FDA Approves Test That Spots Aggressive Breast Cancer (HealthDay)

TUESDAY, June 14 (HealthDay News) -- A new genetic test that helps determine if breast cancer patients are good candidates for treatment with the drug Herceptin was approved Tuesday by the U.S. Food and Drug Administration.

About 20 percent of breast cancers are HER2-positive, and respond well to Herceptin (trastuzumab).

The new Inform Dual ISH test reveals the number of copies of the HER2 gene in tumor tissue.

"When used with other clinical information and laboratory tests, this test can provide health-care professionals with additional insight on treatment decisions for patients with breast cancer," Alberto Gutierrez, director of the Office of In Vitro Diagnostic Device Evaluation and Safety in the FDA's Center for Devices and Radiological Health, said in an agency news release.

The FDA's approval of the test was based on a U.S. study that included tumor samples from 510 breast cancer patients. The study found that the test was effective in confirming a higher than normal number of copies of the HER2 gene in 96 percent of the HER2-positive tumor samples.

The test was also effective in excluding the possibility that more than the normal number of copies of the HER2 gene were present in 92.3 percent of HER2-negative tumor samples, according to the FDA.

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said the new test will help "in acquiring the data about a woman's cancer more quickly and efficiently. This will help speed the process of formulating a treatment plan during a time when a woman is searching for answers regarding her future.

"The faster a treatment plan is formulated, the easier it is for a woman to deal with her diagnosis. When faced with too many unknowns, the diagnosis of breast cancer can be overwhelming. Because this test can be performed in a standard lab, the information regarding HER2 status will be known quickly, and a woman will know if her treatment will be over within a few months, or might go on for a full year," Bernick said.

Dr. Freya Schnabel, director of Breast Surgery at NYU Langone Medical Center, said: HER2 testing is an "important part of the assessment of breast cancer tissue, because it tells us important information about the biology of the tumor and also helps identify the subset of patients who would benefit from treatment with Herceptin. At this point, testing for HER2/neu frequently involves two levels of testing and there is sometimes lack of agreement between test results, making a patient's status unclear."

The new test is made by Tucson, Ariz.-based Ventana Medical Systems.

More information

The American Cancer Society has more about breast cancer.

New Test Helps Evaluate Breast Cancer Patients for Herceptin Use (HealthDay)

TUESDAY, June 14 (HealthDay News) -- A genetic test to help doctors evaluate whether women with breast cancer are candidates for treatment with the drug Herceptin (trastuzumab) has been approved by the U.S. Food and Drug Administration.

The Inform Dual ISH test measures whether there are excessive copies of the HER2 gene in breast tumor tissue. HER2-positive breast cancer is a fast-growing, aggressive form of the disease, making up about 20 percent of all breast cancer cases, the FDA said in a news release. Women with an above-normal number of copies of the HER2 gene are candidates for Herceptin therapy.

Clinical studies involving 510 women with breast cancer showed the new test was 96 percent accurate in identifying HER2-positive tumor samples, the agency said. The test correctly identified HER2-negative tumors in 92.3 percent of cases.

Breast cancer is the second-leading cause of cancer deaths among women, the FDA said, citing some 207,090 cases diagnosed in the United States last year, and about 39,840 deaths from the disease.

The new test is produced by Ventana Medical Systems, based in Tucson, Ariz.

More information

The U.S. National Institutes of Health has more about breast cancer.

"Spider-Man" producer Laura Ziskin dies of cancer (Reuters)

LOS ANGELES (Reuters) – Laura Ziskin, the Hollywood producer who helped turn "Pretty Woman" heroine Julia Roberts into a star and brought "Spider-Man" to the big screen, died on Sunday after a public battle with breast cancer. She was 61.

According to a statement from Sony Pictures, where her production company was based, Ziskin died at her Los Angeles home after fighting the disease for seven years.

In 2008 Ziskin, along with other entertainment notables including newswoman Katie Couric, co-founded Stand Up To Cancer, an advocacy group for cancer research. Later that year -- and again last September -- Ziskin produced all-star telethons that aired live on the major U.S. networks.

In addition to making movies, Ziskin also produced the Academy Awards broadcast twice, and served as president of Fox 2000 Pictures, a feature film division of 20th Century Fox.

She was perhaps best known for producing the three "Spider-Man" movies starring Tobey Maguire and Kirsten Dunst. The trilogy grossed $2.5 billion at the worldwide box office. The franchise is currently being overhauled with a new cast and a focus on the superhero's early years.

Among the films Ziskin championed at Fox 2000 was the searingly brutal drama "Fight Club," starring Brad Pitt and Edward Norton. Following an advance screening that left other studio executives bewildered and angry, Ziskin boldly proclaimed it was brilliant, according to author Sharon Waxman's "Rebels on the Backlot."

Still she did blanch at one comical line -- "I want to have your abortion -- and begged director David Fincher to replace it. He reluctantly agreed, but the new line was even more grotesque and she begged him to revert to the old line. He refused, according to the book.

Ziskin, a Los Angeles native who started out as a personal assistant, started making features in the mid-1980s. She teamed with actress Sally Field to produce "Murphy's Romance," a 1985 comedy-drama for which James Garner received an Oscar nomination.

She hired hot young stars Kevin Costner for "No Way Out" (1987) and Dennis Quaid for "D.O.A." (1988), and helped transform Roberts into Hollywood's biggest sensation with "Pretty Woman," the 1990 smash which she executive produced.

Ziskin rescued legendary Hollywood scribe Buck Henry ("The Graduate") from a long dry spell by recruiting him to write the adaptation for "To Die For," a dark comedy directed by Gus Van Sant and starring Nicole Kidman.

By the time it was released in 1995, Ziskin was ensconced at Fox 2000 where she also oversaw such films as "Courage Under Fire," "One Fine Day," "Soul Food" and "The Thin Red Line."

In 2002, she became the first woman to produce the Oscar broadcast solo. The show, presented for the first time at the Kodak Theater in Hollywood, also marked the first Oscarcast appearance of the Cirque du Soleil acrobatic troupe. She also produced the 2007 ceremony.

She was diagnosed with cancer in 2004, and underwent a mastectomy, chemotherapy, a stem-cell transplant and radiation. The cancer returned in 2009, having spread to her liver and bones.

Sony Pictures said a memorial would be planned. Ziskin is survived by her husband Alvin Sargent, an Oscar-winning screenwriter ("Ordinary People," "Julia") who collaborated on the "Spider-Man" films; and a daughter from her first marriage.

(Reporting by Dean Goodman)

Drugs for Enlarged Prostate May Raise Risk of Aggressive Cancer (HealthDay)

THURSDAY, June 9 (HealthDay News) -- The U.S. Food and Drug Administration is calling for new warning labels on a class of drugs used primarily to treat enlarged prostates, because the medications may raise the risk of developing an aggressive form of prostate cancer.

In a statement released Thursday, the agency said the drugs involved include popular medications sold under the brand names Proscar and Propecia (sold by Merck & Co.) and Avodart and Jalyn (sold by GlaxoSmithKline).

According to the FDA, almost 5 million men were prescribed one of these medications between 2002 and 2009. Of these, nearly 3 million men were between the ages of 50 and 79.

The agency is advising doctors not to start patients on these drugs until prostate cancer -- which can mimic the symptoms of an enlarged prostate -- and other urological conditions have been ruled out.

According to the agency, this new warning is based on the results of two large prostate cancer trials.

Although these trials did not include Propecia, which is prescribed to treat hair loss in men, its label is also being updated. However, the FDA said "the applicability of the Avodart and Proscar studies to Propecia, is currently unknown."

All of these drugs are part of a class of medications called 5-alpha reductase inhibitors (5-ARI). According to the FDA, Proscar, Avodart and Jalyn are approved to treat symptoms of enlarged prostate, while Proscar and Avodart are also approved to reduce the risk of urinary retention or surgery related to an enlarged prostate. Propecia is a lower-dose version of Proscar.

Merck issued a statement Thursday on the FDA ruling.

"Merck stands behind the demonstrated safety and efficacy of Proscar [finasteride, 5mg] and Propecia [finasteride, 1mg]. Both products have been prescribed to millions of men, with Proscar prescribed to those suffering from benign prostatic hyperplasia (BPH or enlarged prostate) since 1992, and Propecia prescribed to men with male pattern hair loss since 1997," the company statement said. "Merck's goal is to ensure the product labeling includes all relevant trial information to help health-care professionals and their patients make informed treatment decisions."

Less than a year ago, GlaxoSmithKline asked the FDA to approve the use of Avodart to prevent prostate cancer, although the FDA declined that request in January. The company based its reasoning on the results of one of the trials on which the agency is now basing its new warning.

In addition to this new side effect, recent research has shown that Proscar, Propecia and Avodart are all associated with increasing the risk of erectile dysfunction in men who take the medications.

Commenting on the FDA warning, prostate cancer expert Dr. Anthony D'Amico, chief of genitourinary radiation oncology at Brigham and Women's Hospital in Boston, said, "I think that the warning is appropriate. The risk is very small, but not zero."

"What both studies show conclusively is there is about a 1 percent increase in being diagnosed with high-grade prostate cancer if you got these drugs -- even though you are less likely to get a low-grade cancer."

Why that is is not clear, D'Amico said. "But I think the warning is fair," he added.

The drugs really do work in preventing prostate cancer, D'Amico said. "You have to weigh the 24 percent reduction against the 1 percent increased incidence of high-grade disease," he said.

"These drugs should only be used in men who have an additional indication to take them beyond prostate cancer prevention," D'Amico said.

More information

For more on prostate cancer, visit the American Cancer Society.

I'm a Cancer Survivor. Now What? (The Daily Beast)

NEW YORK – Every year cancer survivors gather to celebrate life after the disease, but to also take stock of the harsh realities that follow survival. Lance Armstrong and Doug Ulman on the toll it takes.

You’ve done it. You’ve beaten cancer. Come through the chemo. Endured the pain and the fear and emerged a new person: tougher, wiser and more resilient than ever. Now what? “Your cancer treatment is over and all of the focus that was on you during the treatment is now over,” a survivor told us recently. “You are left with many side effects and no support or answers.”

Last weekend marked National Cancer Survivors Day and for both of us and millions of other Americans, it’s a time to celebrate being alive. It’s also a chance to take stock of how America deals with life after cancer.

Ruth Rechis has been dealing with cancer her entire life. Her older sister, Sarah, died of leukemia when she was three years old. When Ruth was only 15, she was diagnosed with Hodgkin Lymphoma. Ruth is now 18 years post-treatment. She survived but finished treatment with a feeling of, “What now?” The effects of cancer and her treatment have stayed with her. Her risks for heart disease and for breast cancer have skyrocketed as a result of the type of chemotherapy and radiation she received. The emotional toll of that knowledge is a daily burden. Luckily, unlike many Americans, Ruth has a community of support, good insurance and a strong focus on her survivorship.

For decades, research has been focused on helping people beat cancer. This year alone, 1.5 million Americans will face a new diagnosis and due to advances in medicine and treatment options, more of them will survive than ever before. But once they have completed treatment and said goodbye to their medical team, they will find that while cancer may leave their bodies, its effects can last a lifetime—physically, emotionally and financially. Calibrating these effects and off-setting them with resources and support is the focus of an emerging field in the cancer community—survivorship.

To help shed light on the challenges survivors face and how the survivorship field can address them, LIVESTRONG released the second installment of its Survey for People Affected by Cancer this week, an undertaking which included more than 11,000 cancer survivors, their loved ones and family members. It shows fewer Americans today are getting help for physical, emotional, and practical concerns after cancer than in 2006.

Medical bills are the leading cause of bankruptcy in America.

Medical bills are the leading cause of bankruptcy in America. However, only one in five respondents received help with debt, insurance coverage, or career concerns. Seventy-nine percent said they suffered from fear centered on a possible recurrence yet only 49 percent got emotional help. That’s down 2 percent since 2006. And many reported chronic physical effects like trouble concentrating, lingering pain, and lack of energy with varying levels of help for those challenges.

The report shows survivorship has a long way to go. The good news is that there are resources to help survivors and their families navigate the after-effects of cancer.

Lance Armstrong, LIVESTRONG Founder and Chairman, is a world-renowned cyclist and cancer survivor/advocate.

Doug Ulman, LIVESTRONG President & CEO

Within the cancer community, there are many non-profit organizations and services who seek to fill the gaps. LIVESTRONG’s navigation services, like the American Cancer Society’s, connect survivors with information and services to overcome the during- and post-treatment challenges they face. Through our ongoing work and with the findings in this study we aim to continue to advocate for treating survivorship as a distinct phase of the cancer continuum. We hope to see public policy makers, health advocates and medical professionals acknowledge that survivorship is a critical piece of cancer care, and work to help more people live successfully with the long-term impact of cancer.

Fundamentally, our organization is about hope. Hope for a cancer-free future. But until we get there, we will continue to work each day to fight cancer, help people live and thrive with and through cancer, and bring the voice of survivors to life. By being their voice we will advocate for better care, better medicine, better treatments and better answers for the millions of people who will someday wake up and ask: now what?

Lance Armstrong is a cycling champion, cancer survivor and father of five. Doug Ulman is a three-time cancer survivor who recently welcomed his first child into the world.

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For inquiries, please contact The Daily Beast at editorial@thedailybeast.com.

Drugs for Enlarged Prostate May Raise Risk of Aggressive Cancer (HealthDay)

THURSDAY, June 9 (HealthDay News) -- The U.S. Food and Drug Administration is calling for new warning labels on a class of drugs used primarily to treat enlarged prostates, because the medications may raise the risk of developing an aggressive form of prostate cancer.

In a statement released Thursday, the agency said the drugs involved include popular medications sold under the brand names Proscar and Propecia (sold by Merck & Co.) and Avodart and Jalyn (sold by GlaxoSmithKline).

According to the FDA, almost 5 million men were prescribed one of these medications between 2002 and 2009. Of these, nearly 3 million men were between the ages of 50 and 79.

The agency is advising doctors not to start patients on these drugs until prostate cancer -- which can mimic the symptoms of an enlarged prostate -- and other urological conditions have been ruled out.

According to the agency, this new warning is based on the results of two large prostate cancer trials.

Although these trials did not include Propecia, which is prescribed to treat hair loss in men, its label is also being updated. However, the FDA said "the applicability of the Avodart and Proscar studies to Propecia, is currently unknown."

All of these drugs are part of a class of medications called 5-alpha reductase inhibitors (5-ARI). According to the FDA, Proscar, Avodart and Jalyn are approved to treat symptoms of enlarged prostate, while Proscar and Avodart are also approved to reduce the risk of urinary retention or surgery related to an enlarged prostate. Propecia is a lower-dose version of Proscar.

Merck issued a statement Thursday on the FDA ruling.

"Merck stands behind the demonstrated safety and efficacy of Proscar [finasteride, 5mg] and Propecia [finasteride, 1mg]. Both products have been prescribed to millions of men, with Proscar prescribed to those suffering from benign prostatic hyperplasia (BPH or enlarged prostate) since 1992, and Propecia prescribed to men with male pattern hair loss since 1997," the company statement said. "Merck's goal is to ensure the product labeling includes all relevant trial information to help health-care professionals and their patients make informed treatment decisions."

Less than a year ago, GlaxoSmithKline asked the FDA to approve the use of Avodart to prevent prostate cancer, although the FDA declined that request in January. The company based its reasoning on the results of one of the trials on which the agency is now basing its new warning.

In addition to this new side effect, recent research has shown that Proscar, Propecia and Avodart are all associated with increasing the risk of erectile dysfunction in men who take the medications.

Commenting on the FDA warning, prostate cancer expert Dr. Anthony D'Amico, chief of genitourinary radiation oncology at Brigham and Women's Hospital in Boston, said, "I think that the warning is appropriate. The risk is very small, but not zero."

"What both studies show conclusively is there is about a 1 percent increase in being diagnosed with high-grade prostate cancer if you got these drugs -- even though you are less likely to get a low-grade cancer."

Why that is is not clear, D'Amico said. "But I think the warning is fair," he added.

The drugs really do work in preventing prostate cancer, D'Amico said. "You have to weigh the 24 percent reduction against the 1 percent increased incidence of high-grade disease," he said.

"These drugs should only be used in men who have an additional indication to take them beyond prostate cancer prevention," D'Amico said.

More information

For more on prostate cancer, visit the American Cancer Society.

Chemo for Late-Stage Cancer Patients May Be Unjustified (HealthDay)

THURSDAY, June 9 (HealthDay News) -- Some patients with advanced cancer receive drugs that won't help them but could cause them harm, a U.S. study suggests.

University of Chicago researchers analyzed medical and pharmaceutical claims from 1,041 patients with metastatic colon cancer who were treated between January 2007 and June 2010. Of those patients, about one in eight received chemotherapy treatments that weren't supported by evidence from clinical trials or by clinical practice guidelines.

The researchers focused on three specific treatments. One had insufficient data to support its use, one had been shown to be ineffective, and one was not supported by data or a compelling rationale, according to the study.

The treatment with insufficient data involved the use of Avastin (bevacizumab) after a patient's cancer had progressed despite treatment with a combination of the drug and chemotherapy. The treatment shown to be ineffective was Xeloda (capecitabine) after cancer progression while being treated with the same class of drug. The treatment with no compelling rationale was Erbitux (panitumumab/cetuximab) after cancer progression while being treated with similar drugs.

The researchers said the patients who received these treatments were exposed to significant risk without proven benefits at an estimated cost of more than $2 million just for the drugs.

"Patients with advanced cancers that do no respond to standard therapies should either be looking for clinical trials, where there is a chance for benefit, or should have been thinking about shifting toward palliative care," study author Dr. Jonas De Souza, a hematology/oncology fellow, said in a university news release.

"Patients should not face the risks, discomforts and costs of aggressive and often quite toxic chemotherapy with treatment regimens that did not provide a benefit in previous studies," he added.

The study was presented this week at the American Society for Clinical Oncology's annual meeting in Chicago. Experts note that research presented at meetings should be considered preliminary because it has not been subjected to the rigorous scrutiny given to research published in medical journals.

More information

The U.S. National Cancer Institute has more about metastatic cancer.

Prostate drugs raise risk of prostate cancer: FDA (Reuters)

WASHINGTON (Reuters) – A class of drugs meant to improve symptoms of an enlarged prostate gland actually increase the chance of getting a more serious form of prostate cancer, health officials said on Thursday.

However, they also said the drugs' benefits outweigh the risks.

The drugs in this group include Merck & Co's Proscar and GlaxoSmithKline's Avodar and Jalyn, as well as Merck's Propecia, which is approved to treat male pattern hair loss.

The Food and Drug Administration said it revised the labels on all such drugs, called 5-alpha reductase inhibitors (5-ARI), to include the risk after reviewing two large studies.

The randomized controlled studies found that daily use of 5-ARIs for several years decreased the chance of getting lower-risk forms of prostate cancer but made it more likely that patients would get a high-grade prostate cancer, which grows and spreads more quickly.

"This risk appears to be low, but healthcare professionals should be aware of this safety information, and weigh the known benefits against the potential risks when deciding to start or continue treatment with 5-ARIs in men," the FDA said on its website.

5-ARI drugs are known clinically as finasteride and dutasteride and are used to treat benign prostatic hyperplasia (BPH), or prostate enlargement, a common condition in men over 40. Propecia, for male baldness, includes a smaller dose of finasteride.

The FDA said about 5 million male patients were given a prescription for a 5-ARI from 2002 to 2009. The drugs' benefits in treating BPH still outweighed any risks, it said.

Another class of medicines known as alpha-blockers can also be used to treat symptoms of BPH. Drugs of this type include Astellas Pharma's Flomax, Pfizer Inc's Cardura, and Rapaflo from Watson Pharmaceuticals.

(Reporting by Anna Yukhananov; editing by John Wallace)

Bankruptcy Risk Nearly Doubles in Year After Cancer Diagnosis (HealthDay)

WEDNESDAY, June 8 (HealthDay News) -- As cancer patients' survival times increase, so do their bankruptcy rates.

That's the finding of a new study by researchers who compared U.S. bankruptcy court records to cancer registry data from nearly 232,000 adult cancer survivors in western Washington over 14 years. The investigators reported that, on average, bankruptcy rates quadrupled within five years of cancer diagnosis.

Compared to the general population, bankruptcy rates among cancer survivors were nearly twice as high one year after diagnosis, and the median time to bankruptcy was 2.5 years after cancer diagnosis.

"The risk of bankruptcy for cancer patients is not well known, and previous studies have relied on individual self-reports about medically related reasons for bankruptcy filing," study leader Dr. Scott Ramsey, a health care economist and internist at Fred Hutchinson Cancer Research Center, said in a center news release. "By linking two irrefutable government records of cancer and bankruptcy, we are able to determine how financial insolvency risk varies by cancer type, treatment and other factors."

The risk of bankruptcy was highest among patients with cancer of the lung, thyroid and leukemia/lymphoma. People over 65 -- who are typically covered by Medicare -- have a much lower risk of bankruptcy than their younger counterparts. The researchers also noted that the number of U.S. cancer patients declaring bankruptcy has increased significantly since the recent economic downturn began.

"Patients diagnosed with cancer may face significant financial stress due to income loss and out-of-pocket costs associated with their treatment," Ramsey said in the news release.

The study was presented this week at the American Society of Clinical Oncology's annual meeting in Chicago. Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Society of Clinical Oncology has more about the costs of cancer care.

Mladic 'was treated for cancer in Belgrade' (AFP)

THE HAGUE (AFP) – Wartime Bosnian Serb army chief Ratko Mladic was treated for cancer two years ago while evading genocide charges, his lawyer said Thursday on the eve of the ex-general's first appearance at a UN court.

"I have medical records showing that he was treated for lymphoma in 2009 in a Belgrade hospital," Belgrade-based lawyer Milos Saljic who has previously said his client won't live to see trial, told AFP.

The prosecution of the International Criminal Tribunal for the former Yugoslavia (ICTY), meanwhile, said the trial of the man dubbed the "Butcher of Bosnia" would not start for months.

"It is a complex case, it will take time to prepare," spokesman Frederick Swinnen said.

"It will take several months before the trial starts." The trial itself is expected to last several years.

Mladic's one-time mentor, Serbian President Slobodan Milosevic, died in The Hague four years into his own genocide trial in 2006, of a heart attack.

On Friday, 69-year-old Mladic will be asked to plead to 11 counts of genocide, war crimes and crimes against humanity at the UN-backed court in The Hague.

For long Europe's most wanted man for atrocities committed during Bosnia's 1992-95 war that killed 100,000 people, Mladic was arrested in northeast Serbia last Thursday and flown to The Netherlands on Tuesday after Serbian judges denied his appeal on health grounds and found him fit to stand trial.

Belgrade daily Press quoted Saljic as saying that Mladic had suffered three strokes and two heart attacks.

At his first court appearance on Friday, Mladic will be asked by a judge to identify himself and to answer questions about his health and conditions of detention.

He may then have the 62-page indictment read out, after which he will be asked to plead to the charges. He will have 30 days to do so, failing which the court will enter a not-guilty plea on his behalf.

Mladic is accused of masterminding the 1995 Srebrenica massacre of about 8,000 Muslim men and boys, and the 44-month siege of the capital Sarajevo from May 1992 in which 10,000 people died.

If Mladic does enter a guilty plea, there will be no trial and a date will be set for a sentencing hearing. Fe faces a maximum sentence of life in prison.

International news crews swarmed into The Hague Thursday and satellite TV trucks jostled for space outside the tribunal.

The tribunal had to rent extra space at a conference centre across the road to handle the expected overflow of visitors hoping to catch a glimpse of the ex-general in the dock.

Large screens will be erected and extra chairs put out for people to follow the hearing, with the 100-odd seats in the courtroom and even the ICTY lobby expected to be overrun, according to the court's press office.

The ICTY also announced it has assigned a Serbian lawyer from a list of accredited counsel to represent Mladic at his first appearance.

Mladic has been informed of his right to appoint a permanent lawyer or to have one assigned to him by the court if he cannot pay, said a court document.

But it was not clear whether he has retained counsel or would opt instead to conduct his own defence, as his former political head Radovan Karadzic has been doing since his own trial on similar charges opened in October 2009.

Swinnen said Thursday it was "possible but not probable" that the trials of the two men regarded as the political and military architects of the Bosnian campaign will be joined, pointing to practical difficulties arising from the fact that Karadzic's case has been running for 18 months.

Mladic's family are not expected among the throngs at court Friday.

"The family will not go to The Hague in the next 15 days," Saljic has told AFP, adding they would wait for the initial appearance to pass and then visit him "calmly" in The Hague.

Five representatives of victims' groups said Thursday they were on their way to The Hague to attend the hearing.

But a lawyer for Alma Mustafic, who lost her father Rizo in the Srebrenica massacre, said she was not ready to face Mladic and would stay home.

"Her father's remains have just been discovered in a mass grave and he will be reburied on July 11 in Srebrenica. She is not yet up to meeting her father's murderer," lawyer Liesbeth Zegveld told AFP.