picture Academy in late November. "It came true," she stage-whispered as she picked up her trophy for her performance, the centerpiece of which is the lament "I Dreamed a Dream."

Oscars 2013: Backstage | Quotes | Best & Worst moments

Some of the evening's wins were bittersweet.

The animated feature Oscar was shared by "Brave" directors Mark Andrews and Brenda Chapman, an unusual pairing given that Chapman was fired from the Pixar Animation Studios film and replaced by Andrews in the middle of production. "Making these are a struggle — it's a battle, it's a war," Andrews said backstage. "I was very happy it was him who took my place," Chapman said.

Rhythm & Hues Studios, the company behind "Life of Pi's" visual effects win, recently filed for bankruptcy and laid off hundreds of its employees. As Oscar winner Bill Westenhofer addressed the situation in his acceptance speech, he ran over time and the theme from "Jaws" began to play him off the stage. His microphone was cut off just as he said the words "I urge you all…"

William Goldenberg was a double nominee in the film editing category — he worked on both "Argo" and "Zero Dark Thirty" — and won the prize for Affleck's CIA drama.

"Working at my father's deli, I had to do a million things at one time," Goldenberg said backstage about the best training for his job. "It really does prepare you for the multitasking it takes to be in an editing room."

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Online Jihadi Forums Fear a U.S.-Israel-Iran Alliance Will Take Over Syria

There is a conspiracy to destroy Syria, fear the jihadis and jihadi-wannabes on one of the internet’s most prominent extremist forums. Pose as they might as enemies, the U.S. will team up with Iran to take advantage of the Syrian civil war.

“With time, everyone will be exhausted, all weapons in Syria will be destroyed, and all signs of civilization will be obliterated and cast back to what existed before the Stone Age,” predicts a thread on the password-protected Shumukh forum, one of the major jihadist warrens of the internet. “Thus will the path be paved for direct and indirect military intervention in Syria, and for redrawing the map in accordance with the wishes of the Zionist-Crusader-Zoroastrian alliance.”

In case you’re not familiar with the language of Sunni jihadi conspiracy theorists, “Zionist-Crusader-Zoroastrian alliance” refers to the U.S., Israel and Iran, which to all outward appearances are foes, not least of which because Iran identifies Israel and the United States as its main foes. Oh, and the key media organ of this unlikely entente is the “lying channel” al-Jazeera, which is waging “a concerted media war against the brothers in Syria.” No need to troll this thread.

For all the discussion in the American press about how the al-Qaida-aligned Nusra front is the strongest Syrian revolutionary faction, the Shumukh forum isn’t optimistic that Nusra is going to be victorious. The “revolutionary and the mujahideen are currently being besieged in an effort to prevent their acquiring arms,” laments a lengthy forum thread dedicated to strategizing a path to success. Their enemies in the aforementioned Zionist-Crusader-Zoroastrian alliance are likely to “wrest control of or destroy the chemical weapons facilities within Syria.” (Apparently Shumukh participants don’t put much stock in the fears of the chairman of the Joint Chiefs of Staff, who says he probably won’t have enough advance intelligence to avert a Syrian chemical attack.)

The thread, compiled and translated by the invaluable Jihadica website, doesn’t offer much in the way of a strategy to save the Nusra Front’s fortunes. It proposes “collecting the greatest possible amount of heavy and unconventional weapons” (presumably including chemical arms); “patience, and trust in God alone in all things”; and “preaching, consciousness raising, and communications” on behalf of the Syrian jihadis. Significantly, Shumukh is stopping short of calling for the mobilization of jihadist sympathizers to the conflict.

“What this means is that there first be peaceful activities, as we have indicated [in point seven],” the forum says, “but that they be accompanied by the threat of plunging the entire region into a vast war if our brothers in Syria are besieged or conspired against whether [by elements] from beyond Syria or by the brothers of the revolution itself.” The “brothers from the Islamic State of Iraq” — that is to say, al-Qaida in Iraq — are supposed to be the “strategic depth” of the Nusra Front and allied groups. Shumukh apparently sees the Syrian conflict as not a high enough priority to fight for.

It will come as news to the Crusader-Zionist-Zoroastrian Alliance that they are locked in an alliance. A persistent argument for U.S. intervention in the conflict is to weaken Iranian regional influence by deposing Tehran’s proxy, Syrian dictator Bashar Assad. Marine Gen. James Mattis, the outgoing commander of all U.S. troops in the Mideast and South Asia, sounded persuaded by that logic. Meanwhile, the Syrian rebel factions that the U.S. does want to help are frustrated by what they see as fainthearted support from Washington.

There’s a broader irony staring the Shumukh denizens in their faces. Nominally, they’re the ones aligned with the Crusaders and the Zionists, at least in the sense that all three entities want the Assad regime destroyed, while the Zoroastrians are trying to preserve Assad’s bloody hold on power. Coming to terms with that stark geopolitical reality would make for a way better thread.

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Well: Flu Shot Tied to Healthy Pregnancy

Pregnant women who received the flu vaccine during the 2009 flu pandemic lowered their risk of delivering premature babies, a new study found.

Typically flu vaccination rates among pregnant women have hovered between 13 to 18 percent nationally. But a push by health officials during the 2009 season drove vaccination rates for the H1N1 vaccine up to about 45 percent in the United States, where they have remained since.

Some expectant mothers have been reluctant to get a flu shot over concern about the health of the fetus, but the study showed that flu vaccination was not only safe but protective, said Dr. Saad Omer of the Rollins School of Public Health at Emory University, the senior author of the study.

Dr. Omer and his colleagues looked at the electronic medical records of 3,327 pregnant women between April 2009 and April 2010. The study, published in the journal Clinical Infectious Diseases, found that the infants born to vaccinated mothers had a 37 percent lower likelihood of being premature, and they also weighed more at birth than babies born to unvaccinated women.

“Our thinking is that by preventing flu infection, we are reducing the likelihood of inflammation in pregnant women and therefore having a protective effect against preterm birth,” Dr. Omer said.

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Media Decoder Blog: Online Piracy Alert System to Begin This Week

The Copyright Alert System, a program of escalating warnings and prods against people suspected of online copyright infringement, is finally going into effect this week, more than a year and a half after the plan was announced as part of an agreement between the entertainment industry and five major Internet service providers.

The Center for Copyright Information, the organization created to administer the system, announced on Monday that the Internet providers would begin putting it in place “over the course of the next several days,” though it gave no specifics. The Internet companies are AT&T, Cablevision, Comcast, Verizon and Time Warner Cable.

In the alert system, media companies monitor online traffic through a third party and can complain to Internet providers if a file is downloaded illegally. The suspected violator is then given the first of six warnings, some of which carry “educational” messages and must be acknowledged. After the fifth and sixth warnings, the customer’s Internet speed can be slowed to a crawl.

The Center for Copyright Information says it will not ask for repeat offenders’ Internet access to be blocked, but most service providers have the right to do that if a customer violates its terms of service. The findings can be contested for a $35 fee, to be refunded if an appeal is successful.

The introduction of the alert system has been notably slow. Nearly a year passed before the group had a leader in place, and its own prediction failed when it said in October that the system would be coming in two months. Part of the reason for that might be the relationships between media companies and Internet service providers, which in the past have often been adversarial over issues of piracy and control.

So-called graduated response programs like the Copyright Alert System have been tried in other countries, with mixed results. France’s Hadopi law, passed in 2009, set up a system of three “strikes,” culminating in a fine. More than a million warnings have been issued through that plan, but a recent government report said that its effects were “hard to evaluate precisely.”

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Oscars stage manager braces for his final cues to the stars

He delivered a forgotten harmonica to Stevie Wonder onstage at the Grammy Awards, supplied a shoulder to lean on for a post-hip-surgery Gregory Peck at the Oscars and served as a human Xanax for hundreds of other stars in the most terrifying and exhilarating moments of their careers.

Stage manager Dency Nelson, 61, works behind the scenes at the Oscars, plus at times the Grammys, Screen Actors Guild Awards, Teen Choice Awards, MTV Movie Awards and other shows. This year will mark his 25th — and last, he said — Academy Awards, as he plans to retire from one of show business' least known but most stressful gigs.

An anonymous but critical piece of the Hollywood awards season machinery, stage managers like Nelson control the chaos of the live TV broadcast — they deliver the correct winning envelopes, ensure that the pop-up microphone actually pops up and, most delicately, orchestrate the flow of talent through the stage wings.

Oscars 2013: Nominee list | Ballot | Trivia | Timeline

An avuncular former hippie with twinkling green eyes, a silver earring and a scruffy, salt-and-pepper beard, Nelson is stationed in the stage-right wings, a hot spot where most of the Oscar telecast's jittery presenters enter and elated winners exit.

"It's like air traffic control," he said one recent afternoon at the Dolby Theatre at the Hollywood & Highland Center, where he was preparing for Sunday's show. "Ninety percent of the people in the room don't know my name, but when they round the corner and come into the wings there's a smile, 'Oh, that guy.'"

Even seasoned performers rely on stage managers for assurance in the unforgiving medium of live TV, and backstage figures like Nelson develop a rapport with stars they see at multiple shows.

Last year, before Meryl Streep stepped onto the Oscar stage to present an award, she reviewed her script, smoothed her gown and cast a tentative glance at Nelson. "You'll push me out when it's time?" she asked. He gently led the actress by the arm to the edge of the curtain, sending her off to face an audience of 40 million.

An hour later, after winning lead actress for "The Iron Lady," the first person an emotional Streep saw was Nelson, with a chair and a welcome water bottle.

"Dency's businesslike, but he makes people comfortable," said American Film Institute founder George Stevens Jr., who met him when the recent college grad was lugging heavy film reels for the L.A.-based nonprofit. Charmed by the young man's work ethic, nearly four decades later Stevens still hires him to stage-manage the "Kennedy Center Honors" and "Christmas in Washington" shows every year.

Many of the approximately 500-person backstage crew at the Oscars have been performers themselves, including head stage manager Gary Natoli (Nelson's boss) and a stage manager who specializes in talent, Valdez Flagg, both former actors and dancers.

TIMELINE: Academy Award winners

According to guild minimums, the stage managers must make at least $746 for a 12-hour day, and many work other steady jobs. Thanks to the proliferation of performance-based reality shows such as "American Idol" and "The Voice," there's a lot of work available for the specialized group who know how to do it.

Nelson has stage-managed the game show "Let's Make a Deal" and the syndicated variety program "The Wayne Brady Show."

"Anyone can do this job as long as nothing goes wrong," said Flagg. "If you can't go with the flow, you won't last. You'll freak out."

The year Wonder forgot his harmonica, for instance, the Grammys crew had to think quickly — how do you subtly signal a blind man? Ultimately, Nelson asked the director to frame a tight shot on the singer's face while he sneaked up from below and tugged on Wonder's pant-leg. At the Emmys, when an impostor tried to walk off with "Hill Street Blues" star Betty Thomas' trophy, Nelson skidded on stage with another.

And then there's that other occupational hazard: jerks. "People are just nervous in some cases and take it out on you," Nelson said with a shrug.

This year's Oscar telecast is a particularly taxing one for the stage crew, with many singing and dancing casts to maneuver. The consequences of a missed cue can be dire — at several points in the show, 34.5-foot lifts built into the stage floor will open to move scenery pieces.

Nelson, who grew up in Menlo Park the son of an Army auditor, originally wanted to be an actor. As a child he hosted the Andy Williams Christmas show by himself in front of the Christmas tree, with a toilet paper roll as a microphone.

After graduating from UC Santa Cruz with a degree in theater, he took a job as a driver and mail clerk for AFI and worked behind the scenes as "the guy who guarded the doughnuts" for the 1970s soap opera parody "Mary Hartman, Mary Hartman" and a cue card man for "Saturday Night Live" and David Letterman.

Play-at-home ballot: Have you made your picks yet?

Along the way he continued to act in commercials, basement theaters and tiny walk-on roles (in Woody Allen's "Manhattan," you can see Nelson stride across Park Avenue carrying an attaché case). "I wasn't really getting anywhere," he said. "I just saw my actor colleagues, their talent, and saw I'm not that."

The frustrated performance experience, however, gives Nelson a nuanced understanding of what the people he's pushing into the lights on Oscar night are feeling. "There have been plenty of times where I have held a trembling hand and smiled," he said. "I so admire anyone who can do that."

The stage crew prepares with the thoroughness of a military campaign. During rehearsals, Nelson marks his show rundown with different colors of highlighters and pens, noting when he'll send a performer upstage or where a piece of scenery will move. Unlike some younger stage managers, he still uses paper, not an electronic device, for storing his "road map."

In a change this year, six college film students will deliver the trophies onstage, instead of the usual cadre of models who float from show to show. On Wednesday, Nelson was coaching them on the subtle art of statuette distribution.

"Let the kiss and hug happen," he said, his hands stained with red ink from jotting notes on his script, six roles of tape swinging from his belt. "Just linger upstage, let that traffic happen."

At Nelson's first Oscars, before the students were born, Jack Lemmon was the host. Over the years, Nelson said he's noticed an evolution in the awards show scene, as older performers who approached show business with a certain gentility have given way to a more casual and sometimes cruder generation.

"I'm no prude, but there was a certain formality and respect to things," he said. "I'm sorry to see it go, although I understand the financial necessity 'cause it's about the ratings."

A married father of one grown daughter, Nelson lives in Hermosa Beach and is active in Democratic party politics and environmental causes; he helped found a nonprofit devoted to alternative vehicles called Plug in America (he owns two electric cars). Especially engaged in the union to which stage managers belong, the Directors Guild of America, this year he received the guild's Franklin J. Schaffner Award for service.

He said he's retiring to devote more time to his political passions, but he also appears ready to shed the pressures of awards season.

"I don't want to make any mistakes," Nelson said. "The worst is just before the show starts. That's awful. That last hour in the wings.... It's not calm inside. As I am nearing my retirement, I just keep thinking of Jack Nicholson's line in 'Terms of Endearment' ... 'Inches from a clean getaway.'"

Play-at-home ballot: Have you made your picks yet?

rebecca.keegan@latimes.com

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Wired Space Photo of the Day: Glowing Gas in Omega Nebula

This image is a colour composite of the Omega Nebula (M 17) made from exposures from the Digitized Sky Survey 2 (DSS2). The field of view is approximatelly 4.7 x 3.7 degrees.

Image: ESO/Digitized Sky Survey 2. Acknowledgment: Davide De Martin. [high-resolution]

Caption: ESO

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. She said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted over $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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