***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Adjuvant endocrine therapy improves recurrence and survival rates , but has side effects and is inconvenient . The aim of this study was to determine the preferences of premenopausal women who had adjuvant endocrine therapy in a r and omised trial . In all , 85 ( or eighty-five ) women completed semistructured interviews 6–30 months after finishing adjuvant endocrine therapy .  Hypothetical scenarios based on known potential survival times ( 5 or 15 years ) and rates ( 60 % or 80 % at 5 years ) without adjuvant endocrine therapy were used to determine the smallest gains women judged necessary to make their adjuvant endocrine therapy worthwhile . Although a third of the women considered gains of 1 % in survival rates or 6 months in survival times sufficient to make their adjuvant endocrine therapy worthwhile , more than half the women required gains of at least 5 % in survival rates or 3 years in survival time as necessary to make adjuvant endocrine therapy worthwhile . Larger benefits were required by women who had longer treatment , worse side effects , and by those who were treated with goserelin alone . The route of administration ( tablet vs injection ) did not affect preferences and some women judged small benefits sufficient to make their adjuvant endocrine therapy worthwhile , but many women required larger benefits than their counterparts in similar studies of preferences for adjuvant chemotherapy OBJECTIVE This study examined the long-term effects on women 's  health related quality of life ( HRQOL ) of involvement in decision-making about their treatment for breast cancer and about follow-up care after treatment . METHODS Using a cross-sectional survey design , a sample of breast cancer survivors from Western Washington who were 2 , 5 , and 10 years postdiagnosis were recruited via a cancer registry and interviewed about their HRQOL and their involvement in decision-making about their cancer treatment and follow-up care . MAIN OUTCOME MEASURES HRQOL was assessed using the SF-36 . RESULTS Multiple regression analyses examining demographic and disease characteristics revealed age , and education , but not stage of cancer at diagnosis , to be significant predictors of perceived involvement in decision-making about cancer treatment and follow-up . Controlling for demographic and disease characteristics , perceived involvement in decision-making about treatment overall , surgery , chemotherapeutic treatment , and follow-up care were each associated with improved HRQOL , including the general health and vitality subscales of the SF-36 ( p < .05 ) . Involvement in decision-making about surgery was also associated with better mental health among survivors of breast cancer . Congruence of involvement in decision-making with a patient 's preferred level of involvement was also associated with improved survivor HRQOL on several subscales . CONCLUSIONS Perceived involvement in decision-making about breast cancer treatment , and about follow-up care is associated with better HRQOL for survivors 2 , 5 , and 10 years postdiagnosis . Prospect i ve studies may be warranted to determine the possible mechanisms by which perceived involvement in decision-making about aspects of treatment other than surgery type might influence survivor HRQOL HYPOTHESIS Physician-related factors as well as patient characteristics may explain why women aged 65 years or older with early-stage breast cancer undergo lumpectomy less often than younger women , despite National Institutes of Health recommendations favoring lumpectomy over mastectomy . DESIGN A descriptive and analytical retrospective computer-assisted telephone survey . SETTING A population -based r and om sample of breast cancer survivors in Colorado , identified from the Colorado Central Cancer Registry . PATIENTS Women aged 65 to 84 years when diagnosed as having stage I or II breast cancer , treated 1 to 6 years previously with mastectomy or lumpectomy , and without recurrence or second primary cancers . Among women contacted , 58 % participated . Results of 198 interviews are reported . METHODS Survey questions included patient decision-making participation and physician recommendations , sources and amount of treatment information  provided by physicians , physician characteristics , and patient surgery preferences and demographic characteristics . A multivariate logistic regression model identified factors independently associated with lumpectomy . RESULTS Lumpectomy was strongly associated with higher patient education , female physician sex , patient age 75 years or older , and amount of physician-provided information . The number of physician-provided information sources was associated with surgery explanations , and female physicians provided more sources of information . A physician decision or recommendation for surgery type was reported by 61 % of women , of whom 93 % underwent the recommended procedure . A subset of patients ( 13 % ) reported deferring the surgery decision to someone else . CONCLUSIONS These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy , and that physicians may influence breast cancer patients ' decisions about surgery type PURPOSE To assess the use of breast-conserving surgery in two states reported to differ with respect to surgical treatment of breast cancer . METHODS A retrospective cohort study based on data collected from medical records and patients was performed among 1,514 patients diagnosed with early-stage breast cancer in Massachusetts and 1,061 patients in Minnesota . Patients were identified at 18 r and omly selected hospitals in Massachusetts and at 30 hospitals in Minnesota . The rate of breast-conserving surgery in both states and the correlates of breast-conserving surgery among women eligible for the procedure were determined . RESULTS The rate of breast-conserving surgery  in both states was much higher than previously reported . Among those eligible for the procedure , nearly 75 % underwent  breast-conserving surgery  in Massachusetts and nearly half did so in Minnesota . Significantly ( P < .003 ) more women who underwent  mastectomy  in Minnesota ( 27 % ) than in Massachusetts ( 15 % ) reported that their surgeon did not discuss  breast-conserving surgery  with them . Among women who underwent mastectomy and who reported being informed of both surgical alternatives , more women ( P < .001 ) in Minnesota ( 74 % ) than in Massachusetts ( 62 % ) said they ultimately chose  mastectomy  because their surgeon recommended it . In Massachusetts , women treated at teaching hospitals were twice as likely as other women to undergo  breast-conserving surgery .  In Minnesota , women over age 70 and those who lived in rural areas were less likely than other women to undergo breast-conserving surgery .  CONCLUSION Although the rate of  breast-conserving surgery  in each state was higher than expected based on earlier reports , the rates differed considerably between states . Additional studies are needed to determine whether variation in practice between geographic areas is due to differences in patients ' preferences and values or to surgeons ' propensity for one type of surgery based on where they practice BACKGROUND Adjuvant endocrine therapies such as tamoxifen , goserelin , and oophorectomy improve survival for premenopausal women diagnosed with early-stage breast cancer . However , these treatments often result in menopausal symptoms , sexual dysfunction , permanent infertility , or the need to delay pregnancy . We aim ed to quantify the survival gains that premenopausal patients with early-stage breast cancer require to justify the side-effects and inconvenience of adjuvant endocrine treatments . METHODS Participants consisted of 102 women who had been diagnosed with early-stage ( stage I-II ) breast cancer 6 - 60 months previously , who were aged 40 years or younger at diagnosis , and who had been treated for a minimum of 3 months with endocrine therapy ( 67 with tamoxifen alone , seven with goserelin alone , and 28 with tamoxifen and goserelin or oophorectomy ) . 76 patients also received chemotherapy , and 75 received radiotherapy .  Participants attended a face-to-face patient-preference interview , in which they were presented with four hypothetical clinical scenarios that were used to quantify the gains in survival rate and life expectancy that women judged necessary to make their endocrine therapy worthwhile . They also completed a question naire on st and ard psychological measures . FINDINGS About half of participants thought that adjuvant endocrine therapy was worthwhile for an absolute gain in survival of 2 % from a baseline of either 65 % or 85 % , and for a gain in life expectancy of 3 months from a baseline of 5 years and of 6 months for a baseline of 15 years . Women who had had more severe endocrine side-effects required larger gains to make endocrine therapy worthwhile ( univariate p=0.02 , multivariate p=0.04 ) . INTERPRETATION Modest gains in survival are sufficient to make adjuvant endocrine treatment worthwhile for premenopausal women with early-stage breast cancer . Knowing and incorporating what women think should enhance shared decision-making One hundred and sixty-three patients with primary breast cancer were prospect ively studied . Using recently developed selection criteria 91 patients were offered a choice of treatment . Forty-one chose to undergo conservation treatment and 47 chose to undergo simple mastectomy . In those women who were offered a choice of treatment there was a significant tendency for younger patients to choose breast conserving treatment BACKGROUND In 1976 , we initiated a r and omized trial to determine whether lumpectomy with or without radiation therapy was as effective as total mastectomy for the treatment of invasive breast cancer . METHODS A total of 1851 women for whom follow-up data were available and nodal status was known underwent r and omly assigned treatment consisting of total mastectomy , lumpectomy alone , or lumpectomy and breast irradiation . Kaplan-Meier and cumulative-incidence estimates of the outcome were obtained . RESULTS The cumulative incidence of recurrent tumor in the ipsilateral breast was 14.3 percent in the women who underwent lumpectomy and breast irradiation , as compared with 39.2 percent in the women who underwent lumpectomy without irradiation ( P<0.001 ) . No significant differences were observed among the three groups of women with respect to disease-free survival , distant-disease-free survival , or overall survival . The hazard ratio for death among the women who underwent lumpectomy alone , as compared with those who underwent total mastectomy , was 1.05 ( 95 percent confidence interval , 0.90 to 1.23 ; P=0.51 ) . The hazard ratio for death among the women who underwent lumpectomy followed by breast irradiation , as compared with those who underwent total mastectomy , was 0.97 ( 95 percent confidence interval , 0.83 to 1.14 ; P=0.74 ) . Among the lumpectomy-treated women whose surgical specimens had tumor-free margins , the hazard ratio for death among the women who underwent postoperative breast irradiation , as compared with those who did not , was 0.91 ( 95 percent confidence interval , 0.77 to 1.06 ; P=0.23 ) . Radiation therapy was associated with a marginally significant decrease in deaths due to breast cancer . This decrease was partially offset by an increase in deaths from other causes . CONCLUSIONS Lumpectomy followed by breast irradiation continues to be appropriate therapy for women with breast cancer , provided that the margins of resected specimens are free of tumor and an acceptable cosmetic result can be obtained PURPOSE The purpose of this study was to measure the degree to which informed women chose  mastectomy  , and to reveal their reasons for this choice . PATIENTS AND METHODS This was a prospect i ve cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery ( BCS ; n = 125 ) . Participants completed question naires at three time points : baseline , after viewing a decision aid , and after a surgical consultation . Question naires assessed clinical history , preference for participation in decision making , information comprehension , values , decisional conflict , and preferred treatment . RESULTS Of 125 participants , 44 ( 35 % ) chose mastectomy . Most understood that BCS and mastectomy offer an equivalent survival benefit ( 98 % ) and that BCS has a slightly higher local recurrence risk ( 63 % ) ; most accurately identified the magnitude of ipsilateral local recurrence risk ( 91 % ) . Values assigned to three treatment attributes/ outcomes ( " remove breast for peace of mind , " " avoid radiation , " and " keep breast " ) clearly discriminated between patients choosing mastectomy or BCS . High decisional conflict scores improved after both the decision aid and surgical consultation . CONCLUSION Although conventional wisdom may view BCS as the preferred treatment , a notable proportion of well informed women choose mastectomy . Whereas prior studies have linked objective factors to treatment choice , this study reveals subjective preferences that underlie decision making . The systematic use of a decision aid before the surgical consultation may help women make informed , values-based decisions , while clearly reducing decisional conflict This study was performed to describe women 's satisfaction with body image before and 8 weeks after the surgical treatment of breast cancer compared with women without breast cancer . Additional aims were to describe women 's perceived participation in decisions regarding choice of surgical procedure to treat their breast cancer , and postoperative satisfaction with their breast cancer treatment , as well as to explore factors influencing women 's decisions regarding choice of surgical procedure . The design was prospect i ve with a descriptive , comparative design . The convenience sample included 31 women with breast cancer from an urban breast health center , and 30 women without breast cancer from the community . The majority were college educated , white , ranging in age from 29 - 82 years . Women with breast cancer completed instruments before and 8 weeks after surgery . Women without breast cancer completed the instruments two times 8 weeks apart . Three instruments measuring body image satisfaction were used . Participation in treatment decision-making , having a treatment choice , and posttreatment satisfaction , along with a description of important factors in decision making , were measured with open and closed-ended questions . During the study period , women with breast cancer experienced a significant decrease in satisfaction with body image after surgery ( p < .004 
    Output:
    
Decisive factors in patients ' preferences for surgery type commonly relate to body image and survival/recurrence .
Most participants judged small to moderate benefits sufficient to consider adjuvant systemic therapy worthwhile , but individual preferences varied widely .