SAN FRANCISCO -- A federal court in San Francisco Tuesday struck down Arizona's ban on abortions after 20 weeks of pregnancy.

The 9th U.S. Circuit Court of Appeals ruled that the law violates a string of U.S. Supreme Court rulings starting with Roe v. Wade that guarantees a woman's right to an abortion before a fetus is able to survive outside the womb. That's generally considered to be about 24 weeks. Normal pregnancies run about 40 weeks

Several states have enacted similar bans starting at 20 weeks. But the 9th Circuit's ruling is binding only in the nine Western states under the court's jurisdiction. Idaho is the only other state in the region covered by the 9th Circuit with a similar ban.

A trial judge had ruled that the ban could take effect. U.S. District Judge James Teilborg ruled it was constitutional, partly because of concerns about the health of women and possible pain for fetuses.

But abortion-rights groups appealed that decision, saying the 20-week ban would not give some women time to carefully decide whether to abort problem pregnancies.

The ban included an exception for medical emergencies.

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

LONDON -- British fertility experts have devised a new IVF technique that takes thousands of snapshots of a developing embryo that they say can help doctors pick those most likely to implant successfully and develop into healthy babies.

At a briefing in London before publishing their results, the researchers said they are already using the technique to select "low risk" embryos that are the least likely to have chromosomal abnormalities that could hamper their development.

In their study, published in the journal Reproductive BioMedicine Online, the team's chances of producing a successful live birth after in-vitro fertilization (IVF) were increased by 56 percent using the new technique compared to the standard method of selecting embryos that look best through a microscope.

"In the 35 years I have been in this field, this is probably the most exciting and significant development that can be of value to all patients seeking IVF," said Simon Fishel, a leading fertility doctor and director at the IVF clinic operator CARE Fertility where the technique is being developed.

Independent scientists not involved in the work welcomed it as a significant advance but said full randomized controlled trials - the gold standard in medicine - should be conducted before it is adopted as mainstream practice.

"This paper is interesting because we really do need to make advances in selecting the best embryos created during IVF," said Allan Pacey of Sheffield University, chair of the British Fertility Society.

"The idea of monitoring embryo development more closely is being used increasingly in clinics around the world and so it is good to see the science involved submitted to peer review and publication," he added. "All too often, developments in IVF are trumpeted as advances when they remain unproven."

Experts say that today, as many as 1 to 2 percent of babies in the Western world are conceived through IVF. The standard methods of selecting embryos are based largely on what they look like through a microscope, and many IVF cycles fail because the embryo chosen and transferred to the womb fails to develop.

The scientists who led this study said that using time-lapse images, they had found that developmental delays in the embryo at crucial stages are good indicators of likely chromosomal abnormalities that could result in a failed pregnancy.

"In conventional IVF laboratories, embryo development will be checked up to six times over a 5-day period," said Alison Campbell, Care Fertility's embryology director and the lead researcher on the study being published.

"With time-lapse we have the ability to view more than 5,000 images over the same time period to observe and measure more closely each stage of division and growth."

Using this new knowledge, the team developed what they call morphokinetic algorithms to predict success (MAPS). By applying these MAPS to the selection of embryos, they predict they could reach a live birth rate for patients undergoing IVF of 78 percent - about three times the national average.

Fishel, whose CARE Fertility clinics are Britain's largest independent provider of assisted conception cycles, with around 3,500 a year, said he is charging around 750 pounds ($1,100) for IVF using the MAPS technique - compared to several thousand pounds for a standard IVF cycle.

But Sue Avery, head of the Women's Fertility Centre in Birmingham, said it was too soon for all clinics to adopt it.

"Until the new technique is compared to current practice we cannot know whether different embryos are being chosen," she said. "The IVF community needs a prospective randomized controlled trial to prove that the new approach delivers better results before it can be recommended to patients."

A federal judge on Friday reversed a contentious Food and Drug Administration ruling and ordered the agency to make the so-called "morning-after pill" available without a prescription to all girls of reproductive age, including those younger than 17.

The ruling by U.S. District Judge Edward Korman in Brooklyn, New York, comes in a lawsuit brought by reproductive-rights groups that had sought to remove age and other restrictions on emergency contraception.

Currently, only women aged 17 and or older can obtain emergency contraception without a prescription. For those women, the medication is available only at health clinics or pharmacies and they're required to show identification to obtain it.

The rule requiring girls younger than 17 to obtain a doctor's prescription was confirmed in December 2011, when Health and Human Services Secretary Kathleen Sebelius overruled an FDA recommendation -- and Commissioner Margaret Hamburg -- to force the agency to limit access to emergency contraception for young girls.

In her decision, Sebelius said she wasn't convinced that drug makers had proven that access should be broadened and she expressed concern that girls who reached reproductive maturity at ages as young as 11 could have access to the medication. 

At the time, that decision drew intense criticism from medical and women's rights groups, who said that denying access defied strong scientific data that showed that emergency contraception is safe and effective for girls and women of all ages. Sebelius' action was widely seen as a move to protect President Barack Obama's administration from the appearance of encouraging sexual activity in such young girls.

Korman said the FDA's rejection of requests to remove age restrictions to obtain the pill had been "arbitrary, capricious and unreasonable." The 59-page ruling says that Sebelius' actions were "politically motivated, scientifically unjustified and contrary to agency precedent."

The ruling orders the FDA to make levonorgestrel-based emergency contraception available without age or so-called "point of sale" restrictions within 30 days. It appears to apply to all brands of the morning-after pill, although Korman gave FDA the option of limiting the expanded access to the Plan B One-Step single-pill product if the agency "actually believes there is any significant difference between the one- and two-pill products."

Nancy Northup, president of the Center for Reproductive Rights, hailed the ruling. "Women all over the country will no longer face arbitrary delays and barriers just to get emergency contraception," she said.

The group was among those that brought the lawsuit, the culmination of more than a decade of political and legal wrangling. 

"Today's court order has swept away all the FDA stalling, all the interference and all the gamesmanship," Northup told reporters in a conference call. 

Anti-abortion activists reacted swiftly to the ruling, saying it provided access for vulnerable young girls to drugs that the groups believe induce abortions.

“Teen girls need parents, not unfettered access to abortion-inducing drugs,” said Marjorie Dannenfelser, president of the Susan B. Anthony List. “Judge Korman’s decision is reckless and denies girls the protection that comes along with the involvement of parents and doctors."

The U.S. Conference of Catholic Bishops also opposed the change, saying the court acted "irresponsibly" by making powerful hormonal drugs available without prescription to minors. 

"Plan B does not prevent or treat any disease, but makes young adolescent girls more available to sexual predators," said Deirdre McQuade, spokeswoman for the conference, in a statement. "The court's action undermines parents' ability to protect their daughters from such exploitation and from the adverse effects of the drug itself." 

Meanwhile, news of the ruling was applauded by a range of medical, women's rights and reproductive rights groups. 

Dr. Cora Collette Breuner, a Seattle pediatrician and professor of adolescent medicine, said the American Academy of Pediatrics regards the ruling as a victory of science over politics.

"Finally, my children and their children will have access to a product they didn't have before," she said. 

Cecile Richards, president of the Planned Parenthood Federation of America, also praised the move. 

“Lifting the age restrictions on over-the-counter emergency contraception is a significant and long-overdue step forward for women’s health that will benefit women of all ages," she said in a statement. 

The ruling would particularly benefit immigrant women by removing requirements to show identification to buy the drugs, and also by making them available in a wide range of settings, advocates said.

"It's getting EC right on the store shelves, right next to the condoms and the cough medicines, where it belongs," said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health.

FDA spokeswoman Erica Jefferson declined to comment on the ruling, saying it was an ongoing legal matter.

It wasn't immediately clear if the U.S. Department of Justice would appeal the judge's ruling. Allison Price, a department spokeswoman, told NBC News the agency was reviewing the opinion.

In the past, druggists and store owners who regarded the morning-after pill as a form of abortion had refused to dispense or sell the products. It's not yet clear whether some stores would refuse to stock the drugs, or whether they would keep them behind locked counters to dissuade shoplifting. The drugs typically sell for about $50 a package. 

Emergency contraception uses high doses of the same hormones used in birth control to prevent pregnancy when taken within 72 hours of unprotected sexual intercourse. Taken in one- or two-pill doses, the product can prevent or delay ovulation, prevent fertilization or, in some cases, prevent implantation of a fertilized egg into the lining of the uterus. It does not cause miscarriages or abortions and would have no effect if a woman were already pregnant, medical experts say. 

Related: 

• Plan B won't be available OTC to younger teens, HHS says
• Bioethicist: It's high time for 'morning-after pill' ruling

Staff reviewers for the U.S. Food and Drug Administration said that a potential increased risk of cancer with drugs containing calcitonin salmon appears plausible.

In briefing documents released on Friday, the reviewers said the risk raises concerns about the overall risk versus benefit of calcitonin products to treat osteoporosis in postmenopausal women.

Calcitonin products include Novartis AG's Miacalcin injection and nasal spray and Unigene Laboratories Inc's nasal spray. Privately held Upsher Smith Laboratories Inc. distributes Unigene's product in the United States. Generic calcitonin products are also available.
Calcitonin salmon is a man-made version of the hormone calcitonin that is found in salmon.

The reviewers said significant questions remain about calcitonin salmon's effectiveness in reducing fractures in the treatment of postmenopausal osteoporosis.

An advisory panel to the FDA is scheduled to discuss the products on March 5 and will make a recommendation to the agency on whether to allow the continued marketing of these products for that use.

Last July European regulators recommended that long-term use of calcitonin be curtailed after a review found evidence of a small increased risk of cancer with long-term use of the drugs.

They recommended that they should only be authorized for short-term use in Paget's disease, a bone disorder; for acute bone loss due to sudden immobilization; and for excess calcium in the blood caused by cancer. They ruled that the benefits of calcitonin-containing medicines did not outweigh their risks in the treatment of osteoporosis and that they should no longer be used for this condition.

Unigene officials declined to comment on the FDA staff review as they do not distribute a calcitonin product in the United States. Upsher Smith officials were not immediately available for comment. Novartis said in a statement that it "places the highest priority on patient safety and the appropriate use of its medicines and is looking forward to the opportunity to engage in the discussion at the upcoming meeting."

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