Number of homes entering foreclosure drops 22.1% to six-year low

California's foreclosure crisis eased considerably during the final quarter of last year, with the number of homes entering foreclosure dropping to a six-year low.

The steep decline, accompanied by a similar drop in home repossessions, clears the path for a quickened pace of recovery this year. Fewer foreclosures on the market should lead to higher home prices and a healthier real estate market.

"Ultimately, fewer foreclosures means an even tighter market, which means a more rapid recovery," said Christopher Thornberg, a principal at Beacon Economics. "I see very little to forestall the real estate market this year."

The real estate research firm DataQuick reported a 22.1% decline in default notices during the final three months of 2012 compared with the previous quarter — and a 37.9% drop from a year earlier. A total of 38,212 default notices were logged on California houses and condominiums last quarter, the lowest number since the final quarter of 2006. A default notice is the first formal step in the state's foreclosure process.

Since the number of new foreclosure cases peaked in early 2009, experts and analysts have feared a second wave of home loan defaults flooding the market. Three years later, that appears unlikely as banks turn to foreclosure alternatives and home prices rise.

"We are past the peak of this," said Kenneth Rosen, chairman of the Fisher Center for Real Estate and Urban Economics at UC Berkeley's Haas School of Business.

A steadily improving economy has helped ease homeowner woes. And the vast number of underwater borrowers — those owing more on their homes than they're worth — have continued to pay their mortgages instead of walking away. Rising home prices should help more underwater homeowners come up for air, allowing them to regain equity and sell their homes if they run into financial trouble.

"Home values increased through most of 2012, and the rate of increase picked up toward the end of the year," DataQuick President John Walsh said in a news release. "That means fewer and fewer homeowners are underwater."

California's median home price rose 22.4% last quarter to $300,000.

California has also been able to work through its foreclosure problem faster than other states, in part because foreclosures take place largely outside the courtroom, said Celia Chen, a housing economist with Moody's Economy.com. That means California has not been bogged down with the same level of paperwork issues and delays that states such as Florida or New York have experienced.

California has also benefited from economic growth from Asian trade and from the technology industry centered around Silicon Valley. Indeed, the technology-rich Bay Area's declines in default notices outpaced both the statewide drops and those in every other region.

Those foreclosed homes that are hitting the market are being snapped up by investors to either rent or flip. Investors bought 42% of all homes sold at foreclosure auctions statewide last quarter, according to DataQuick.

Big hedge funds have become so interested in cheaply priced homes that flippers are now increasingly searching for homes in the $400,000 to $600,000 range throughout Los Angeles County, said Robert Fragoso, executive vice president for Anchor Loans, which makes short-term loans to investors. The new interest among renovators in pricier homes should also push up prices. Already, some homes are selling for more than the asking price, Fragoso said.

"I am seeing the inventory levels right now at very, very, very low rates, especially when you are talking about the product that has already been remodeled," he said. "We are getting multiple offers on almost everything within days of it hitting the market."

Banks have been increasingly averse to foreclosure because state and federal regulators increased scrutiny on the process, which led to huge settlements as well as new laws. Major lenders have now stepped up short sales and other kinds of loan modifications to deal with troubled borrowers.

Although the foreclosure crisis has abated, the number of people losing their homes remains at a very high level compared with historical averages, said Paul Leonard, California director for the Center for Responsible Lending. Those entering foreclosure are most likely people suffering from California's still tough economy or those with the most limited resources. Aid programs and reforms by federal and state authorities are still needed, he said.

"One has to be very cautious," Leonard said, "even as we have seen substantial declines in the overall levels of default and foreclosure."

alejandro.lazo@latimes.com

andrew.khouri@latimes.com

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Google Tells Cops to Get Warrants for User E-Mail, Cloud Data

Google demands probable-cause, court-issued warrants to divulge the contents of Gmail and other cloud-stored documents to authorities in the United States — a startling revelation Wednesday that runs counter to federal law that does not always demand warrants.

The development surfaced as Google publicly announced that more than two-thirds of the user data Google forwards to government agencies across the United States is handed over without a probable-cause warrant.

A Google spokesman told Wired that the media giant demands that government agencies — from the locals to the feds — get a probable-cause warrant for content on its e-mail, Google Drive cloud storage and other platforms — despite the Electronic Communications Privacy Act allowing the government to access such customer data without a warrant if it’s stored on Google’s servers for more than 180 days.

“Google requires an ECPA search warrant for contents of Gmail and other services based on the Fourth Amendment to the Constitution, which prevents unreasonable search and seizure,” Chris Gaither, a Google spokesman, said.

Some of the customer data doled out without a warrant include names listed when creating Gmail accounts, the IP address from where the account was created, and where and what time a user signs in and out of an account. What’s more, Google hands over without warrants the IP address associated with a particular e-mail sent from a Gmail account or used to change the account password, in addition to the non-content portion of e-mail headers such as the “from,” “to” and “date” fields.

It was not immediately known whether other ISPs are traveling Google’s path when it comes to demanding probable-cause warrants for all stored content. But Google can seemingly grant more privacy than the four corners of the law allows because there’s been a string of conflicting court opinions on whether warrants are required for data stored on third-party servers longer than 180 days. The Supreme Court has never weighed in on the topic — and the authorities are seemingly abiding by Google’s rules to avoid a high court showdown.

The Electronic Communications Privacy Act of 1986, the relevant law in question, was adopted at a time when e-mail wasn’t stored on servers for a long time, but instead was held there briefly on its way to the recipient’s inbox. In the 1980s, e-mail more than 6 months old was assumed abandoned, and therefore ripe for the taking without a probable-cause warrant.

That law is still on the books today, even as the advancement of technology has undermined its original theory.

But clearly, changing the law to comport with Google’s interpretation has been met with unreceptive members of Congress.

The Senate Judiciary Committee approved a measure last year mirroring Google’s interpretation, but the bill died a quiet death. Moves to change the law have been scuttled over and again.

For now, under the letter of the ECPA law, the government only needs to show that it has “reasonable grounds to believe” e-mail and other documents stored in the cloud for more than 180 days would be useful to an investigation.

Gaither, the Google spokesman, did not know when Google began demanding warrants. But there were two federal appellate decisions on the topic rendered 2010, one requiring a warrant for content and another saying federal judges had the discretion to demand one.

Meantime, Google released Wednesday its so-called “Transparency Report” shedding light on government requests for data. Globally, the United States again ranked No. 1 in terms of demands for Google customer data. India, France, Germany, the United Kingdom and Brazil were trailing in that order.

The figures for the first time provide a brief outline on whether data was handed over with or without a court warrant — a praiseworthy move we’ve been agitating for at Threat Level following the report’s inception. Google first began releasing its Transparency Report in 2009.

Google offers e-mail, cloud storage, a blogging platform, a phone and texting platform, web search and other services.

The data Google is coughing up to the authorities includes e-mail and text-messaging communications, cloud-stored documents and, among other things, browsing activity, and even IP addresses used to create an account.

In all, agencies across the United States demanded 8,438 times that Google fork over data on some 14,791 accounts for the six-month period ending December 2012. Probable-cause search warrants were issued in 1,896 of the cases. Subpoenas, which require the government to assert that the data is relevant to an investigation, were issued 5,784 times. Google could not quantify the remaining 758.

Google’s transparency data is limited as it does not include requests under the Patriot Act, which can include National Security Letters with gag orders attached. Nor do the data include anti-terrorism eavesdropping court orders known as FISA orders or any dragnet surveillance programs legalized in 2008, as those are secret, too. In all those instances, probable-cause warrants generally are not required, even for customer content stored in Google’s servers.

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Adele to perform Bond theme song “Skyfall” live at Oscars

LONDON (Reuters) – British singer Adele will return to the stage next month after a year absence to perform her Oscar-nominated song “Skyfall” at the 85th Academy Awards, the show’s producers said on Wednesday.

The theme tune to the latest James Bond movie was written by Adele and Paul Epworth. It is the first Bond theme to be nominated for the original song award at the Oscars since “For Your Eyes Only” in 1981.

The February 24 show will be Adele’s first live performance since the Grammy Awards last April and the first time she will perform “Skyfall” live, as she has kept a low profile since giving birth to a son last October.

“It’s an honor to be nominated and terrifyingly wonderful to be singing in front of people who have captured my imagination over and over again,” Adele, 24, said in a statement.

“It’s something I’ve never experienced and probably only ever will once!”

She was in Hollywood last month to pick up the Golden Globe for the best original song prize for “Skyfall”.

Adele’s album “21″ scored the rare feat in December of topping all U.S. album sales for the second straight year. She records on the indie record label XL.

(Reporting by Belinda Goldsmith; editing by Patricia Reaney)

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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

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Novartis Profit Rises; Its Chairman Will Step Down

Daniel Vasella, the longtime chairman and former chief executive of Novartis, the Swiss drug maker, plans to step down next month, the company said on Wednesday, when it also reported a jump in fourth-quarter profit.

The board is proposing that Jörg Reinhardt, the chairman of the German rival Bayer HealthCare, succeed Mr. Vasella. Joseph Jimenez will remain as chief executive.

Novartis said that its profit rose in the fourth quarter but that sales were flat because of price cuts and competition from cheaper drugs. Net income was $2.08 billion, compared with $1.21 billion in the period a year earlier, when it took a $900 million charge from ending its clinical study into wider uses of the hypertension drug Tekturna.

The results were slightly above most analysts’ expectations.

Mr. Jimenez said Novartis had a strong range of new products coming from research and development — including an infant vaccine for meningitis — and predicted net sales to grow after 2013.

Fourth-quarter sales were almost flat at $14.83 billion, compared with $14.78 billion in the period a year earlier, and sales in 2013 are expected to suffer from the expiration of patents on the hypertension drug Diovan.

Novartis said Gilenya, its once-a-day pill against multiple sclerosis, attained what it called “blockbuster status,” with full-year sales of $1.2 billion in 2012.

Novartis expects the Food and Drug Administration to carry out an inspection in the coming months at its plant in Lincoln, Neb., which was shut down at the end of 2011 after officials found numerous problems with quality control. Mr. Jimenez told reporters in a conference call that in the meantime, the company was relying on third-party manufacturers to ensure the continued supply of products like Excedrin across the United States.

Separately, Abbott Laboratories said on Wednesday that its profit fell 35 percent in the fourth quarter on costs from the spinoff of its drug business into the new company AbbVie.

Abbott completed the split on Jan. 1, leaving it with a business model built around generic drugs, medical implants and nutritional formula. AbbVie will market the company’s branded prescription drugs, including the popular anti-inflammatory drug Humira.

In Abbott’s last quarter as a combined unit, the company earned $1.05 billion, or 66 cents a share, compared with $1.62 billion, or $1.02 a share, in the period a year earlier.

Earnings were weighed down by a number of one-time charges, including $265 million in separation costs. Excluding that and other charges, Abbott would have earned $1.51 a share. Revenue increased 4 percent, to $10.84 billion.

Analysts polled by FactSet expected, on average, earnings per share of 70 cents a share on revenue of $10.61 billion.

Finally, Amgen, the maker of the anemia treatments Aranesp and Epogen, posted a 16 percent drop in fourth-quarter profit as higher costs for production, marketing, research and other items offset higher sales for many of its biologic medicines. The results fell short of Wall Street expectations.

Net income was $788 million, or $1.01 a share, compared with $934 million, or $1.08 a share, in the period a year earlier.

Excluding one-time items, net income would have been $1.40 a share, 4 cents less than analysts expected, on average, according to FactSet.

Revenue rose 11 percent, to $4.42 billion.

Sales were led by the immune disorder treatment Enbrel, up 23 percent, to $1.16 billion, and Neulasta and Neupogen for fighting infection in cancer patients. They had a combined $1.31 billion in sales, down 1 percent.

Sales of Aranesp and Epogen fell 9 percent and 1 percent, to a combined $968 million.

Several newer drugs, like Prolia, Xgeva and Sensipar, had double-digit jumps in revenue.

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Hans Massaquoi dies at 87; wrote of growing up black in Nazi Germany

Hans Massaquoi, a former managing editor of Ebony magazine who wrote a distinctive memoir about his unusual childhood growing up black in Nazi Germany, died in Jacksonville, Fla., on Saturday, his 87th birthday.

He had been hospitalized over the Christmas holidays, said his son, Hans J. Massaquoi Jr.

Inspired by the late Alex Haley, the author of "Roots," Massaquoi decided to share his experience of being "both an insider in Nazi Germany and, paradoxically, an endangered outsider." His autobiography, "Destined to Witness: Growing Up Black in Nazi Germany," was published in the U.S. in 1999, followed by a German translation.

Massaquoi was born Jan. 19, 1926, in the port city of Hamburg. His mother was a German nurse and his father the son of a Liberian diplomat. When his grandfather was recalled to Liberia, Massaquoi's father decided to return to Africa too, but his mother insisted on staying behind.

Living with his mother, Massaquoi grew up in working-class neighborhoods of Hamburg. There were other black Germans, but not many; some were offspring of European colonial troops who occupied the Rhineland after World War I.

In his book, he recounted a story from 1933, when he was in second grade. Wanting to show what a good German he was, Massaquoi said he cajoled his baby-sitter into sewing a swastika onto his sweater. When his mother spotted it that evening, she snipped it off, but a teacher had already taken a snapshot. Massaquoi, the only dark-skinned child in the photo, is also the only one wearing a swastika.

He wrote that one of his saddest moments as a child was when his homeroom teacher told him he couldn't join the Hitler Youth.

"Of course I wanted to join. I was a kid and most of my friends were joining," he said. "They had cool uniforms and they did exciting things — camping, parades, playing drums."

Germany was at war by the time he was a teenager, and he describes in the book the near-destruction of Hamburg during the Operation Gomorrah bombing attack in the summer of 1943.

Massaquoi had a theory to explain why he avoided deportation to concentration camps during the Nazi reign.

"Unlike Jews, blacks were so few in numbers that they were relegated to low-priority status in the Nazis' lineup for extermination," he said in a 2001 interview with London's Independent newspaper.

After the collapse of Germany at the end of the war, he played saxophone in clubs that catered to the American Merchant Marine and worked as a translator for the British occupying forces.

Eventually he left Germany, first joining his father's family in Liberia, before moving to Chicago on a student visa to attend an aviation mechanics school. He was drafted into the U.S. Army in 1951 and served stateside during the Korean War. Afterward, he became a U.S. citizen, earned a bachelor's degree from the University of Illinois and began a career as a journalist.

He worked first for Jet magazine before moving to Chicago-based Ebony, where he rose to managing editor of the magazine aimed at African American readers.

Chicago author Studs Terkel interviewed Massaquoi for his 1984 book, "The Good War: An Oral History of World War II." By the late 1990s, approaching retirement, Massaquoi decided to tell his own story in an autobiography.

He was surprised by its reception in Germany.

"I had expected some interest there, but this has surpassed all my expectations," he told the Contra Costa Times in 2000. "I think the Germans want to get some closure about those years."

news.obits@latimes.com

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LG's Next Flagship, the Optimus G Pro, Outed by Japanese Carrier

LG is already prepping its next handset, the Optimus G Pro, for launch, even though the Optimus G — the basis for the Google’s Nexus 4 — appeared just five months ago and is still rolling out in 50 new markets.

The Optimus G Pro is slated for an April release date, according to Japanese carrier NT DoCoMo. The company detailed its smartphone lineup, which includes the Optimus G Pro, on Tuesday. It’s remarkable, because LG hasn’t formally announced the phone yet, and the rumor is that won’t happen until Mobile World Congress in Barcelona next month.

According to NT DoCoMo, the Optimus G Pro will feature a 5-inch, 1080-display, Qualcomm’s Snapdragon S4 quad-core CPU, 2GB of RAM, 32GB of built-in storage and 4G LTE connectivity. It’ll run Google’s Android 4.1 Jelly Bean operating system. Since LG hasn’t officially acknowledged the phone’s existence, we don’t know for certain whether it’ll land in the United States. But, the fact the Optimus G is sold here by AT&T and Sprint — and the Nexus 4 has gotten all kinds of critical acclaim — it’s a safe bet the Optimus G Pro will arrive on our shores sometime this year.

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Justin Bieber tops Lady Gaga to rule Twitter

(Reuters) – Teen heartthrob Justin Bieber with his hordes of fans known of Beliebers became the King of Twitter on Tuesday, topping fellow pop star Lady Gaga as the user with the most followers.

Data from TwitterCounter.com showed that the 18-year-old Canadian singer jumped into the lead with 33.33 million followers, topping Lady Gaga’s 33.32 million and ending her two-and-a-half year rule of the microblogging site.

A spokesman from TwitterCounter.com said Lady Gaga has held the top slot on Twitter since August 2010 when she overtook U.S. pop star Britney Spears.

Bieber rose to fame as a baby-faced pop star singing love songs such as “Baby” after being discovered on YouTube in 2008. He has released two No. 1 albums in the past 18 months – the holiday-themed “Under the Mistletoe” and “Believe.”

Bieber was named by Forbes magazine in 2012 as the third-most powerful celebrity in the world and his huge following on Twitter was cited as a reason why marketers need to take notice of the 140-character micro-blogging site.

Lady Gaga has dropped to second in Twitter followed by singer Katy Perry in third with 31.49 million followers then Rihanna and Barack Obama with 26.17 million followers. Britney Spears has slipped to sixth place.

(Reporting by Belinda Goldsmith; editing by Patricia Reaney)

(You can see the Twitter top 100 list http://twittercounter.com/pages/100)

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The Well Column: Facing Cancer, a Stark Choice

In the 1970s, women’s health advocates were highly suspicious of mastectomies. They argued that surgeons — in those days, pretty much an all-male club — were far too quick to remove a breast after a diagnosis of cancer, with disfiguring results.

But today, the pendulum has swung the other way. A new generation of women want doctors to take a more aggressive approach, and more and more are asking that even healthy breasts be removed to ward off cancer before it can strike.

Researchers estimate that as many as 15 percent of women with breast cancer — 30,000 a year — opt to have both breasts removed, up from less than 3 percent in the late 1990s. Notably, it appears that the vast majority of these women have never received genetic testing or counseling and are basing the decision on exaggerated fears about their risk of recurrence.

In addition, doctors say an increasing number of women who have never had a cancer diagnosis are demanding mastectomies based on genetic risk. (Cancer databases don’t track these women, so their numbers are unknown.)

“We are confronting almost an epidemic of prophylactic mastectomy,” said Dr. Isabelle Bedrosian, a surgical oncologist at M. D. Anderson Cancer Center in Houston. “I think the medical community has taken notice. We don’t have data that say oncologically this is a necessity, so why are women making this choice?”

One reason may be the never-ending awareness campaigns that have left many women in perpetual fear of the disease. Improvements in breast reconstruction may also be driving the trend, along with celebrities who go public with their decision to undergo preventive mastectomy.

This month Allyn Rose, a 24-year-old Miss America contestant from Washington, D.C., made headlines when she announced plans to have both her healthy breasts removed after the pageant; both her mother and her grandmother died from breast cancer. The television personality Giuliana Rancic, 37, and the actress Christina Applegate, 41, also talked publicly about having double mastectomies after diagnoses of early-stage breast cancer.

“You’re not going to find other organs that people cut out of their bodies because they’re worried about disease,” said the medical historian Dr. Barron H. Lerner, author of “The Breast Cancer Wars” (2001). “Because breast cancer is a disease that is so emotionally charged and gets so much attention, I think at times women feel almost obligated to be as proactive as possible — that’s the culture of breast cancer.”

Most of the data on prophylactic mastectomy come from the University of Minnesota, where researchers tracked contralateral mastectomy trends (removing a healthy breast alongside one with cancer) from 1998 to 2006. Dr. Todd M. Tuttle, chief of surgical oncology, said double mastectomy rates more than doubled during that period and the rise showed no signs of slowing.

From those trends as well as anecdotal reports, Dr. Tuttle estimates that at least 15 percent of women who receive a breast cancer diagnosis will have the second, healthy breast removed. “It’s younger women who are doing it,” he said.

The risk that a woman with breast cancer will develop cancer in the other breast is about 5 percent over 10 years, Dr. Tuttle said. Yet a University of Minnesota study found that women estimated their risk to be more than 30 percent.

“I think there are women who markedly overestimate their risk of getting cancer,” he said.

Most experts agree that double mastectomy is a reasonable option for women who have a strong genetic risk and have tested positive for a breast cancer gene. That was the case with Allison Gilbert, 42, a writer in Westchester County who discovered her genetic risk after her grandmother died of breast cancer and her mother died of ovarian cancer.

Even so, she delayed the decision to get prophylactic mastectomy until her aunt died from an aggressive breast cancer. In August, she had a double mastectomy. (She had her ovaries removed earlier.)

“I feel the women in my family didn’t have a way to avoid their fate,” said Ms. Gilbert, author of the 2011 book “Parentless Parents,” about how losing a parent influences one’s own style of parenting. “Here I was given an incredible opportunity to know what I have and to do something about it and, God willing, be around for my kids longer.”

Even so, she said her decisions were not made lightly. The double mastectomy and reconstruction required an initial 11 1/2-hour surgery and an “intense” recovery. She got genetic counseling, joined support groups and researched her options.

But doctors say many women are not making such informed decisions. Last month, University of Michigan researchers reported on a study of more than 1,446 women who had breast cancer. Four years after their diagnosis, 35 percent were considering removing their healthy breast and 7 percent had already done so.

Notably, most of the women who had a double mastectomy were not at high risk for a cancer recurrence. In fact, studies suggest that most women who have double mastectomies never seek genetic testing or counseling.

“Breast cancer becomes very emotional for people, and they view a breast differently than an arm or a required body part that you use every day,” said Sarah T. Hawley, an associate professor of internal medicine at the University of Michigan. “Women feel like it’s a body part over which they totally have a choice, and they say, ‘I want to put this behind me — I don’t want to worry about it anymore.’ ”

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DealBook: Can Britain Forge Looser Ties to Europe Without Losing Influence?

LONDON — Last year, Prime Minister David Cameron of Britain used his appearance at the World Economic Forum to vent frustration with the European Union, listing some of the policies he would ditch if he could throw off Europe’s regulatory shackles.

“In the name of social protection, the E.U. has promoted unnecessary measures that impose burdens on businesses and governments, and can destroy jobs,” he argued, adding a list of directives that he would like to scrap.

One year later, Mr. Cameron is following through on that pledge. He is promising to renegotiate Britain’s ties to the 27-nation bloc, forge a new and looser relationship, and is expected to say on Wednesday that he would put the outcome of those talks to a referendum.

A speech on Europe, planned for last week, was postponed because of the crisis in Algeria. It has been rescheduled for Wednesday, ahead of a possible visit by Mr. Cameron to Davos, Switzerland.

It was unclear whether Mr. Cameron would attend Davos this year and speak on the same theme. But his tough line on Europe echoes growing British disenchantment with a bloc whose single currency union, which the British never joined, has been in crisis for three years.

Yet, supposing Mr. Cameron were to succeed in scaling down Britain’s involvement, some central questions will arise. Can Britain play a more limited role in Brussels and still retain significant influence there? And what might that mean for Britain’s full participation in one of the world’s biggest single markets?

In their 40-year history of engagement with a unifying Europe, Britons have never embraced the ideal of unity; instead they have seen their ties to the Continent in pragmatic terms. Increasingly, London’s conclusion seems to be that the costs in terms of regulatory burdens and financial contributions are not outweighed by clear benefits.

Mr. Cameron argues that to stabilize support for the European Union in Britain, the relationship must be loosened and focused more on the bloc’s single market of almost 500 million people.

Britain, which is in the second tier of European Union membership, not only stayed out of the euro — and unlike most of the others on the sidelines has no intention of joining — but also does not participate in Europe’s Schengen passport-free travel zone. The British government also announced last year that it would opt out of a range of justice and security policy areas.

A group of Conservative lawmakers argued last week for five treaty changes, including those that would allow any country to block new European Union legislation on financial services, and would repatriate social and employment laws to national capitals. Britain’s euro skeptics are also blunt in their criticism of the bloc’s agricultural, fisheries and regional aid programs

Many would ideally like to keep just one element of European Union membership, access to the single market, though achieving such status looks highly improbable.

Even those who sympathize with Mr. Cameron’s stance argue that a more detached position comes at the price of reduced influence, though they contend the cost of not changing would be higher. They also argue that leverage in some of the policy areas is of limited value anyway.

“There is a trade-off, there is no doubt,” said Mats Persson, director of Open Europe, a research organization that favors a change in Britain’s relationship with the union. “If you reduce the level of E.U. influence in the British economy and society, you will lose some influence over some policy areas.”

But Mr. Persson argues that “if there is no change in Britain’s E.U. relationship, its membership is in question, which would really reduce its influence.”

Others worry that Britain is weakening its own position. Charles Grant, director of the Center for European Reform, a research institute in London, says that already “British influence in Brussels is at its lowest level in the 25 years I have been following the E.U.”

And critics argue that standing back from more policy arenas would increase the country’s sense of alienation from the bloc and fuel popular sentiment that things are stacked against Britain. A more detached relationship could also prove a disadvantage in the deal-making culture that prevails in Brussels.

Officially, decisions on legislation in Brussels are made by national governments under a complex series of rules before going to the European Parliament, whose approval is also required. In some cases, like tax policy, all 27 national governments need to agree, though in many others a weighted majority is required.

But relatively few decisions are actually put to a vote by governments. In practice, countries strike informal agreements and compromises, often trading support on one issue for a reciprocal agreement, sometimes in an unrelated area of policy.

For example, Britain once supported Germany, which wanted to water down planned rules on takeovers, in exchange for help from Berlin to soften new European Union legislation on workers’ rights.

The fewer areas in which a country participates, the less influence it has to barter.

Something similar affects another area of unofficial influence: control of crucial positions in Brussels. When the last round of top European Union jobs was decided, Tony Blair, a former British prime minister, was a contender to become the president of the European Council, the body in which national governments meet. But Britain’s absence from the euro currency and the Schengen zone made this a nonstarter.

The prime minister at the time, Gordon Brown, wanted a top economic post for Britain in the European Commission, the executive of the bloc. Instead, he got a foreign policy position for Catherine Ashton, reflecting the fact that Britain remained an engaged player in that area.

The euro has dominated the agenda in Brussels for the last three years, but Britons have reduced prospects of making big careers in this policy area because London has no power to lobby for them.

“If you are in the Treasury in London, why the hell would you go to Brussels?” said one European Union official not authorized to speak publicly.

That trend now looks likely to extend to justice and security policy. Britain recently held the most senior position in the justice and home affairs directorate of the European Commission, partly because the British used to be enthusiastic about cooperation in that forum. A Briton, Rob Wainwright, is currently the director of Europol, the bloc’s law enforcement agency.

But given the government’s decision to distance itself, it will be harder for Britons to get such top jobs in the future.

Declining career prospects for British officials are reflected in staff recruitment figures, released in April 2011. They showed that the European Commission now employed more Poles than Britons, though Britain has a larger population and joined the European Union’s forerunner more than 30 years before Polish accession in 2004.

Britain has fewer than half France’s number of European Commission officials, and the situation seems destined to deteriorate because relatively few Britons are applying for entry-level jobs.

All this risks creating a downward spiral in British influence, which the country would need to counter by being more effective in the areas in which it remains.

“I think Britain still could have clout in more limited areas if it keeps friends and allies,” Mr. Grant said. “But the fact that we are not, for example, so engaged in justice and home affairs weakens our bargaining power across policy areas and weakens the career prospects of British officials.”

Mr. Grant added, “There has been a steady diminution in the last few years, which you could plot on a graph: the more you distance yourself the less influence you have.”

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