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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Greek man charged in NY Dali theft pleads guilty

NEW YORK (AP) — A Greek man has admitted to stealing a Salvador Dali painting from a New York City gallery, only to return it in the mail.

Phivos Istavrioglou pleaded guilty on Tuesday following his arrest in the theft of a work titled "Cartel de Don Juan Tenorio."

Prosecutors say the fashion industry publicist walked into the Manhattan gallery in June, put the painting valued at about $150,000 in a shopping bag and walked out. He anonymously mailed the piece back to the United States from Greece after seeing news coverage of the theft.

Under the plea deal, Istavrioglou avoids additional jail time if he remains incarcerated until his formal sentencing on March 12. He also must pay more than $9,000 in restitution.

His lawyer said it was a stupid thing to do.

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What's next for revitalized Chicago Loop?

Michael Edwards has only been in town for a few months, but the new executive director of the Chicago Loop Alliance says the warm reception he's getting makes him feel part of something distinctly Chicago.

There's the strong handshake upon meeting. Direct eye contact. A hearty "Welcome to Chicago," he notes. "It's really a dynamic thing," Edwards says with a laugh. "I get it all the time."

A Buffalo, N.Y., native who took the role in November, Edwards arrived at a crucial time for the alliance, which is charged with representing downtown businesses and promoting the area as a destination to live, work and play. On the rebound from the Great Recession, the Loop is aiming to solidify its place as a hub for businesses, retail and residents — from college students to urban professionals to empty nesters who seek easy access to transportation, Millennium Park and museums.

But the return hasn't been easy. During the economic downturn, vacancies shot up, but a rash of new apartments are under construction in downtown Chicago. Target Corp. filled the long-empty Carson Pirie Scott & Co. storefront with its new urban format on State Street in July, and a few blocks up The Gap will open a new store in the spring. State Street's crown jewel, Block 37, is still trying to land a big tenant to drive more foot traffic to the mall.

Now that vacancies are declining and rents are climbing, Edwards and other civic leaders are aiming to figure out what's next for the business district and State Street retail corridor.

At its annual meeting Tuesday, Edwards and the Chicago Loop Alliance announced development of a five-year strategic plan aimed at clarifying the organization's role in economic development, housing, transportation, tourism, culture and services in the Loop. It's the first ever in the organization's history.

The process will tap input from business owners, elected officials, civic leaders and alliance board members, said Edwards, who held similar positions in Pittsburgh and Spokane, Wash. He replaced executive director Ty Tabing, who left in the summer to head up an economic development organization in Singapore.

The strategic planning process is under way, and a draft is due in June. Oakland, Calif.- based MIG Inc. was hired to assist in developing the new strategy.

With the Loop moving in the right direction, it's time to shift gears and ask residents and business owners what they think of its opportunities and challenges, as well as the role of the alliance, Edwards says.

The need for a new plan is driven in part by Edwards' arrival, but also by the fact that the State Street special service area, one of 44 local tax districts that fund expanded services and programs with a property tax levy, is up for renewal in 2016. The State Street SSA collects about $2.5 million annually.

Part of the planning process will include determining whether the SSA, which is administered by the Chicago Loop Alliance and pays for such services as public way maintenance and district marketing, security and economic development, should be expanded to encompass all of the Loop's business and retail districts, including Dearborn Street and Wabash Avenue as well as North Michigan Avenue, he said.

No decisions have been yet, Edwards said. "We're pretty focused on State Street, but can we provide that level of service to other areas?" he said.

Edwards said the new strategy will also determine whether the alliance, which has an annual budget of about $3.4 million, should take on a larger role as an advocate for the Loop.

"We have a website that's all about our members that gets about 10,000 hits a year, and we need about 2 million hits a year. And we need to control the narrative about what's going on downtown," he said.

With other local organizations such as Choose Chicago and World Business Chicago tasked with touting the region, "Is there a role for us to amplify this notion that we're an authentic American city that's an economic engine for the region?" asked Edwards. "Is there a role for the CLA to help promote that or not?"

If the new focus of the alliance has yet to be determined, Edwards has few opinions. Any new partnerships with other local groups, he said, will have to be formed "organically."

And he predicts the alliance's focus will likely shift to "typical downtown management duties — keeping the area safe and clean," coupled with "a little more economic development sensibility as opposed to an arts sensibility," he said.

For years, the Chicago Loop Alliance has run the PopUp Art Loop program in which public art was showcased in vacant storefronts. But the number of empty retail spaces along State Street has been cut in half, to about six, Edwards said.

Now that State Street has evolved, it's time the alliance's role evolved too, according to officials.

"We're seeing a lot of tremendous opportunities for growth in the Loop, whether it's in retail, new companies coming downtown, new residents or tourism," said Martin Stern, executive vice president and managing director at US Equities Realty and board chairman of the Chicago Loop Alliance.

Added Edwards: "There's a sort of feeling that we need to be more focused, provide more value, provide more leadership."

crshropshire@tribune.com

Twitter @corilyns

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HP sells webOS operating system to LG Electronics

SAN FRANCISCO (Reuters) - Hewlett-Packard Co said on Monday it will sell the webOS operating system to South Korea's LG Electronics Inc, unloading the smartphone software it acquired through a $1.2 billion acquisition of Palm in 2010.

LG will use the operating software, used in now-defunct Palm smartphones years ago, for its "smart" or Internet-connected TVs. The Asian electronics company had worked with HP on WebOS before offering to buy it outright.

Under the terms of their agreement, LG acquires the operating software's source code, associated documentation, engineering talent, various associated websites, and licenses under HP's intellectual property including patents covering fundamental operating system and user interface technology.

HP will retain the patents and all the technology relating to the cloud service of webOS, HP Chief Operating Officer Bill Veghte said in an interview.

"As we looked at it, we saw a very compelling IP that was very unique in the marketplace," he said, adding that HP has already had a partnership with LG on webOS before the deal was announced.

"As a result of this collaboration, LG offered to acquire the webOS operating system technology," Veghte said.

Skott Ahn, President and CTO, LG Electronics, said the company will incorporate the operating system in the Smart TV line-up first "and then hopefully all the other devices in the future."

Both companies declined to reveal the terms of the deal.

LG will keep the WebOS team in Silicon Valley and, for now, will continue to be based out of HP offices, Ahn said.

HP opened its webOS mobile operating system to developers and companies in 2012 after trying to figure out how to recoup its investment in Palm, one of the pioneers of the smartphone industry.

The company had tried to build products based on webOS with the now-defunct TouchPad tablet its flagship product.

HP launched and discontinued the TouchPad in 2010, a little over a month after it hit store shelves with costly fanfare after it saw poor demand for a tablet priced on par with Apple's dominant iPad.

WebOS is widely viewed as a strong mobile platform, but has been assailed for its paucity of applications, an important consideration while choosing a mobile device.

(Additional reporting By Paul Sandle and Alistair Barr; Editing by Gerald E. McCormick, Tim Dobbyn and M.D. Golan)

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AP source: Tom Brady gets 3-year extension

Tom Brady will be a Patriot until he is 40 years old.

Brady agreed to a three-year contract extension with New England on Monday, a person familiar with the contract told The Associated Press. The extension is worth about $27 million and will free up nearly $15 million in salary cap room for the team, which has several younger players it needs to re-sign or negotiate new deals with.

The person spoke on condition of anonymity because the extension has not been announced.

Sports Illustrated first reported the extension.

The 35-year-old two-time league MVP was signed through 2014, and has said he wants to play at least five more years.

A three-time Super Bowl champion, Brady will make far less in those three seasons than the going rate for star quarterbacks. Brady currently has a four-year, $72 million deal with $48 million guaranteed.

Drew Brees and Peyton Manning are the NFL's highest-paid quarterbacks, at an average of $20 million and $18 million a year, respectively.

Brady has made it clear he wants to finish his career with the Patriots, whom he led to Super Bowl wins for the 2001, 2003 and 2004 seasons, and losses in the big game after the 2007 and 2011 seasons. By taking less money in the extension and redoing his current contract, he's hopeful New England can surround him with the parts to win more titles.

Among the Patriots' free agents are top receiver Wes Welker and his backup, Julian Edelman; right tackle Sebastian Vollmer; cornerback Aqib Talib; and running back Danny Woodhead.

Brady has been the most successful quarterback of his era, of course, as well as one of the NFL's best leaders. His skill at running the no-huddle offense is unsurpassed, and he's easily adapted to the different offensive schemes New England has concentrated on through his 13 pro seasons.

The Patriots have gone from run-oriented in Brady's early days to a deep passing team with Randy Moss to an offense dominated by throws to tight ends, running backs and slot receivers.

Brady holds the NFL record for touchdown passes in a season with 50 in 2007, when the Patriots went 18-0 before losing the Super Bowl to the Giants. He has thrown for at least 28 touchdowns seven times and led the league three times.

Last season, Brady had 34 TD passes and eight interceptions as the Patriots went 12-4, leading the league with 557 points, 76 more than runner-up Denver.

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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."

___

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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Singer Morrissey says no to Kimmel, 'Duck Dynasty'

LOS ANGELES (AP) — The TV series "Duck Dynasty" is coming between Morrissey and Jimmy Kimmel.

The singer and animal rights activist says he canceled his appearance Tuesday on ABC's "Jimmy Kimmel Live" because "Duck Dynasty" cast members will be on the talk show.

Morrissey says he can't perform on a show with what he called people who "amount to animal serial killers."

A&E's "Duck Dynasty" reality show follows a Louisiana family with a business selling duck calls and decoys.

A&E did not immediately respond to requests for comment from it and the Robertson family.

A person familiar with the Kimmel show's plans confirmed that Morrissey was to appear. The person lacked authority to discuss the matter publicly and spoke on condition of anonymity.

The person says Morrissey's performance will be rescheduled.

ABC says the Churchill band will perform Tuesday on Kimmel's show but declined comment on the switch.

___

Reach AP Television Writer Lynn Elber at http://www.twitter.com/lynnelber .

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5 of top 15 teaching hospitals in Chicago area

By Peter Frost




Tribune reporter

11:27 a.m. CST, February 25, 2013

Five of the country's top 15 major teaching hospitals are in the Chicago area, according to an annual study released Monday that evaluates performance in 10 categories of publicly available data.

The study, conducted by Truven Health Analytics, the former health care business of Thomson Reuters, listed seven Chicagoland hospitals among the nation's top 100, including four owned by Advocate Health Care.

Researchers evaluated 2,922 acute-care hospitals using information from the federal Centers for Medicare and Medicaid Services, including cost, patient satisfaction and quality measures, such as re-admission rates, patient safety, mortality and medical complications.  Hospitals do not apply or pay for inclusion on the list, which has been produced since 1993.

The seven Illinois hospitals that made the Top 100

• Advocate Christ Medical Center in Oak Lawn


• Advocate Illinois Masonic Medical Center in Chicago


• Advocate Lutheran General Hospital in Park Ridge


• Advocate Good Samaritan Hospital in Downers Grove


• Central DuPage Hospital in Winfield


• NorthShore University HealthSystem in Evanston


• Northwestern Memorial Hospital in Chicago

pfrost@tribune.com | Twitter: @peterfrost

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State lawmaker's bill seeks to limit use of drones to fight crime

SPRINGFIELD — As the Obama administration comes under fire for its use of unmanned drones in foreign lands, a state senator is pressing to have Illinois join the national debate on whether states should regulate drones to ensure the high-tech snooping isn't used to invade the privacy of ordinary citizens on U.S. soil.

Democratic Sen. Daniel Biss has introduced legislation that would require police to get a search warrant before using a drone to gather evidence. Along with banning the use of lethal and nonlethal weapons on the drones — except in emergencies — the proposal would require information a drone gathers to be destroyed unless it is part of an investigation.

Under the legislation, Illinois would step up to combat the issue of drones flying over U.S. airspace. President Barack Obama signed a Federal Aviation Administration mandate last year requesting the agency integrate unmanned aircraft into the national system.

With the possibility of drones becoming the latest aircraft traversing the skies, Biss said this is "the exact moment states should be looking into" unmanned aircraft legislation.

"We're heading into a world where technology surveillance is unreal," the Evanston lawmaker said.

More than 20 states are pursuing similar legislation, according to the National Conference of State Legislatures. While some states are trying to regulate unmanned aircraft use, others are trying to impose moratoriums that ban them, Biss said.

Virginia lawmakers approved a two-year moratorium on the aircraft in the state last week to allow time for a study. The legislation awaits the governor's signature.

In Illinois, authorities in Cook and Champaign counties are considering the use of drones to combat crime.

Cook County Sheriff Tom Dart is in the "exploratory stages" of looking into drone technology for future operations, spokesman Frank Bilecki said. If the county were to employ any drones, they would be "specifically for law enforcement use" and not to invade personal privacy, Bilecki said.

Dart's thinking is that drones would be cheaper to use and cost less taxpayer money than using helicopters for aerial operations, Bilecki said. A small, unmanned aircraft used for search and rescue can cost on average between $38,000 and $50,000, much less than in years past, said James Hill, president of AirCover Integrated Solutions, a California-based drone manufacturer.

To gain traction at the Capitol, Biss potentially might have to overcome resistance from law enforcement leaders. To that end, Biss said he's talking with police chiefs, the Illinois State Police and other police agencies to iron out any wrinkles.

The American Civil Liberties Union thinks the time is ripe to look at drone regulations.

"Technology is changing," said Ed Yohnka, spokesman for the ACLU's Illinois chapter. "And the idea is we need to get ahead of the technology to be better prepared."

raguerrero2@tribune.com

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Apple signals emerging-market rethink with India push

NEW DELHI/BANGALORE (Reuters) - As BlackBerry launches the first smartphone from its make-or-break BB10 line in India, one of its most loyal markets, the company faces new competition from a formidable rival that has long had a minimal presence in the country.

More than four years after it started selling iPhones in India, Apple Inc is now aggressively pushing the iconic device through installment payment plans that make it more affordable, a new distribution model and heavy marketing blitz.

"Now your dream phone" at 5,056 rupees ($93), read a recent full front-page ad for an iPhone 5 in the Times of India, referring to the initial payment on a phone priced at $840, or almost two months' wages for an entry-level software engineer.

The new-found interest in India suggests a subtle strategy shift for Apple, which has moved tentatively in emerging markets and has allowed rivals such as Samsung and Blackberry to dominate with more affordable smartphones. With the exception of China, all of its Apple stores are in advanced economies.

Apple expanded its India sales effort in the latter half of 2012 by adding two distributors. Previously it sold iPhones only through a few carriers and stores it calls premium resellers.

The result: iPhone shipments to India between October and December nearly tripled to 250,000 units from 90,000 in the previous quarter, according to an estimate by Jessica Kwee, a Singapore-based analyst at consultancy Canalys.

At The MobileStore, an Indian chain owned by the Essar conglomerate, which says it sells 15 percent of iPhones in the country, iPhone sales tripled between December and January, thanks to a monthly payment scheme launched last month.

"Most people in India can't afford a dollar-priced phone when the salaries in India are rupee salaries. But the desire is the same," said Himanshu Chakrawarti, its chief executive.

Apple, the distributors, retailers and banks share the advertising and interest cost of the marketing push, according to Chakrawarti. Carriers like Bharti Airtel Ltd, which also sell the iPhone 5, run separate ads.

India is the world's No. 2 cellphone market by users, but most Indians can't afford fancy handsets. Smartphones account for just a tenth of total phone sales. In India, 95 percent of cellphone users have prepaid accounts without a fixed contract. Unlike in the United States, carriers do not subsidize handsets.

Within the smartphone segment, Apple's Indian market share last quarter was just 5 percent, according to Canalys, meaning its overall penetration is tiny.

Still, industry research firm IDC expects the Indian smartphone market to grow more than five times from about 19 million units last year to 108 million in 2016, which presents a big opportunity.

Samsung Electronics dominates Indian smartphone sales with a 40 percent share, thanks to its wide portfolio of Android devices priced as low as $110. The market has also been flooded by cheaper Android phones from local brands such as Micromax and Lava.

Most smartphones sold in India are much cheaper than the iPhone, said Gartner analyst Anshul Gupta.

"Where the masses are - there, Apple still has a gap."

'I LOVE INDIA, BUT...'

Apple helped create the smartphone industry with the iPhone in 2007. But last year Apple lost its lead globally to Samsung whose smartphones, which run Google's free Android software, are especially attractive in Asia.

Many in Silicon Valley and Wall Street believe the surest way to penetrate lower-income Asian markets would be with a cheaper iPhone, as has been widely reported but never confirmed. The risk is that a cheap iPhone would cannibalize demand for the premium version and eat into Apple's peerless margins.

The new monthly payment plan in India goes a long way to expanding the potential market, said Chakrawarti.

"The Apple campaign is not meant for really the regular top-end customer, it is meant to upgrade the 10,000-12,000 handset guy to 45,000 rupees," he said.

Apple's main focus for expansion in Asia has been Greater China, including Taiwan and Hong Kong, where revenue grew 60 percent last quarter to $7.3 billion.

Asked last year why Apple had not been as successful in India, Chief Executive Tim Cook said its business in India was growing but the group remained more focused on other markets.

"I love India, but I believe that Apple has some higher potential in the intermediate term in some other countries," Cook said. "The multi-layer distribution there really adds to the cost of getting products to market," he said at the time.

Apple, which has partly addressed that by adding distributors, did not respond to an email seeking comment.

Ingram Micro Inc, one of its new distributors, also declined comment. Executives at Redington (India) Ltd, the other distributor, could not immediately be reached.

BlackBerry, which has seen its global market share shrivel to 3.4 percent from 20 percent over the past three years, is making what is seen as a last-ditch effort to save itself with the BB10 series.

The high-end BlackBerry Z10 to be launched in India on Monday is expected to be priced not far from the 45,500 rupees price tag for an iPhone 5 with 16 gigabytes of memory. Samsung's Galaxy S3 and Galaxy Note 2, Nokia's Lumia 920 and two HTC Corp models are the main iPhone rivals.

Until last year, Blackberry was the No. 3 smartphone brand in India with market share of more than 10 percent, thanks to a push into the consumer segment with lower-priced phones. Last quarter its share fell to about 5 percent, putting it in fifth place, according to Canalys. Apple was sixth.

(This story is corrected in para 16 to make clear that Google owns Android software)

(Additional reporting by Aradhana Aravindan in MUMBAI and Poornima Gupta in SAN FRANCISCO; Editing by Tony Munroe and Mark Bendeich)

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