***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: Background In Australia , bowel cancer screening participation using faecal occult blood testing ( FOBT ) is low . Decision support tailored to psychological predictors of participation may increase screening . The study compared tailored computerised decision support to non-tailored computer or paper information . The primary outcome was FOBT return within 12 weeks . Additional analyses were conducted on movement in decision to screen and change on psychological variables . Methods A parallel , r and omised controlled , trial invited 25,511 people aged 50–74 years to complete an eligibility question naire . Eligible respondents ( n = 3,408 ) were assigned to Tailored Personalised Decision Support ( TPDS ) , Non-Tailored PDS ( NTPDS ) , or Control ( CG ) ( intention-to-treat , ITT sample ) . TPDS and NTPDS groups completed an on-line baseline survey ( BS ) and accessed generic information . The TPDS group additionally received a tailored intervention . CG participants completed a paper BS only . Those completing the BS ( n = 2270 ) were mailed an FOBT and requested to complete an endpoint survey ( ES ) that re-measured BS variables ( per- protocol , PP sample ) . Results FOBT return : In the ITT sample , there was no significant difference between any group ( χ2(2 ) = 2.57 , p = .26 ; TPDS , 32.5 % ; NTPDS , 33 % ; and CG , 34.5 % ) . In the PP sample , FOBT return in the internet groups was significantly higher than the paper group ( χ2(2 ) = 17.01 , p < .001 ; TPDS , 80 % ; NTPDS , 83 % ; and CG , 74 % ) . FOBT completion by TPDS and NTPDS did not differ ( χ2(1 ) = 2.23 , p = .13 ) . Age was positively associated with kit return . Decision to screen : 2227/2270 of the PP sample provided complete BS data . Participants not wanting to screen at baseline ( 1083/2227 ) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG . FOBT return by TPDS and NTPDS did not differ from one another ( OR = 1.16 , p = .42).Change on psychosocial predictors : Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging . Conclusions Online information re sources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes , perceptions and behaviour . Trial registration Australian New Zeal and Clinical Trials Registry The U.S. Preventive Services Task Force ( USPSTF ) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms . It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance . The USPSTF does not consider the costs of providing a service in this assessment . The USPSTF recognizes that clinical decisions involve more considerations than evidence alone . Clinicians should underst and the evidence but individualize decision making to the specific patient or situation . Similarly , the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms . Summary of Recommendations and Evidence The USPSTF recommends biennial screening mammography for women aged 50 to 74 years . ( B recommendation ) The decision to start screening  mammography  in women prior to age 50 years should be an individual one . Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years . ( C recommendation ) For women who are at average risk for breast cancer , most of the benefit of mammography results from biennial screening during ages 50 to 74 years . Of all of the age groups , women aged 60 to 69 years are most likely to avoid breast cancer death through mammography screening . While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death , the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger . The balance of benefits and harms is likely to improve as women move from their early to late 40s . In addition to false-positive results and unnecessary biopsies , all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health , or even apparent , during their lifetime ( known as overdiagnosis ) . Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment . Women with a parent , sibling , or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s . Go to the Clinical Considerations section for information on implementation of the C recommendation . The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older . ( I statement ) The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomo synthesis ( DBT ) as a primary screening method for breast cancer . ( I statement ) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography , magnetic resonance imaging ( MRI ) , DBT , or other methods in women identified to have dense breasts on an otherwise negative screening mammogram . ( I statement ) These recommendations apply to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation ( such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome ) or a history of chest radiation at a young age . See Figure 1 for a summary of the recommendation and suggestions for clinical practice . Figure 1 . Screening for breast cancer : clinical summary . Appendix Table 1 describes the USPSTF grade s , and Appendix Table 2 describes the USPSTF classification of levels of certainty about net benefit . Appendix Table 1 . What the USPSTF Grade s Mean and Suggestions for Practice Appendix Table 2 . USPSTF Levels of Certainty Regarding Net Benefit Supplement . Consumer Fact Sheet Rationale Importance Breast cancer is the second-leading cause of cancer death among women in the United States . In 2015 , an estimated 232000 women were diagnosed with the disease and 40000 women died of it . It is most frequently diagnosed among women aged 55 to 64 years , and the median age of death from breast cancer is 68 years ( 1 ) . Benefit and Harms of Screening and Early Treatment The USPSTF found adequate evidence that mammography screening reduces breast cancer mortality in women aged 40 to 74 years . The number of breast cancer deaths averted increases with age ; women aged 40 to 49 years benefit the least and women aged 60 to 69 years benefit the most . Age is the most important risk factor for breast cancer , and the increased benefit observed with age is at least partly due to the increase in risk . Women aged 40 to 49 years who have a first-degree relative with breast cancer have a risk for breast cancer similar to that of women aged 50 to 59 years without a family history . Direct evidence about the benefits of screening mammography in women aged 75 years or older is lacking . The USPSTF found adequate evidence that screening for breast cancer with mammography results in harms for women aged 40 to 74 years . The most important harm is the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to a woman 's health , or even apparent , during her lifetime ( that is , overdiagnosis and overtreatment ) . False-positive results are common and lead to unnecessary and sometimes invasive follow-up testing , with the potential for psychological harms ( such as anxiety ) . False-negative results ( that is , missed cancer ) also occur and may provide false reassurance . Radiation-induced breast cancer and result ing death can also occur , although the number of both of these events is predicted to be low . The USPSTF found inadequate evidence on the benefits and harms of DBT as a primary screening method for breast cancer . Similarly , the USPSTF found inadequate evidence on the benefits and harms of adjunctive screening for breast cancer using breast ultrasonography , MRI , DBT , or other methods in women identified to have dense breasts on an otherwise negative screening mammogram . In both cases , while there is some information about the accuracy of these methods , there is no information on the effects of their use on health outcomes , such as breast cancer incidence , mortality , or overdiagnosis rates . USPSTF Assessment The USPSTF concludes with moderate certainty that the net benefit of screening  mammography  in women aged 50 to 74 years is moderate . The USPSTF concludes with moderate certainty that the net benefit of  screening mammography  in the general population of women aged 40 to 49 years , while positive , is small . The USPSTF concludes that the evidence on  mammography screening  in women age 75 years and older is insufficient , and the balance of benefits and harms can not be determined . The USPSTF concludes that the evidence on DBT as a primary screening method for breast cancer is insufficient , and the balance of benefits and harms can not be determined . The USPSTF concludes that the evidence on adjunctive screening for breast cancer using breast ultrasound , MRI , DBT , or other methods in women identified to have dense breasts on an otherwise negative screening mammogram is insufficient , and the balance of benefits and harms can not be determined . Clinical Considerations Benefit of Screening The results of the meta- analysis of clinical trials from the systematic evidence review commissioned by the USPSTF are summarized in Table 1 . Over a 10-year period , screening 10000 women aged 60 to 69 years will result in 21 ( 95 % CI , 11 to 32 ) fewer breast cancer deaths . The benefit is smaller in younger women : Screening 10000 women aged 50 to 59 years will result in 8 ( CI , 2 to 17 ) fewer breast cancer deaths , and screening 10000 women aged 40 to 49 years will result in 3 ( CI , 0 to 9 ) fewer breast cancer deaths ( 2 , 3 ) . Most of these trials began enrollment more than 30 years ago , and these estimates may not reflect the current likelihood of avoiding a breast cancer death with contemporary screening mammography technology . Mammography imaging has since improved , which may result in more tumors being detected at a curable stage today than at the time of these trials . However , breast cancer treatments have also improved , and as treatment improves , the advantage of earlier detection decreases , so that some of the women who died of breast cancer in the nonscreened groups in these trials would survive today . Table 1 . Breast Cancer Deaths Avoided ( 95 % CI ) per 10 000 Women Screened by Repeat Screening Mammography Over 10 Years : Data From R and omized , Controlled Trials * Harms of Screening The most important harm of screening is the detection and treatment of invasive and noninvasive cancer that would never have been detected , or threaten health , in the absence of screening ( overdiagnosis and overtreatment ) . Existing science does not allow for the ability to determine precisely what proportion of cancer diagnosed by mammography today reflects overdiagnosis , and estimates vary widely depending on the data source and method of calculation used ( 2 , 4 ) . In the United States , the rate of diagnosis of invasive plus noninvasive breast cancer increased by 50 % during the era of mammography screening ( Figure 2 ) ( 5 ) . It is not possible to know with certainty what proportion of that increase is due to overdiagnosis and what proportion reflects other reasons for a rising incidence . If overdiagnosis is the only explanation for the increase , 1 in 3 women diagnosed with breast cancer today is being treated for cancer that would never have been discovered or caused her health problems in the absence of screening . The best estimates from r and omized , controlled trials ( RCTs ) evaluating Background : Interventions to improve adherence to regular mammography screening  have had conflicting results . Many studies have depended on women ’s self-report rather than clinical evidence of a mammography encounter . Methods : We tested the impact of two interventions on a population -based sample of NH women who were not receiving routine mammography to determine if adherence to screening could be improved . The interventions included a mailing of women ’s health information and a telephone counseling intervention based on the Transtheoretical Model . Participant eligibility and outcome measures were based on clinical events obtained from a population -based mammography registry . Results : Two hundred and fifty eight women completed all aspects of the intervention study . The women were r and omly assigned to one of two study groups : 51 % received the mail intervention and 49 % received the telephone intervention . Among women who received the telephone counseling intervention , 67 % percent reported being in either an action or maintenance stage at Call 1 , which increased to 84 % at Call 2 ( p<0.001 ) . Seventy-six percent of women identified barriers to screening mammography at Call 1 , which decreased to 44 % at Call 2 ( p<0.01 ) . The most frequently identified barrier was confusion over the guidelines for screening mammography . At the first assessment time interval , greater than 60 % of women were up-to- date for screening mammography in the group that received telephone counseling versus 48 % in the group that received health information by mail ( 
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Factors such as patient-provider communication , engagement with the health care system , and receipt of information were consistently reported to be associated with higher rates of surveillance .
The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence -based surveillance .
There is paucity of rigorous studies evaluating interventions to increase surveillance in this population .