***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Results from the r and omized trial conducted by the Health Insurance Plan ( HIP ) to determine the efficacy of breast cancer screening with mammography and palpation are reported for longer periods than previously available . By the end of 10 years after entry , the study group 's  mortality due to breast cancer was about 30 % below the control group 's . Arithmetic gains due to screening were maintained through year 14 ; relative gains declined . With increases in the period of follow-up , cumulative survival rates among cases detected by mammography alone ( palpation negative during screening ) , decreased more rapidly than rates among other subgroups , but survival rates for mammography cases remained relatively high . Study women aged 40 - 49 years at entry began to show lower breast cancer mortality than those in the control group as duration of follow-up increased . Reservations are advanced about the acceptance of this finding as evidence of the efficacy of screening under age 50 under the conditions of the HIP study . The reservations are based on the observation that the decrease of mortality among the study group aged 45 - 49 at entry is concentrated entirely among cases diagnosed after they reached 50 years of age A trial in the UK to study the effect on mortality from breast cancer of invitation for annual mammography from the age of 40–41 , has r and omised a total of 160 921 women in the ratio 1 : 2 to the intervention and control arms . All breast cancers diagnosed in the two arms have been identified , and the histology review ed . This paper presents the results of an interim analysis using surrogate outcome measures to compare predicted breast cancer mortality in the two arms based on 1287 cases diagnosed to 31.12.1999 . Due to earlier diagnosis , there is currently an 8 % excess of invasive breast cancers in the intervention arm . The ratio of predicted deaths at 10 years in the intervention arm relative to the control arm , adjusted for this excess diagnosis , ranges from 0.89 ( 95 % confidence interval ( CI ) 0.78–1.01 ) to 0.90 ( 95 % CI 0.80–1.01 ) . Screening from age 40 may result in a lower reduction in breast cancer mortality than that observed in other trials including women below age 50 . This analysis based on surrogate outcome measures suggests that a reduction in breast cancer mortality may be observed in this trial . However , a number of assumptions have been necessary and firm conclusions must await the analysis of observed mortality from breast cancer PURPOSE We investigated the incidence of cardiac adverse events in patients with early breast cancer in the Herceptin Adjuvant ( HERA ) trial who were treated with 1 year of trastuzumab after completion of (neo)adjuvant chemotherapy . PATIENTS AND METHODS The HERA trial is a three-group , r and omized trial that compared 1 year or 2 years of trastuzumab with observation in women with human epidermal growth factor receptor-2 ( HER2 ) -positive early breast cancer . Eligible patients had normal left ventricular ejection fraction ( LVEF ; > or= 55 % ) after completion of (neo)adjuvant chemotherapy with or without radiotherapy .  Cardiac function was monitored throughout the trial . This analysis considers patients r and omly assigned to 1 year of trastuzumab treatment or observation . RESULTS There were 1,698 patients r and omly assigned to observation and 1,703 r and omly assigned to 1 year of trastuzumab treatment ; 94.1 % of patients had been treated with anthracyclines . The incidence of discontinuation of trastuzumab because of cardiac disorders was low ( 5.1 % ) . At a median follow-up of 3.6 years , the incidence of cardiac end points remained low , though it was higher in the trastuzumab group than in the observation group ( severe CHF , 0.8 % v 0.0 % ; confirmed significant LVEF decreases , 3.6 % v 0.6 % ) In the trastuzumab group , 59 of 73 patients with a cardiac end point reached acute recovery ; of these 59 patients , 52 were considered by the cardiac advisory board ( CAB ) to have a favorable outcome from the cardiac end point . CONCLUSION The incidence of cardiac end points remains low even after longer-term follow-up . The cumulative incidence of any type of cardiac end point increases during the scheduled treatment period of 1 year , but it remains relatively constant thereafter Abstract Objectives : To examine the implication s of false positive results of mammography in terms of the time lag from screening and complete mammography to the point when women with false positive results are declared free of cancer ; the extra examinations , biopsies , and check ups required ; and the cost of these extra procedures . Design : Review of women with false positive results from the Stockholm mammography screening trial . Setting : Department of Oncology , South Hospital , Stockholm . Subjects : 352 and 150 women with false positive results of mammography from the first and second screening rounds of the Stockholm trial . Main outcome measures : Extra examinations and investigations required and the cost of these procedures . Results : The 352 women from the first screening round made 1112 visits to the physician and had 397 fine needle aspiration biopsies , 187 mammograms , and 90 surgical biopsies before being declared free of cancer . After six months 64 % of the women ( 219/342 ) were declared cancer free . The 150 women in the second round made 427 visits to the physician and had 145 fine needle aspiration biopsies , 70 mammograms , and 28 surgical biopsies , and after six months 73 % ( 107/147 ) were declared cancer free . The follow up costs of the false positive screening results were Kr2.54 m ( pounds sterling250000 ) in the first round and Kr0.85 m ( pounds sterling84000 ) in the second round . Women under 50 accounted for about 41 % of these costs . Conclusions : The examinations and investigations carried out after false positive mammography — especially in women under 50— and the cost of these procedures are a neglected but substantial problem . Key messages Key messages These extra costs come from the examinations and investigations required during follow up — for example , repeated biopsy of benign tissue — before the patient is declared cancer free In this series the costs of following up women with false positive mammograms were almost one third of the cost of screening all women in the r and omised Stockholm mammography trial These extra costs and other negative aspects of false positive results of mammography — especially in women under 50—are a neglected but substantial problem The benefits of mammography must be carefully weighed against the potential negative aspects , especially in women under Background : False-positive recall is a recognized disadvantage of mammographic breast screening , and the rate of such recalls may be higher in younger women , potentially limiting the value of screening below age 50 . Methods : Attendance and screening outcome data for 53,884 women in the intervention arm of the U.K. Age trial were analyzed to report observed false-positive recall rates during 13 years of trial fieldwork . The Age trial was a r and omized controlled trial of the effect of mammographic screening from age 40 on breast cancer mortality , conducted in 23 National Health Service screening centers between 1991 and 2004 . Women r and omized to the intervention arm were offered annual invitation to mammography from age 40 or 41 to age 48 . Results : Overall , 7,893 women ( 14.6 % of women the intervention arm and 18.1 % of women attending at least one routine screen ) experienced one or more false-positive screen during the trial . The rates of false-positive mammography at first and subsequent routine screens were 4.9 % and 3.2 % , respectively . The cumulative false-positive rate over seven screens was 20.5 % . Eighty-nine percent of women who had a false-positive recall at their previous screen attended their next invitation to routine screening . Conclusions : The rates of false-positive recall in the Age trial were comparable with the national screening program ; however , the positive predictive value of referral was lower . Experiencing a false-positive screen did not seem to lessen the likelihood of re-attendance in the trial . Impact : The question of greatly increased false-positive rates in this age group and of their compromising re-attendance is refuted by the findings of this study . Cancer Epidemiol Biomarkers Prev ; 19(11 ) ; 2758–64 . © 2010 AACR OBJECTIVES To evaluate the efficacy of the combination of annual screening with mammography , physical examination of the breasts and the teaching of breast self-examination in reducing the rate of death from breast cancer among women aged 40 to 49 years on entry . DESIGN Individually r and omized controlled trial . SETTING Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer . PARTICIPANTS Women with no history of breast cancer and no mammography in the previous 12 months were r and omly assigned to undergo either  annual mammography and physical examination ( MP group ) or usual care after an initial physical examination ( UC group ) . The 50,430 women enrolled from January 1980 through March 1985 were followed for a mean of 8.5 years . DATA COLLECTION Derived from the participants by initial and annual self-administered question naires , from the screening examinations , from the patients ' physicians , from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base . Expert panels evaluated histologic and death data . MAIN OUTCOME MEASURES Rates of referral from screening , rates of detection of breast cancer from screening and from community care , nodal status , tumour size , and rates of death from all causes and from breast cancer . RESULTS Over 90 % of the women in each group attended the screening sessions or returned the annual question naires , or both , over years 2 to 5 . The characteristics of the women in the two groups were similar . Compared with the Canadian population , the participants were more likely to be married , have fewer children , have more education , be in a professional occupation , smoke less and have been born in North America . The rate of screen-detected breast cancer on first examination was 3.89 per 1000 in the MP group and 2.46 per 1000 in the UC group ; more node-positive tumours were found in the MP group than in the UC group . During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.26 in the MP group and 1.02 in the UC group . Of the women with invasive breast cancer through to 7 years , 191 and 157 women in the MP and UC groups respectively had no node involvement , 55 and 43 had one to three nodes involved , 47 and 23 had four or more nodes involved , and 38 and 49 had an unknown nodal status . There were 38 deaths from breast cancer in the MP group and 28 in the UC group . The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 1.36 ( 95 % confidence interval 0.84 to 2.21 ) . The survival rates were similar in the two groups . The highest survival rate occurred among women whose cancer had been detected by mammography alone . CONCLUSION The study was internally valid , and there was no evidence of r and omization bias . Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative , small tumours than usual care , but it had no impact on the rate of death from breast cancer up to 7 years ' follow-up from entry The Swedish two county trial of breast cancer screening  is now in its tenth year . This paper presents detailed results on mortality from breast cancer and from all other causes , and on the population denominators at risk for each of the first 8 years of follow up , for each county separately . These data represent a two year up date on the last major report . Results show an increasingly significant deficit in deaths from breast cancer among the 77,092 women invited to screening  relative to the 56,000 not invited ( RR = 0.68 , p = 0.002 ) , with no significant difference between the effects of screening in the two counties ( p = 0.5 ) . These results remain the same when adjusted for age . Analysis of all cause deaths shows no significant effect of  screening  ( p = 0.5 ) , nor was there any significant effect of screening on deaths from all causes other than breast cancer ( p = 0.9 ) . The rates of deaths from intercurrent illness in breast cancer cases were almost identical in the group invited to screening and the group not invited ( p = 0.7 ) . This result remained the same when adjusted for age . We calculate that in the age group 50 - 69 at entry , one breast cancer death was prevented per 4000 woman/years , per 1460 mammographic examinations , per 13.5 biopsies , and per 7.4 breast cancers detected Context Seven- and 10-year results of the Canadian National Breast Screening Study ( CNBSS ) showed no reduction in breast cancer mortality from five annual mammographies and breast examinations for 40- to 49-year-old women . Some authors have argued that longer follow-up would reveal important benefits . Contribution After 11 to 16 years , the cumulative rate ratios for mammography versus usual care were 0.97 ( 95 % CI , 0.74 to 1.27 ) for breast cancer mortality without adjustment for non study mammography and 1.06 ( CI , 0.80 to 1.40 ) with adjustment . Clinical Implication s The CNBSS suggests that screening 40- to 49-year-old women is unlikely to reduce breast cancer by 20 % or more . Controversy will persist because other studies suggest that screening causes small reductions in breast cancer mortality . 
    Output:
    
The meta- analysis did not reveal excess non-breast cancer mortality caused by screening .
Conclusions The all-cause death rate was not significantly reduced by screening when compared to the rate observed in unscreened women .
However , mammography screening does not seem to induce excess mortality .