This year's Miss America pageant is shaping up to be a historic one with high possibilities that the winner could be the first to suffer from autism or has had a double mastectomy.
The 92nd edition of the venerable US pageant has more of an edge this year, with Miss Montana Alexis Wineman, 18, and Miss District of Columbia Allyn Rose, 24, personifying two major health issues.
Wineman, this year's youngest contestant, was diagnosed at the age of 11 with pervasive developmental disorder including borderline Asperger's syndrome -- and she has been outspoken about her life with autism.
"So many people expect autistic people to all be the same, that it's a brain disorder so we can't function in society," Wineman, the first autistic contestant in Miss America history, told Time magazine this week.
"I want people to realize there's a whole spectrum of people who live with autism. There are high-functioning people and low-functioning people," added Wineman, whose state title has earned her a coveted college scholarship.
From the nation's capital, paralegal Rose -- who was 16 when her mother died of breast cancer -- said she will undertake a preventative double mastectomy after the pageant, even if she wins the title.
"I can either be incredibly vigilant for the rest of my life," she told Washington's WJLA television in November after capturing the Miss District of Columbia title.
"Or I can make this other decision (to undergo a double mastectomy) -- something that's incredibly drastic, but at the same time it's something that can help prolong my life."
Rose, a University of Maryland politics graduate and keen skater who also once played in a punk band, previously competed as Miss Maryland in the rival Miss USA pageant. Her grandmother and great aunt also died of breast cancer.
Other contestants this year include Miss Iowa Mariah Cary, who struggles with Tourette's syndrome, Miss Maine Molly Bouchard, who lost more than 50 pounds (23 kilograms) before winning her state title, and Miss Wyoming Lexie Madden, who once wrestled pigs for scholarship money.
Despite a decline in TV ratings and disdain among many feminists who consider them demeaning, pageants in the United States have no problem finding contestants -- especially with the sometimes generous scholarships on offer.
Previous winners include Heather Whitestone, a deaf native of Alabama who in 1994 became the first Miss America with a disability, and 1974 winner Rebecca Ann King, a lawyer who openly supported abortion.
A decade later Vanessa Williams became the first black Miss America, but she resigned during her reign amid a scandal after nude photos of her appeared in Penthouse magazine. She went on to a successful music and acting career.