John Makely / NBC News

Sisters Cathy Balsamo, left, Patti Broccoli, center, and Cindy Lepore, right, have all tested positive for the BRCA1 genetic mutation that raises the risk of breast and ovarian cancer. All three sisters have had preventive surgery to have their breasts and ovaries removed. Two weeks after her surgery, Broccoli was diagnosed with breast cancer.

Actress Angelina Jolie’s revelation this week that she’d had both breasts removed to lower her elevated risk of cancer came as a bombshell to many -- but not to three sisters from Berkeley Heights, N.J.

The women -- Cathy Balsamo, Cindy Lepore and Patti Broccoli -- have spent most of the past year grappling with the very dilemma that Jolie faced: What to do when a genetic mutation means you’ve got a sky-high chance of breast or ovarian cancer?

“Rich, poor, famous, not famous -- it’s the same decision,” said Balsamo, 46, who was the first to learn last spring that she had a mutation of the BRCA1 gene, which boosts the risk of both kinds of cancer.

“It doesn’t make it easier or harder.”

The family -- which includes the three sisters and a brother, Joseph Zichichi, 48 -- offers an extreme example of the issues now illuminated by Jolie’s spotlight. 

Like Jolie, all three women opted for preventive double mastectomies. Unlike Jolie, who’s 37, the 40-something sisters also all had concurrent operations to remove their ovaries. Jolie wrote in the New York Times that she plans to have that surgery later.

“The option of waiting and watching was never an option,” said Broccoli, a 49-year-old nurse. “Why would we wait for cancer?”

Though their mother, Patricia Zichichi, had always warned of a family history rife with cancer -- a grandmother and two great-aunts died young of what was then called “women’s cancer” -- the sisters didn’t know about their actual genetic risk until Balsamo asked her doctor to perform the BRCA test in April 2012.

“He was just so upset and said ‘I hate to have to tell you this,’” recalled Balsamo, who is an activity director at a nursing home. “Immediately, when he said BRCA1, breast and ovarian, I said, ‘I’m getting a double mastectomy and a hysterectomy.”

Within weeks, her sisters had the same test -- with the same results. It’s not surprising that all three women would turn up positive for BRCA mutations, said Dr. Larissa Korde, a breast cancer specialist at the Seattle Cancer Care Alliance in Washington. If one parent carries the defective gene, there’s 50 percent chance any child will get it.

“Sometimes you see it in families where everybody’s got it,” Korde said. “It’s just chance.”

A woman with a harmful BRCA1 or BRCA2 mutation has a 60 percent chance of developing breast cancer during her lifetime, about five times higher than the overall rate of 12 percent, cancer experts say. She has a 15 percent to 40 percent lifetime chance of getting ovarian cancer, compared with about 1.4 percent in the general population.

With those odds, the sisters opted for surgery within months of each other. Lepore, 42, a respiratory therapist who has type 1 diabetes, had her initial and reconstruction surgeries last October. Broccoli had her surgery in January and Balsamo followed in February.

Ironically, Broccoli’s preventive surgery actually may have saved her life. Two weeks after her double mastectomy in January, she was diagnosed with breast cancer -- but at such an early stage her chance of cure is very good. A mammogram and two MRIs before surgery had suggested strongly she was cancer-free, but doctors detected ductal disease after Broccoli's operation. 

“I consider it a blessing,” said Broccoli, who lost her hair to three rounds of chemotherapy. “I know what could have happened if it hadn’t been caught early.”

Rates of women opting for preventive mastectomies have risen by as much as 50 percent in recent years, cancer experts estimate. That's despite the small chance of getting cancer anyway, the risk of major surgery and the fact that there are alternatives, including drugs and careful monitoring. 

Still, some women who learn of BRCA mutations are devastated by the information -- and by the dilemma of whether to have surgery, Korde said. “I’ve definitely had women who were through childbearing and who feel emotionally conflicted about losing their breasts.”

But the New Jersey sisters aren’t among them. “For me, it was a no-brainer,” Balsamo said. “The good of it outweighed the bad. So I don’t have terrific boobs. I’ll never have nipples. I didn’t have that emotional thing.”

John Makely / NBC News

The sisters all live within a mile of each other in Berkeley Heights, N.J. They say they've supported each other through the ordeal.

What does make them emotional, the sisters said, is what the genetic legacy might mean for the rest of the family. Joe Zichichi is scheduled to be tested for BRCA mutations soon, too, the women said.

The results could have implications for him in the form of an increased risk of pancreatic, prostate or other cancers, doctors say.

“There’s more to BRCA genes than breast and ovary cancer,” said Dr. Eileen O’Reilly, a gastrointestinal cancer specialist at Memorial Sloan Kettering Cancer Center in New York. “As much as 5 percent of pancreatic cancer risk might be related to BRCA mutations.”

But the family is especially concerned about possible future effects on their children. They all live within a mile of each other; there are 13 grandchildren in the family, including Joe Zichichi’s four daughters.

Two of the granddaughters are in their early 20s. The U.S. Preventive Services Task Force recommends BRCA testing only for women with a strong family history of cancer, about 2 percent of all women in the U.S. But for those with that high risk, testing can be done at age 25.

Whether such young women choose to be tested -- and what action they’ll take afterward -- is something serious to ponder, the sisters said. 

“We have a good four years to figure this out,” said Balsamo. “God willing there will be something in that period of time that helps our daughters deal with it.”

It’s not clear when Jolie learned of her genetic risk or how long it took to decide that surgery was the best option. Her decision has prompted a flood of calls and inquiries to cancer centers nationwide, including Korde’s, and to geneticists, said Dr. Michael Watson, executive director of the American College of Medical Genetics and Genomics.

The New Jersey sisters said they’re grateful for the awareness that Jolie’s decision brings to an issue that has become central to their daily lives.

“I was actually very happy,” said Lepore. “In this world, it takes someone like Angelina Jolie to get recognition of important things.”

What choice would you make if you had a BRCA mutation, dramatically raising your cancer risk? Talk about it on Facebook.

Related stories: 

• More women opting for preventive mastectomy -- but should they be?
• Angelina Jolie: I had a double mastectomy because of high breast cancer risk
• Doctors detail Angelina Jolie's breast cancer surgery

Angelina Jolie says she has undergone a preventive double mastectomy after being told that she had an 87 percent risk of breast cancer, along with a 50 percent risk of ovarian cancer.

In an article published in the opinion section of Tuesday's New York Times, Jolie said her decision was informed by her mother's long fight against cancer. Marcheline Bertrand died in 2007 at age 56.

Jolie said she hoped that other women would find encouragement from her story. 

"I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer," Jolie said in the Times article. "It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options." 

Jolie, an Oscar-winning actress and activist, said she carries a gene, BRCA1, that increases the risk of breast and ovarian cancer. According to Jolie and a fact sheet from the Cancer Institute at Stanford Medicine, women with the BRCA1 gene have an average of a 65 percent lifetime risk for breast cancer, along with heightened risk of the cancer at an early age. Jolie is 37. 

Jolie said three months of medical procedures that the mastectomies involved were completed April 27. She said the surgery included implants to reconstruct her breasts.

She said that her partner, Brad Pitt, was present for the surgeries. She said her six children, who range in age from 11 to 4, saw nothing that made them uncomfortable.

"They can see my small scars and that’s it," Jolie wrote. "Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can."

Other famous women with the BRCA1 or BRCA2 genes have undergone preventive double mastectomies, including reality star Sharon Osbourne, wife of rocker Ozzy.

"I've had cancer before and I didn't want to live under that cloud," Osborne said in an interview last fall.

In January, Miss America contestant Allyn Rose, representing the District of Columbia, announced that she carries another genetic mutation -- not BRCA1 or BRCA2 -- and plans to have a double mastectomy after her year of serving as Miss D.C.

Friends and fans were quick to support Jolie via messages on Twitter. Actress Marlee Matlin called her "brave, honest (and) strong." And "Veronica Mars" star Kristen Bell praised Jolie's article as "admirable."

Slideshow: Angelina Jolie

Toby Melville / Reuters

Highlights from her Oscar-winning acting career, family life with Brad Pitt and worldwide humanitarian efforts.

Launch slideshow

Related stories:

Some cancer patients may face high drug costs under new health care law

Jolie isn't alone: Other celebrities have battled breast cancer

Cancer patients could face high costs for medications under President Barack Obama's health care law, industry analysts and advocates warn.

Where you live could make a huge difference in what you'll pay.

To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.

Such "specialty drugs" can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month's supply, says the Leukemia & Lymphoma Society.

New York is taking a different approach, setting flat dollar copayments for medications. The highest is $70, and it would apply to specialty drugs as well.

Critics fear most states will follow California's lead, and that could defeat the purpose of Obama's overhaul, because some of the sickest patients may be unable to afford their prescriptions.

"It's important that the benefit design not discriminate against people with chronic illness, and high copays do that," said Dan Mendelson, president of Avalere Health, a data analysis firm catering to the health care industry and government.

Avalere's research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.

"You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill," Mendelson said. "It's going to be very important for states to take a long, hard look at their benefit design."

Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.

A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.

"We are trying to keep the insurance affordable across the board," said Dana Howard, the group's spokesman. "This is just part of trying to manage the overall risk of the pool." Covered California is one of the new state marketplaces where people who don't get coverage on the job will be able to shop for private insurance starting this fall. Coverage takes effect Jan. 1.

Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them. The Obama administration says the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance. And officials say it's important to realize that the law sets overall limits on patients' liability, even if those seem high to some people. Still, a full picture of costs and benefits isn't likely to come into focus until the fall.

Howard said California officials are aware of the concerns about drug costs and are trying to make medications more affordable.

Meanwhile, he said consumers will be protected because the law limits total out-of-pocket costs — the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people. Once that limit is reached, insurance pays 100 percent.

That's still a lot of money, and such reassurances haven't dispelled the concerns.

"The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. He adds that there is a danger that the insurance marketplaces "will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA."

The group has been joined by Rep. Doris Matsui, D-Calif., in urging state officials to reconsider the policy. The high copays "could prevent many patients from receiving the lifesaving treatments they need because of prohibitively high cost," Matsui wrote to the state.

The problem with costly drugs is similar to another money issue with the health care law — a provision that could price millions of smokers out of coverage. Insurers are allowed to charge tobacco users buying an individual policy up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium. California is trying to override that problem by passing its own law. There's also pending state legislation to address some issues with prescription costs, but its prospects are unclear.

Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she's now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.

"I'm scared that when I get a job my copay may be more than $1,500 a month," said Lusk. "I'll just be working to pay for my medications."

Men who are overweight are more likely to have precancerous lesions detected in a benign prostate biopsy and are at a greater risk for subsequently developing prostate cancer, a new study shows.

“It is absolutely clear that obesity increases a man’s risk of dying from prostate cancer,” said Dr. Andrew Rundle, associate professor of epidemiology at Columbia University’s Mailman School of Public Health in New York City, who conducted the study.

But, he told NBCNews.com, “We don’t know if obesity causes it (prostate cancer) or makes it harder to treat.” Rundle’s study was published on Tuesday in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

He noted that being overweight is known to cause five cancers -- post-menopausal breast, colon, kidney, endometrial (uterus) and esophageal. Cancer of the prostate -- the gland that releases the male hormone, testosterone, into the body -- is the leading diagnosed cancer in men and the second leading cancer killer of men behind lung cancer.

According to the American Cancer Society, 28,000 men died of it last year in the United States and over 238,000 new cases will be detected in the country this year.

"Studies conducted in the past have attempted to determine if there are subpopulations of men diagnosed with benign conditions that may be at a greater risk for developing prostate cancer,” Rundle said. “This is one of the first studies to assess the association between obesity and precancerous abnormalities."

Rundle and his colleagues studied obesity and future prostate cancer incidence in 6,692 men at the Henry Ford Health System who were followed for 14 years after a biopsy or transurethral resection of the prostate with benign findings. To determine obesity, he used the standard Body Mass Index, which factors in weight and height combined. Taking an average BMI of 30, Rundle said about one-third of the U.S population is considered obese.

The researchers conducted a case-control study among 494 of these patients and 494 matched controls; they found precancerous abnormalities in 11 percent of the patients' benign specimens. These abnormalities were significantly associated with obesity at the time of the procedure, according to Rundle.

After accounting for variables, including family history of prostate cancer, prostate-specific antigen (PSA) levels in the blood, and the number of PSA tests and digital rectal exams during follow-up, the researchers found that obesity at the time of the initial procedure was associated with a 57 percent increased incidence of prostate cancer during follow-up.

Generally, a biopsy will be performed after a high PSA level, or if a doctor can detect a hardening of the prostate during a digital rectal examination. The biopsy takes minute slivers of tissue from the gland to test for cancerous cells. But it can be inaccurate, depending on where the tissues are taken from, and can miss cancerous cells.

“It is possible that the tumors missed by initial biopsy grew and were detected in a follow-up biopsy," Rundle said.

Helena Furberg, associate attending epidemiologist at Memorial Sloane-Kettering Cancer Center in New York City, said Rundle's findings represented "a significant research study" at a time of controversy over whether obesity is associated with the risk of prostate cancer.

“Now, future studies should look at the question: does losing weight decrease the risk of prostate cancer?” she said in an interview with NBCNews.com.

Furberg also noted the study shows how the accuracy of a biopsy can be affected and fail to detect pre-cancerous lesions in obese patients who have a larger prostate. “In future, clinicians should take into consideration the size of the patients,” she said.

Dr. Marcus Quek, associate professor of urology at Loyola University Medical Center outside Chicago, said previous studies have come to conflicting conclusions about how obesity and prostate cancer may be related.

“This study tells us more work needs to be done on the link between obesity and cancer,” he said. “And if we find they are related, whether we can modify the risk.”

Quek noted Dr. Rundle’s study had found lesions during follow-ups, indicating that they had been missed in the initial biopsy.

“Biopsies are only so accurate,” Quek said. ”People have looked at ways to improve prostate biopsies, with MRI and other imaging technology.”

“But right now, they are only as accurate as where they put the needles.”

No one under 21 would be able to buy cigarettes in New York City, under a new proposal announced Monday that marks the latest in a decade of moves to crack down on smoking in the nation's largest city.

New York City Council Speaker Christine Quinn discussed details of a proposed law that would raise the minimum age for tobacco purchases from 18 to 21. City Health Commissioner Dr. Thomas Farley, some of Quinn's fellow City Council members and health advocates were to join her.

Under federal law, no one under 18 can buy tobacco anywhere in the country, but some states and localities have raised it to 19. Texas lawmakers recently tried to increase the minimum age to 21, but the plan stalled.

Public health advocates say a higher minimum age discourages, or at least delays, young people from starting smoking and thereby limits their health risks. But opponents of such measures have said 18-year-olds, legally considered adults, should be able to make their own decisions about whether or not to smoke.

Some communities, including Needham, Mass., have raised the minimum age to 21, but New York would be the biggest city to do so.

"With this legislation, we'll be targeting the age group at which the overwhelming majority of smokers start," Quinn said.

Officials say 80 percent of NYC smokers started before age 21, and an estimated 20,000 New York City public high school students now smoke. While it's already illegal for many of them to buy cigarettes, officials say this measure would play a key role by making it illegal for them to turn to slightly older friends to buy smokes for them. The vast majority of people who get asked to do that favor are between 18 and 21 themselves, city officials say.

"We know that enforcement is never going to be perfect," but this measure should make it "much harder" for teens to get cigarettes, Farley said.

The Richmond, Va.-based Altria Group Inc., parent company of Philip Morris USA, which makes the top-selling Marlboro brand, had no immediate comment, said spokesman David Sutton. He previously noted that the company supported federal legislation that in 2009 gave the Food and Drug Administration the power to regulate tobacco products, which includes various retail restrictions.

Under Mayor Michael Bloomberg and the health commissioners he has appointed, including Farley, New York has rolled out a slate of anti-smoking initiatives.

Bloomberg, a billionaire who has given $600 million of his own money to anti-smoking efforts around the world, began taking on tobacco use in the city shortly after he became mayor in 2002.

Over his years in office, the city — at times with the council's involvement — helped impose the highest cigarette taxes in the country, barred smoking at parks and on beaches and conducted sometimes graphic advertising campaigns about the hazards of smoking.

Last month, the Bloomberg administration unveiled a proposal to keep cigarettes out of sight in stores until an adult customer asks for a pack, as well as stopping shops from taking cigarette coupons and honoring discounts.

Bloomberg's administration and public health advocates praise the initiatives as bold moves to help people live better. Adult smoking rates in the city have fallen from 21.5 percent in 2002 to 14.8 percent in 2011, Farley has said.

But the measures also have drawn complaints, at least initially, that they are nannyish and bad for business.

Several of New York City's smoking regulations have survived court challenges. But a federal appeals court said last year that the city couldn't force tobacco retailers to display gruesome images of diseased lungs and decaying teeth.

Quinn, a leading Democratic candidate to succeed Bloomberg next year, has often been perceived as an ally of his.

Bloomberg also has pushed a number of other pioneering public-health measures, such as compelling chain restaurants to post calorie counts on their menus, banning artificial trans fats in restaurants, and attempting to limit the size of sugary drinks. A court struck down the big-beverage rule last month, but the city is appealing and Bloomberg has urged voluntary compliance in the meantime.

While Bloomberg has led the way on many anti-smoking initiatives, this one arose from the City Council, Farley said. City Councilman James Gennaro, who lost his mother to lung cancer after she smoked for decades, has been a particularly strong advocate.

Related:

Smokers have worse colon cancer prognosis

By Marilynn Marchione, Associated Press

Cancer and heart disease are bigger killers, but Alzheimer's is the most expensive malady in the U.S., costing families and society $157 billion to $215 billion a year, according to a new study that looked at this in unprecedented detail.

The biggest cost of Alzheimer's and other types of dementia isn't drugs or other medical treatments, but the care that's needed just to get mentally impaired people through daily life, the nonprofit RAND Corp.'s study found.

It also gives what experts say is the most reliable estimate for how many Americans have dementia — around 4.1 million. That's less than the widely cited 5.2 million estimate from the Alzheimer's Association, which comes from a study that included people with less severe impairment.

"The bottom line here is the same: Dementia is among the most costly diseases to society, and we need to address this if we're going to come to terms with the cost to the Medicare and Medicaid system," said Matthew Baumgart, senior director of public policy at the Alzheimer's Association.

Dementia's direct costs, from medicines to nursing homes, are $109 billion a year in 2010 dollars, the new RAND report found. That compares to $102 billion for heart disease and $77 billion for cancer. Informal care by family members and others pushes dementia's total even higher, depending on how that care and lost wages are valued.

"The informal care costs are substantially higher for dementia than for cancer or heart conditions," said Michael Hurd, a RAND economist who led the study. It was sponsored by the government's National Institute on Aging and will be published in Thursday's New England Journal of Medicine.

Alzheimer's is the most common form of dementia and the sixth leading cause of death in the United States. Dementia also can result from a stroke or other diseases. It is rapidly growing in prevalence as the population ages. Current treatments only temporarily ease symptoms and don't slow the disease. Patients live four to eight years on average after an Alzheimer's diagnosis, but some live 20 years. By age 80, about 75 percent of people with Alzheimer's will be in a nursing home compared with only 4 percent of the general population, the Alzheimer's group says.

"Most people have understood the enormous toll in terms of human suffering and cost," but the new comparisons to heart disease and cancer may surprise some, said Dr. Richard Hodes, director of the Institute on Aging.

"Alzheimer's disease has a burden that exceeds many of these other illnesses," especially because of how long people live with it and need care, he said.

For the new study, researchers started with about 11,000 people in a long-running government health survey of a nationally representative sample of the population. They gave 856 of these people extensive tests to determine how many had dementia, and projected that to the larger group to determine a prevalence rate — nearly 15 percent of people over age 70.

Using Medicare and other records, they tallied the cost of purchased care — nursing homes, medicines, other treatments — including out-of-pocket expenses for dementia in 2010. Next, they subtracted spending for other health conditions such as high blood pressure, diabetes or depression so they could isolate the true cost of dementia alone.

"This is an important difference" from other studies that could not determine how much health care cost was attributable just to dementia, said Dr. Kenneth Langa, a University of Michigan researcher who helped lead the work.

Even with that adjustment, dementia topped heart disease and cancer in cost, according to data on spending for those conditions from the federal Agency for Healthcare Research and Quality.

Finally, researchers factored in unpaid care using two different ways to estimate its value — foregone wages for caregivers and what the care would have cost if bought from a provider such as a home health aide. That gave a total annual cost of $41,000 to $56,000 per year for each dementia case, depending on which valuation method was used.

"They did a very careful job," and the new estimate that dementia affects about 4.1 million Americans seems the most solidly based than any before, Hodes said. The government doesn't have an official estimate but more recently has been saying "up to 5 million" cases, he said. 

The most worrisome part of the report is the trend it portends, with an aging population and fewer younger people "able to take on the informal caregiving role," Hodes said. "The best hope to change this apparent future is to find a way to intervene" and prevent Alzheimer's or change its course once it develops, he said.

AP

Hua Jun Zhao, 42-year-old researcher at the Medical College of Wisconsin, is charged with espionage after prosecutors say he stole details of a cancer-fighting compound that he wanted to share with China.

When three vials of a possible cancer-fighting compound disappeared recently from a professor's desk at the Medical College of Wisconsin, suspicion quickly fell on a research assistant who had been working in the scientist's lab.

Security video showed Hua Jun Zhao, who studied in China and whose wife lives there, was the only person who entered the professor's office that day. Investigators later found research results from another professor on Zhao's computer.

Zhao has been charged in a federal complaint with economic espionage, accused by prosecutors stealing academic research to pass off as his own in China. Prosecutors said he hoped to study the compound and other materials at Zhejiang University, one of several Chinese schools that have been troubled by plagiarism, fraud and academic misconduct.

Zhao, 42, worked on a team led by professor Marshall Anderson, who is researching whether the compound can help kill cancer cells without damaging healthy ones, school spokeswoman Maureen Mack said. The compound is still being studied in a lab and has not yet advanced to clinical testing, she said.

The stolen vials of the C-25 powder are worth $8,000, the complaint said. Leonard Peace, an FBI spokesman in Milwaukee, said he couldn't comment beyond what was in the complaint, except to confirm the vials had not been recovered.

Anderson noticed the vials missing on Feb. 22. School security video showed Zhao was the only person who entered Anderson's office that day. Federal investigators questioned him about the vials on Feb. 27, but Zhao claimed he did not understand their questions, the complaint said. The school immediately placed him on administrative leave.

Zhao's co-workers told the FBI that Zhao spoke excellent English and he had lived in the U.S. for many years. Mack declined to say how long Zhao worked at the school and would not provide details of his immigration status, referring questions to the FBI.

Zhao was arrested March 29 and charged with economic espionage, which carries a maximum penalty of 15 years in prison and a $500,000 fine. A judge on Monday ordered him held at Milwaukee County Jail until trial. No trial date has been set but a preliminary hearing is scheduled for April 11.

Zhao's public defender, Juval Scott, said it was too early to comment on the case.

"Right now I know that a talented professional has been accused of a serious crime," she said in an email, "and our office looks forward to rolling up our sleeves and working on his behalf."

Zhao traveled to China in December. Since his return in mid-February, he has claimed on his resume that he's an assistant professor at Zhejiang University, the complaint said. Zhejiang University has had previous problems with theft. He Haibo, an associate professor in its College of Pharmaceutical Sciences, was fired in 2009 after it was discovered he had published papers with data stolen from a professor when he was a doctoral student at another Chinese university.

Academic plagiarism and fraud has been a problem in China, where some say professors are given an incentive to cheat because they're often evaluated on the number, rather than the quality, of papers published.

Mark Frankel, director of the American Association for the Advancement of Science's scientific responsibility, human rights and law program, said American universities are vulnerable to theft because there is a culture of openness. Scientists often share research in an effort to verify and reproduce each other's discoveries, he said, adding that the risk also has become greater since the 1980s as universities partner with companies on work that they plan to patent and market.

"As we begin to see that science (and) the knowledge that it creates can be translated into value, this whole notion of theft ... began to populate the university environment," Frankel said.

He recalled a flurry of thefts in the late 1990s and early 2000s but said he believes computer hacking, and data theft related to that, have become a greater problem in recent years.

Zhao allowed the medical college to copy files from his personal laptop, a thumb drive and an external hard drive after he was placed on administrative leave. Investigators found 384 files related to Anderson's research, as well as research results from another professor from the school's cancer department.

Among the files was a grant application to a Chinese foundation that Zhao wrote in Mandarin. In the application he said he discovered the C-25 compound and that he was seeking funding to continue his research in China. Anderson told investigators the application was a verbatim translation of a grant application he himself had written several years earlier in English.

School security staff told FBI agents that on the day of his suspension Zhao also accessed school computers remotely and deleted files related to the C-25 research. The college was able to recover the files. Zhao denied accessing the server or deleting files and said he didn't understand the FBI agents' questions.

Federal authorities subsequently searched Zhao's home and found a receipt for shipment of a package to Zhao's wife along with two airline tickets from Chicago to China leaving Tuesday, as well as an application to the National Natural Science Foundation of China for research funding for C-25.

AP

Terrie Hall, a 52-year-old throat cancer survivor, lost her voice box.

Government health officials launched the second round of a graphic ad campaign Thursday that is designed to get smokers off tobacco, saying they believe the last effort convinced tens of thousands to quit.

The ads feature sad, real-life stories: There is Terrie, a North Carolina woman who lost her voice box. Bill, a diabetic smoker from Michigan who lost his leg. And Aden, a 7-year-old boy from New York, who has asthma attacks from secondhand smoke.

"Most smokers want to quit. These ads encourage them to try," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

The CDC campaign cost $48 million and includes TV, radio and online spots as well as print ads and billboards.

The spending comes as the agency is facing a tough budget squeeze, but officials say the ads should more than pay for themselves by averting future medical costs to society. Smoking is the leading cause of preventable illness and death in the United States. It's responsible for the majority of the nation's lung cancer deaths and is a deadly factor in heart attacks and a variety of other illnesses.

Last year's similar $54 million campaign was the agency's first and largest national advertising effort. The government deemed it a success: That campaign triggered an increase of 200,000 calls to quit lines. The CDC believes that likely prompted tens of thousands of smokers to quit based on calculations that a certain percentage of callers do actually stop.

Like last year, the current 16-week campaign spotlights real people who were hurt and disfigured by smoking. Terrie Hall, a 52-year-old throat cancer survivor makes a repeat performance. She had her voice box removed about a dozen years ago.

AP

The new campaign focuses more toward the impact smokers have on others.

In last year's ad there's a photo of her as a youthful high school cheerleader. Then she is seen more recently putting on a wig, inserting false teeth and covering the hole in her neck with a scarf. It was, by far, the campaign's most popular spot, as judged by YouTube viewings and Web clicks.

In a new ad, Hall addresses the camera, speaking with the buzzing sound of her electrolarynx. She advises smokers to make a video of themselves now, reading a children's book or singing a lullaby. "I wish I had. The only voice my grandson's ever heard is this one," her electric voice growls.

One difference from last year: The new campaign tilts more toward the impact smokers have on others. One ad features a Kentucky high school student who suffers asthma attacks from being around cigarette smoke. Another has a Louisiana woman who was 16 when her mother died from smoking-related causes.

The return of the campaign is already being applauded by some anti-smoking advocates, who say tobacco companies spend more on tobacco product promotion in a week than the CDC spends in a year.

After decades of decline, the adult smoking rate has stalled at roughly 20 percent in recent years. Advocates say the campaign provides a necessary jolt to a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.

"There is an urgent need to continue this campaign," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, in a statement.

It would seem like a bad time for the CDC to be buying air time — the agency is facing roughly $300 million in budget cuts as part of the government's sequestration cuts in federal spending. However, the ad money comes not from the CDC's regular budget but from a special $1 billion public health fund set up years ago through the Affordable Care Act. The fund has set aside more than $80 million for CDC smoking prevention work.

Frieden argues that the ads are extremely cost-effective — spending about $50 million a year to save potentially tens of thousands of lives.

"We're trying to figure out how to have more impact with less resources," he said.

The ads direct people to call 1-800-QUIT-NOW. PlowShare Group, of Stamford, Conn., is again the advertising company that put the ads together.

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More and more people are surviving cancer, thanks to earlier detection and better treatment, and a new report out Wednesday projects the ranks of cancer survivors will grow by nearly a third over the next 10 years.

That’s the good news. The bad news: these 18 million cancer survivors are going to cost the health system a lot of money.

“The increase in the number of survivors will be due primarily to an aging of the population. By 2020, we expect that two-thirds of cancer survivors are going to be age 65 or older,” says Julia Rowland of the National Cancer Institute, which conducted the study.

The NCI says 13.7 million people had survived cancer and were still alive in the U.S. as of Jan. 1, 2012. Nearly two-thirds of them were considered "cured,” having survived five years or more. Forty percent had survived 10 years and 15 percent had lived 20 years past their diagnosis.

“Over the next decade, the number of people who have lived five years or more after their cancer diagnosis is projected to increase approximately 37 percent to 11.9 million,” Rowland’s team writes in the journal Cancer Epidemiology, Biomarkers & Prevention.

Patients with some cancers have an especially rosy outlook. “For patients with prostate cancer, we have a nearly 100 percent five-year survival rate, and breast cancer has made tremendous strides as well, with five-year survival rising from 75 percent in 1975 to almost 89 percent in 2012,” said Rowland.

Related: New gene discoveries help ID cancer risk

“However, we clearly need to have better diagnostic tools and better treatments for lung cancer.” Only 15 percent of lung cancer patients live five years, mostly because the symptoms are so vague that people are not usually diagnosed until it has spread.

The big growth in survivorship is only partly driven by better treatments. A bigger factor is the aging of the population, the report says.

Many studies have shown that cancer patients rarely return to full, 100 percent health. The surgery, radiation and chemotherapy that can save their lives takes a toll on their bodies, raising the risk both for second cancers and for other diseases such as heart disease.

“The growing population of cancer survivors will put pressure on a healthcare system in which cancer drug shortages are increasingly common and the demand for oncology services is poised to outpace the supply of oncologists,” the researchers write.

“The growing number of older survivors also presents a unique challenge to the healthcare system because older cancer survivors are more likely to have multiple chronic diseases and tend to experience poorer physical functioning than younger survivors.”

That means a lot of expense. “By 2020, it is estimated that population growth alone will escalate annual costs of cancer care by 27 percent,” the researchers wrote,  citing a 2011 study in the Journal of the National Cancer Institute.

“Among survivors who are more than one year post-diagnosis, annual healthcare expenditures are double that of the general population, suggesting that the economic burden of cancer in terms of medical expenditures is both considerable and persistent.”

Cancer is the No. 2 cause of death in the United States, after heart disease,  killing more than 500,000 people a year.

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A batch of new gene discoveries nearly doubles the number of genes known to cause three of the most common cancers – breast cancer, prostate cancer and ovarian cancer. While each gene alone affects only a small number of people, taken together they help explain one-third of cases of these cancers, researchers reported on Wednesday.

It took a giant study to find all the genes – nearly 200,000 people took part at 160 institutions. The findings can not only help doctors decide who needs more frequent screening for cancer, but may eventually help target treatments that will work better for particular patients, the researchers said.

People with several of the genetic changes linked with cancer will have a much higher-than-average risk of the cancers, the researchers said. They published their findings in a series of 13 papers in several medical journals, including Nature Genetics and Nature Communications.

“By looking for people who carry most of these variations we will be able to identify those who are at the greatest risk of getting these cancers and then targeting screening tests to these individuals,” said Douglas Easton of Britain’s University of Cambridge, who led some of the studies.

“We now have 76 common genetic variants which are associated with breast cancer risk,” Easton told a news conference. Combined with other research, including the well-known breast cancer genes BRCA1 and BRCA2, genetic susceptibility explains 40 percent of breast cancer cases, he said.

“Any one of those (variants) is so tiny they don’t affect much,” Dr. Fergus Couch of the Mayo Clinic in Rochester, Minn., who worked on the project, told NBC News. “But when we put them together into a complex model … It’s the power of everything together that can make a difference.”

The researchers found 23 new genes linked with prostate cancer and three more for ovarian cancer. Now researchers know about 78 different genes associated with higher prostate cancer risk, and 16 of them are associated with aggressive disease.

The three cancers affect 2.5 million people globally, killing about a third of them. They all are driven by hormones.

“The most immediate practical application is probably going to be for women already at high risk of (breast cancer),” Easton said. A woman with a BRCA1 or BRCA2 mutation already has a very high chance of breast cancer. If she also has one or more of these other alterations, she’s at even higher risk.

Women who have a BRCA1 mutation along with most of the other, newly discovered mutations have an 80 percent chance of developing breast cancer by age 80, the researchers found.

“The 1 percent of people who have lots of these alterations could see their risk of developing prostate cancer increase by nearly 50 percent and breast cancer by 30 percent,” Easton said.

People may soon be able to take a genetic test to see what their risk is. They could then opt for early screening to watch for the disease. “This will be ready for prime time in a little more than a year,” Couch predicted.

Right now, guidelines vary on when women should get mammograms, for instance. Some guidelines call for annual screening starting at age 50; others say women only need them every two years.

A woman with a high genetic risk might opt to start having mammograms at age 30 or younger. There’s also confusion around testing for prostate cancer. U.S. experts say men shouldn’t be routinely screened using a blood test called a PSA test, because it causes too many “false positives” – when men are initially told they may have cancer but it turns out they don’t.

But men with a high genetic risk might opt to have frequent PSA tests.

“These results are the single biggest leap forward in finding the genetic causes of prostate cancer yet made,” said Rosalind Eeles  of Britain’s Institute of Cancer Research.

“They allow us, for the first time, to identify men who have a very high risk of developing prostate cancer during their lifetime,” she added.

The genes play a variety of roles in cancer. Some are supposed to stop the out-of-control growth that marks a tumor; some help cancer cells spread.

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