Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

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Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

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Free-Messaging Apps Siphon Profits from Cellular Providers

For a long time, opening a cellphone bill was scary for the parents of teenagers. Charges for texting could reach hundreds of dollars a month, prompting many families to sign up for unlimited plans. But at perhaps $20 a month for each family member, that quickly added up, too.

Lucas Jackson/Reuters

A man uses his Apple iPhone in New York in September. Cellphone users are sending more text messages than ever, but increasingly they are free — thanks to the Internet.

Apps like Facebook Messenger, top, and WhatsApp, bottom, send their messages using the Internet rather than cellular networks. The shift could cost wireless companies billions of dollars.

Relief is on the way. Cellphone users are sending more text messages than ever, but increasingly they are free — thanks to the Internet. While that is good news for consumers, it could cost the world’s wireless companies tens of billions of dollars in lost revenue.

Standard texting, the kind where you send abbreviation-filled messages over a cellphone network, has been in decline in many parts of the world, and now appears to be shrinking in the United States. That is because smartphones can use free Internet-powered services that send messages over data networks instead, and those services are attracting millions of users.

The shift is opening an opportunity for big companies like Facebook and Apple and smaller start-ups like WhatsApp and Kik, which are making aggressive grabs at this market, aiming to put themselves at the center of how people communicate in the smartphone era.

Peter Deng, a product director at Facebook who oversees its Messenger software, said that text messaging was “ripe for innovation” because it had been held back by outdated technology.

“It’s limited to 160 characters,” Mr. Deng said, “and it’s not at all rich in its expression. People want to connect deeply with each other, and they don’t want to be constrained by various technical boundaries and decisions made 20 years ago.”

Unlike ordinary text messages, Facebook’s messaging service allows people to see when their friends are typing a reply and when messages are received, among other features, he said.

Standard texting is still popular. CTIA, the wireless industry trade group, said that in the first half of this year, Americans sent 1.107 trillion text messages. But that was down 2.6 percent from the 1.137 trillion messages sent in the first half of last year. Ovum, a mobile communications research firm, estimates that by 2016, Internet-based message services will have eaten up $54 billion in revenue that carriers could have made from text messaging.

For years, text messages have been a source of pure profit for carriers because it costs nearly nothing to deliver them. In response to the rise of Internet services, they have been overhauling their pricing plans to stay profitable.

Verizon Wireless and AT&T, for example, offer new plans that include unlimited texting and phone calls, while charging bigger fees for using Internet data, which is likely to be their main source of growth. (Internet messaging over a carrier’s data network does use up some of a customer’s monthly data allotment, but it is a tiny amount relative to, say, watching a video.)

John Walls, vice president for public affairs at CTIA, said carriers were always expanding their services by offering things like all-you-can-eat texting plans and the ability to donate to charity via text. He noted that 72,000 text messages were being sent every second of every day.

“I hardly think the end is in sight for texts,” Mr. Walls said.

For Internet companies, messaging will never be a cash cow. But they have other reasons to get excited about this market.

Facebook benefits if more people use its messaging service, because those people are likely to spend more time on its Web site and mobile apps, seeing more ads. On Tuesday the company said it would allow Android users in some countries to sign up for its messaging service with just a phone number, no Facebook account required, partly because this might eventually persuade non-Facebook users to cave in and sign up for an account. That feature will come to the United States at some point, Facebook said.

Apple’s free texting service, iMessage, comes installed on iPhones, iPads and iPod Touch devices, where it automatically routes messages over the Internet if they are being sent to another Apple device. The service also works with the Messages app on Apple’s computers. That could encourage people to continue buying Apple products to keep in touch with family and friends cheaply and easily. Even the design of iMessage makes people feel like they’re in a special clique: an iMessage shows up on an Apple device as a blue bubble, while a normal text message from a non-Apple phone is green.

Perhaps the most talked-about player in texting right now is the small start-up WhatsApp, based in Mountain View, Calif. The 30-person company, founded by Jan Koum and Brian Acton, two former Yahoo executives, says its service is used in more than 100 countries. Its app is one of the most popular in the world on iPhones and Android devices, and on the BlackBerry it is even bigger than Research in Motion’s own messaging service.

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Op-Ed Contributor: How Cities Can Save China

CHINA is experiencing its most severe economic downturn in decades, and revitalizing its economic model is critical to future prosperity — not only in China, but around the world.

Central to that effort is the transformation of China’s cities. By adopting a new approach to urbanization, its leaders can assure more balanced investment, address a major source of debt, achieve a consumption windfall and clean up the country’s environment. Otherwise, China’s economic and environmental problems will worsen, with vast implications for the rest of the world.

China’s success has been built on two pillars: investment and exports. But after decades of growth, this model is delivering diminishing returns. There is little doubt that China must change to a new model, one that relies on consumption to generate growth, while addressing debt and broadening the use of sustainable energy and environmental practices.

Cities, home to hundreds of millions of Chinese consumers, lie at the core of this problem — and offer a potential solution.

A flawed system of municipal finance is driving debt, corruption and dissent, while unsustainable urban planning has yielded polluted cities that are destroying China’s ecosystem. Yet China’s future requires continued urbanization, which, absent a new approach, will only make the problem worse.

Cities can, however, be part of the solution: better urban policies can put China on a healthier path forward, economically and environmentally.

For one thing, municipal financial reform is essential because debt is crushing Chinese cities, leaving mayors with no means of financing the central government’s policy mandates. Mayors have developed creative ways to raise revenues, including appropriating farmers’ land and seizing land on the outskirts of cities to sell to developers. But these practices contribute to urban sprawl and often feed corruption.

Among other changes, China’s cities need transparent budgets and the devolution of more tax authority to cities.

More innovative urban planning and design are also needed. To achieve the country’s goals of raising living standards for a broader share of the population, cities must be better designed to yield energy efficiency and environmental sustainability.

China’s potential is stifled by traffic and pollution. Gazing out my hotel window in Beijing on a recent trip, I saw air that was hazy and polluted — a stark contrast to the sparkling view of Lake Michigan I enjoy from my kitchen window at home in Chicago.

This isn’t just China’s problem. Experts found that dirty air from China contributed up to 20 percent of the ground-level pollution on the American West Coast in 2010. And that is when just one-tenth of Chinese own cars. Imagine what China’s air quality will become when this number triples, as some experts predict it will within the next several years.

Take another example: construction. Within city centers are countless “superblocks” — half-kilometer-square developments interspersed with huge boulevards that create monster traffic jams and skyrocketing pollution.

In response, an approach that featured smaller blocks and mixed-use neighborhoods and accessible public transportation would alleviate these unintended consequences. Such “livable cities” would balance economic development with energy efficiency, improve air quality and reduce congestion.

Getting China’s urbanization right will matter to us all. Fortunately, many in China understand this, and cooperation with the United States government, corporate world and nonprofit sector, including my own research and advocacy institute, is bringing them the tools they need to prioritize design issues in their cities and adapt infrastructure plans now. These tools include instruction in sustainable practices for government leaders, public education in environmental issues and specialized training for the country’s urban planners.

China must adopt this new approach quickly, before vast infrastructure investment makes the current model irreversible. By 2025, China is projected to have a staggering 200 cities with populations over one million. America has just nine.

Global prosperity depends on China’s continuing to be an engine of growth. We all need China to reinvent its economic model. Working together on urbanization creates progress toward joint solutions to the challenges the world faces from overwhelming pressure on natural ecosystems, resources and commodities.

We need Chinese cities to succeed, and we can help ensure that they do so.

Henry M. Paulson Jr., a former chief executive of Goldman Sachs and Treasury secretary, is the chairman of the Paulson Institute.

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More Dads Buy the Toys, So Barbie, and Stores, Get Makeovers

Barbies are for girls and construction sets are for boys. Or are they?

For the first time in Barbie’s more than 50-year history, Mattel is introducing a Barbie construction set that underscores a huge shift in the marketplace. Fathers are doing more of the family shopping just as girls are being encouraged more than ever by hypervigilant parents to play with toys (as boys already do) that develop math and science skills early on.

It’s a combination that not only has Barbie building luxury mansions — they are pink, of course — but Lego promoting a line of pastel construction toys called Friends that is an early Christmas season hit. The Mega Bloks Barbie Build ’n Style line, available next week, has both girls — and their fathers — in mind.

“Once it’s in the home, dads would very much be able to join in this play that otherwise they might feel is not their territory,” said Dr. Maureen O’Brien, a psychologist who consulted on the new Barbie set.

Consumer surveys show that men are increasingly making the buying decisions for families, reflecting the growth in two-income households and those in which the women work and the men stay home. One-fifth of fathers with preschool-age children and working wives said they were the primary caretaker in 2010, according to the latest Census Bureau data. And 37.6 percent of working wives earned more than their husbands in 2011, up from 30.7 percent 10 years earlier.

“Kids are going to grow up with dads that give them baths and drive them to soccer and are cutting up oranges for team snacks,” said Liz Ross, president for North America of BPN, part of the IPG Mediabrands holding company, which recently completed a study on male consumers. “What will go away, albeit slowly, is the image or the perception of the befuddled dad.”

The change is having consequences beyond toys. Consumer products have traditionally been marketed to appeal to women, and stores have been designed for women’s sensibilities. Now, some brands and stores are catering directly to male decision-makers. Sears is reorganizing stores to put tools next to work wear, for instance, based on men’s preferences. Procter & Gamble is working on men’s grooming aisles at top retailers, a nod to the fact that women are no longer choosing shampoos or shaving creams for their husbands. With the selling point that it helps girls develop spatial reasoning, the Barbie set, a joint effort of Mattel and the toy company Mega Bloks, is also meant to pique fathers’ interest.

“Dad is a bigger influencer in terms of toy purchases over all, and this sets up well for that, because the construction category is something Dad grew up with and definitely has strong feelings and emotions about,” said Vic Bertrand, chief innovation officer of Mega Brands, Mega Bloks’ parent company.

Construction sets for girls are a speedy growth category, thanks to Lego’s introduction of its Friends line in January. Despite criticism that those sets were sexist — themes include a beauty shop and a fashion studio — Lego’s chief executive said in August that the company sold twice as many of the sets in the first half of the year as it had expected, and retailers like Amazon and Target have named them hot holiday toys.

Anne Marie Kehoe, vice president of toys for Walmart U.S., said that, with the Barbie addition, construction toys aimed at girls will represent about 20 percent of the toy construction category by the end of this year, while last year there were just a handful of products.

Research shows that playing with blocks, puzzles and construction toys helps children with spatial development, said Dr. Susan C. Levine, chairwoman of the psychology department at the University of Chicago and co-principal investigator at the National Science Foundation’s Spatial Intelligence and Learning Center. Even controlling for other skills such as verbal and numerical skills, she said, children with better spatial thinking are more likely to eventually go into mathematics, engineering, science and technology.

She said that a set aimed at girls could be beneficial, if only because it might increase girls’ likelihood of participating in construction activities.

Dr. O’Brien, the consultant on the new Barbie set, said adults had traditionally been “the limiting factor” in why girls have not played with those toys as often.

Recently, she said, there has been a shift in attitudes, as parents study research on development and spatial play. “For this particular product, one of the advantages is you can appeal to both moms and dads,” she said of the construction set.

During her research, Dr. O’Brien said, she watched a grandfather jump in to explain building principles to his granddaughter, who was playing with the Barbie. Still, the construction set is not exactly dump trucks and dirt. It remains “unapologetically all girl,” said Stephanie Cota, senior vice president of global marketing for Barbie, girls’ brands and games at Mattel.

The Mega Bloks building pieces are pink (Pantone 219, the signature Barbie color), and the construction choices are scenes like a fashion boutique, a mansion and an ice cream cart. Each set comes with a small Barbie figure that can be snapped into the scene.

Mattel, the world’s largest toy maker, still leans heavily on Barbie, one of its most popular and longest-running franchises. However, pressure to update Barbie has been high — Mattel has introduced Barbies with video cameras and digital cameras in recent years.

Yet sales of Barbie in North America through September fell 1 percent, even as sales of Mattel’s other girl brands, like Disney Princess dolls, rose 44 percent. Mega Brands makes just a fraction of what its larger rival Lego does, and had revenues of about $376 million last year.

The Barbie brand, which tends to raise feminists’ ire for its overly sexualized dolls, not to mention the 1992 version saying “Math class is tough,” has already taken some high-arched steps toward gender equality. A computer-engineer Barbie was introduced two years ago, for instance, with the support of the Society of Women Engineers.

This time, though, the introduction appears to be a response more to market changes than to critics.

Girls “don’t necessarily care about, ‘That’s a boy toy; that’s not for me,’ ” said Ms. Cota of Mattel. “Now, more so than ever, girls are looking at what’s fun, what they like.”

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National Briefing | New England: New Hampshire: Not Guilty Plea in Hepatitis Case

A traveling hospital technologist accused of stealing drugs and infecting patients with hepatitis C through contaminated syringes pleaded not guilty in federal court on Monday. The technologist, David Kwiatkowski, whom prosecutors described as a “serial infector,” was indicted last week on charges of tampering with a consumer product and illegally obtaining drugs. Until May, Mr. Kwiatkowski worked as a cardiac technologist at Exeter Hospital, where 32 patients were given diagnoses of the same strain of hepatitis C he carries. Before that, he worked in 18 hospitals in seven states, moving from job to job despite having been fired twice over accusations of drug use and theft. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Mr. Kwiatkowski carries.

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National Briefing | New England: New Hampshire: Not Guilty Plea in Hepatitis Case

A traveling hospital technologist accused of stealing drugs and infecting patients with hepatitis C through contaminated syringes pleaded not guilty in federal court on Monday. The technologist, David Kwiatkowski, whom prosecutors described as a “serial infector,” was indicted last week on charges of tampering with a consumer product and illegally obtaining drugs. Until May, Mr. Kwiatkowski worked as a cardiac technologist at Exeter Hospital, where 32 patients were given diagnoses of the same strain of hepatitis C he carries. Before that, he worked in 18 hospitals in seven states, moving from job to job despite having been fired twice over accusations of drug use and theft. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Mr. Kwiatkowski carries.

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Gadgetwise Blog: Turn Your Photos into E-Holiday Cards

From Christmas trees to Christmas cards, December is a pretty deadly season for trees. There’s not a lot you can do about the Christmas trees (aluminum tinsel tree anyone?), but you can cut down on the cards.

An iPhone app, Over, lets you put type on top of your own photos. Although it wasn’t intended with holidays in mind – more like a chance to make your own memes – it’s an easy way to make cards the way photo studios used to ages ago.

There are other similar apps, but few if any are as simple to use and as versatile as Over.

To get started, open the app and tap on “take a photo,” or “camera roll,” to take a photo or choose an existing shot.

Sample text tells you to double tap to edit. Once you do that, type in your message and then choose the color you would like your type to be. A yellow triangle on the right-hand side of the photo lets you pick a font and size it. You can move the writing around by dragging it with your finger.

When you are happy with your choices, you can save the photo or go directly to “share” and post your work on Facebook, Twitter, Tumblr or Instagram, or send by email.

If you really want to be a traditionalist, you can still kill trees by having your work turned into a 4 by 6 inch postcard, at $2 for a single card. You buy through the service Sincerely, which gets points off for making people go through sign up and set up without revealing the cost until the last step.

Over is a $2 app, but there is a version for use on Instagram only; it’s Overgram, and it’s free.

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Obama Calls on Russia to Renew Weapons Pact

WASHINGTON — President Obama called on Russia on Monday to renew a two-decade-old nuclear disarmament program that Moscow has threatened to cancel as the two sides try to figure out the future of a rocky relationship now that elections in both countries are behind them.

Russia declared this fall that it would not renew the Nunn-Lugar Cooperative Threat Reduction Program, which has helped rid the former Soviet Union of thousands of nuclear weapons since the end of the cold war. But in a speech, Mr. Obama chose to interpret the Russian statements as a negotiating position to change the program rather than halt it altogether.

“Russia has said that our current agreement hasn’t kept pace with the changing relationship between our countries,” Mr. Obama said at the National Defense University, where he praised the program’s accomplishments. “To which we say, let’s update it. Let’s work with Russia as an equal partner. Let’s continue the work that’s so important to the security of both our countries. And I’m optimistic that we can.”

Whether Russia is willing to do that remains unclear. Even if it is, Moscow has suggested that it would link the renewal of the program to concessions by the United States on its plans to deploy a missile defense system in Europe intended to defend against Iranian aggression. Mr. Obama was overheard telling his Russian counterpart this year that “after my election I have more flexibility” on missile defense, prompting Republicans to accuse him of plotting to sell out the system.

Mr. Obama made no mention of missile defense on Monday, but in reaching out to Moscow he seemed to be taking the opening step in a postelection dance in which the two countries will re-evaluate their ties. His effort to reset the relationship after a rupture over the Georgia war of 2008 succeeded for a time in stabilizing ties, but the atmosphere has cooled noticeably since Vladimir V. Putin returned to the presidency this year.

In recent months, Russia ordered the United States Agency for International Development to leave and enacted laws focused on nongovernmental organizations receiving foreign financing. As a result, the National Democratic Institute, an American-financed organization that promotes democracy, moved to Lithuania last month, and its counterpart, the International Republican Institute, is likely to follow.

The announcement in October that Russia would not renew the Nunn-Lugar program when it expires in the spring underscored how sour relations had become. Through all the ups and downs over the past 20 years, Nunn-Lugar had always been largely immune to the political tides, in part because Russia saw that having American money and help in slimming down its nuclear arsenal was in its own interest.

Since it began, Nunn-Lugar has helped to deactivate 7,600 nuclear warheads and destroy or eliminate 900 intercontinental ballistic missiles, 500 missile silos, 680 submarine-launched ballistic missiles and 900 nuclear air-to-surface missiles. But the program still envisioned getting rid of hundreds more weapons to meet goals for 2017.

Russia said it would take over the costs and responsibilities of continuing the program, in effect asserting that after its economic and geopolitical resurgence of recent years, it no longer needs foreign help. But Mr. Obama has not given up on preserving the program, although aides said no specific negotiations were under way to renew it.

American officials hope that last month’s election will make it possible for the two sides to get back on a better footing. After Mr. Obama’s victory, the two presidents spoke by telephone and Mr. Obama accepted Mr. Putin’s invitation to visit Russia in 2013. Presumably he would go to St. Petersburg for the Group of 20 summit meeting that Mr. Putin will host in September.

Mr. Obama’s outreach to Russia on Nunn-Lugar came during a speech paying tribute to its patrons, former Senator Sam Nunn, Democrat of Georgia, and Senator Richard G. Lugar, Republican of Indiana, who lost a primary this year. Mr. Obama hailed them on Monday as “real visionaries” who “challenged us to think anew, to imagine, after decades of confrontation, how our nations might engage in cooperation.”

But, he added: “We’re nowhere near done, not by a long shot, and you all know this. There’s still much too much material — nuclear, chemical, biological — being stored without enough protection. There are still terrorists and criminal gangs doing everything they can to get their hands on it. And make no mistake, if they get it, they will use it.”

This article has been revised to reflect the following correction:

Correction: December 3, 2012

Because of an editing error, an earlier version of this article misidentified the Indiana Republican Richard G. Lugar. As the article correctly noted, Mr. Lugar lost a primary this year. He will remain in the United States Senate until his successor is sworn in on Jan. 3, 2013; he is not a former senator. 

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Advertising: Ford Plan to Revive Lincoln Hinges on a New Brand

An unusual ad campaign features Abraham Lincoln, the president for whom the car brand is named.

DEARBORN, Mich. — In the fiercely competitive world of luxury cars, the Ford Motor Company’s Lincoln brand has long been stuck in the slow lane, with stodgy models, older buyers and a distinct lack of pizazz.

But Ford is determined to change that. On Monday, the company will announce upgraded customer service initiatives, a new brand name for Lincoln that plays down the Ford connection and an unusual advertising campaign that features Abraham Lincoln, the president for whom the brand is named.

Ford’s chief executive, Alan R. Mulally, will begin the rebranding effort at an event outside Lincoln Center in Manhattan — the first in a series of moves meant to reverse Lincoln’s seemingly perpetual state of decline.

Ford will formally rechristen the brand as the Lincoln Motor Company and introduce a television spot that begins with an image of Lincoln, stovepipe hat and all. The brand’s first Super Bowl commercial is in the works, as is a revamped Web site that links consumers to a Lincoln “concierge” who can arrange test drives or set up appointments at dealerships.

Mr. Mulally will also announce the on-sale date in early 2013 for the radically redesigned Lincoln MKZ sedan, as well as plans for three new vehicles down the road.

If it seems like an all-out grab for attention, well, that’s exactly the point, said James D. Farley Jr., Ford’s head of global sales and marketing and the newly named chief of the Lincoln revival effort.

“The most important thing is for people to be aware that there is a transition going on,” Mr. Farley said. “We have to shake them up.”

The shake-up is long overdue and critically important to Ford, the nation’s second-largest car company behind General Motors.

As recently as the 1990s, Lincoln was the top-selling luxury automotive brand in the United States. Its large Town Car sedan and hulking Navigator S.U.V. defined the brand, and sales topped more than 230,000 vehicles a year.

But since then, Lincoln has been left in the dust by the German category leaders BMW and Mercedes-Benz, and Toyota’s Lexus division. This year, Lincoln ranks eighth in the American luxury segment, with sales down 2 percent, to 69,000, vehicles in the first 10 months of the year.

Its crosstown rival G.M. has had much better success reviving its Cadillac brand.

“Cadillac has been stabilized, but Lincoln is still muddling about,” said Jack Trout, president of the marketing firm Trout and Partners. “The big question is, how can Lincoln convince people it is more than just a gussied-up Ford?”

That task has now fallen to Mr. Farley, who left Toyota five years ago to join Ford just as Mr. Mulally’s transformation of the company was under way. Since then, Ford has introduced a succession of sleeker, more fuel-efficient and technology-laden models that have lifted sales and made it among the most profitable car companies in the world.

Lincoln, however, has not benefited from the turnaround. It accounts for only 3 percent of Ford’s total sales, down from 8 percent during the brand’s heyday. And since Ford has sold off foreign luxury divisions like Volvo and Jaguar, Lincoln is the sole upscale brand in the company.

“There is nothing more frustrating for us than to have someone who loves their Ford car and S.U.V., but goes out to buy a luxury model from another brand because we don’t have one,” Mr. Farley said.

The Lincoln comeback effort starts with the midsize MKZ, which has been redesigned with a sweeping grille, tapered body style and an all-glass retractable roof. It will be followed by three other new models, including a larger sedan and S.U.V.

But the brand’s image needs much more than better cars. Under Mr. Farley’s direction, a newly formed team of 200 people is intent on establishing the Lincoln Motor Company as a boutique luxury line known for personalized service.

Every customer who reserves an MKZ, for example, will be presented with an elegant gift upon receiving the car. Choices include a selection of wines and Champagne, custom-made jewelry or sunglasses, or a one-night stay at a Ritz-Carlton hotel.

Lincoln’s Web site will also have a consultant available 24 hours a day for live discussions about the products and to streamline the buying process. Prospective buyers will be given an opportunity for a “date night” with Lincoln, which includes a two-day test drive and a free meal at a restaurant.

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