***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: & NA ; A multicenter , prospect i ve study ( n = 103 ) examined the psychological implication s of women 's decisions for or against breast reconstruction .  Recognized measures of anxiety , depression , body image , and quality of life were completed before the operation , and 6 and 12 months later . A reduction in psychological distress over the year following the operation was evident in each surgical group ( mastectomy alone or immediate or delayed reconstruction ) . indicating that reconstructive surgery can offer psychological benefits to some women : however , others report improved psychological functioning without this surgical procedure . In contrast to existing retrospective research , the prospect i ve design enabled the process of adjustment during the first year after the operation to be examined . The results indicate that breast reconstruction is not a universal panacea for the emotional and psychological consequences of mastectomy .  Women still reported feeling conscious of altered body image 1 year postoperatively , regardless of whether or not they had elected breast reconstruction . Health professionals should be careful of assuming that breast reconstruction necessarily confers psychological benefits compared with mastectomy alone As weil as the medical outcomes of two distinct operations , namely total mastectomy and breast-conserving therapy , their impact on the psychic structureing of the patient may differ . A group of 40 woman with who had undergone mastectomy were therefore compared with another 40 with who had received breast-conserving therapy  , with regard to the variables of body image , self-esteem and social support . The women who underwent breast-conserving therapy had a more positive body image ( P<0.001 ) . The two groups showed a negligble difference with respect to self-esteem and social support ( P>0.05 ) . A negative correlation was found between body image and social support ( P<0.05 ) . Patients with total mastectomy therefore do have a more negative body image than patients receiving breast-conserving therapy .  Self-esteem and social support in the postoperative period in two groups are comparable BACKGROUND During the last decade , survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy . Limited data exist on the psychosocial aspects of the transitional period between the end of primary treatment and survivorship . We investigated the baseline psychosocial status of women enrolled in a r and omized trial testing two psychosocial interventions for women at the end of primary treatment . METHODS Participants , identified within 1 month after surgery ( registration ) , provided demographic information and limited measures of quality of life . They were followed until they finished primary treatment ( enrollment ) , at which time they completed a mailed baseline survey that included st and ardized measures of quality of life ( including st and ardized scales of physical and emotional functioning ) , mood , symptoms , and sexual functioning .  A total of 558 patients ( mean age = 56.9 years ) were enrolled in the study between July 1 , 1999 , and June 30 , 2002 . Health outcomes were examined according to treatment received : mastectomy with and without chemotherapy , and lumpectomy with and without chemotherapy . All statistical tests were two-sided . RESULTS Among all treatment groups , patients who had a mastectomy had the poorest physical functioning at registration ( P<.001 ) and at enrollment ( P=.05 ) . At enrollment , mood and emotional functioning were similar among all patients , with no differences by type of treatment received . At enrollment , symptoms , including muscle stiffness , breast sensitivity , aches and pains , tendency to take naps , and difficulty concentrating , were common among patients in all groups and were statistically significantly associated with poor physical functioning and emotional well-being . Sexual functioning was worse for women who received chemotherapy than for those who did not , regardless of type of surgery ( P<.001 ) . CONCLUSIONS At the end of primary treatment for breast cancer , women in all treatment groups report good emotional functioning but report decreased physical functioning , particularly among women who have a mastectomy or receive chemotherapy . Clinical interventions to address common symptoms associated with treatment should be considered to improve physical and emotional functioning at the end of primary treatment for breast cancer In the past decade , changing attitudes toward breast reconstruction among both patients and providers have led a growing number of women to seek breast reconstruction after mastectomy . Although investigators have documented the psychological , social , emotional , and functional benefits of breast reconstruction , little research has evaluated the effects of procedure choice on these outcomes . The current study prospect ively evaluated and compared psychosocial outcomes for three common options for mastectomy reconstruction : tissue exp and er/implant , pedicle TRAM , and free TRAM techniques . In a prospect i ve cohort design , patients undergoing postmastectomy reconstruction for the first time with exp and er/implant , pedicle TRAM , or free TRAM procedures were recruited from 12 centers and 23 plastic surgeons in the United States and Canada . Before reconstruction and at 1 year after reconstruction , patients were evaluated by a battery of question naires consisting of both generic and condition-specific surveys . Outcomes assessed included emotional well-being , vitality , general mental health , social functioning , functional well-being , social well-being , and body image . Baseline ( preoperative ) scores and the change in scores ( the difference between postoperative and preoperative scores ) were compared across procedure types using t tests and analysis of covariance . Preoperative and 1-year postoperative surveys were obtained from 273 patients . Procedure type was reported in 250 patients , of whom 56 received implant reconstructions , 128 pedicle TRAM flaps , and 66 free TRAM flaps . A total of 161 immediate and 89 delayed reconstructions were performed . Among women receiving immediate reconstruction , significant improvements were observed in all psychosocial variables except body image . However , no significant effects of procedure type on these changes over time existed . Similarly , delayed reconstruction patients had significant increases in emotional well-being , vitality , general mental health , functional well-being , and body image . Although the choice of reconstructive technique did not significantly impact most of these outcomes , significant differences existed among procedure types for three psychosocial subscales . Patients undergoing delayed exp and er/implant reconstructions reported greater improvements in vitality and social well-being relative to women receiving delayed TRAM procedures . By contrast , delayed TRAM patients noted significantly greater gains in body image compared with women choosing delayed exp and er-implant reconstruction . The authors conclude that both immediate and delayed breast reconstructions provide substantial psychosocial benefits for mastectomy patients . Although the choice of reconstructive procedure does not seem to significantly affect improvements in psychosocial status with immediate reconstruction , our data suggest that procedure type does have a significant effect on gains in vitality and body image for women undergoing delayed reconstruction Purpose To compare the quality -of-life ( QoL ) and psycho-social changes in a group of patients with early breast cancer who underwent conservative surgery ( BCS ) or modified radical mastectomy ( MRM ) .  Methods Self-administered question naire assessing body image perception , social habits , sexual attraction and self-consciousness with relatives/friends , was r and omly assigned to 125 patients ( 61 BCS , 64 MRM ; aged 53±8 and 50±9 years , respectively , p = NS ) . Results MRM patients reported a significantly higher frequency of changes in body image perception and other related social behaviour such as avoiding going to the beach or using low-cut clothes , and reticence with friends . Conversely , no differences were found regarding sexuality , denial of the disease by the husb and /partner , or concealing the disease from family members . Also , no significant differences were found between patients above and below the age of 50 years , for all variables studied after adjustment for surgical procedure . Conclusions Modified radical mastectomy has a negative effect on body image perception and in social behaviour patterns of patients and with a concomitant decrease in QoL. The sexuality of the patient is not significantly affected Background The various surgical procedures for early-stage breast cancer are equivalent in terms of survival . Therefore , other factors , such as the procedures ’ effect on psychosocial adjustment and quality of life ( QOL ) , take on great importance . The aim of the current study was to prospect ively examine the short- and long-term effects of mastectomy with reconstruction , mastectomy without reconstruction , and breast conservation therapy on aspects of psychosocial adjustment and QOL in a sample of 258 women with breast cancer . Methods Participants completed question naires before surgery and then again 1 , 6 , 12 , and 24 months after surgery . Question naires assessed depressive symptoms , anxiety , body image , sexual functioning , and QOL . Results Adjustment patterns differed throughout the 2-year period after surgery . Some short-term changes in adjustment ( less anxiety , less overall body satisfaction ) were similar across surgery groups , whereas others ( satisfaction with chest appearance , QOL in physical health domain ) were higher for women who had breast conservation therapy . However , women who had mastectomy with reconstruction reported greater satisfaction with their abdominal area . During the long-term follow-up period ( 6 months to 2 years after surgery ) , women in all three groups experienced marked improvements in psychosocial adjustment ( depressive symptoms , satisfaction with chest appearance , sexual functioning ) and QOL in physical and mental health domains . In fact , the level for most variables returned to baseline levels or higher . Conclusions Overall , the general patterns of psychosocial adjustment and QOL are similar among the three surgery groups Psychiatric disorders such as depression and anxiety are common among cancer patients . If left untreated , these disorders can lead to poor treatment compliance , prolonged hospital stay and reduced life quality . In this prospect i ve study , we aim ed determine anxiety and depression levels and related factors among female breast cancer patients presenting to a breast surgery clinic in Istanbul and who met the inclusion criteria . Data were collected using a question naire and the Hospital Anxiety and Depression Scale ( HAD ) . The mean age was 48.2 years and the mean post-operative period was 17.9 months . It was found that 46.3 % of the patients had stage I , and 53.7 % stage II , 59.3 % of them undergoing breast conserving surgery and 40.7 % mastectomy . When evaluated according to the HAD Scale , it was found that anxiety scores of 35.1 % of the patients and depression scores of 17.1 % of the patients were higher than their cut-off points . With regard to the affecting factors , depression scores of those with no family history of breast cancer were significantly higher than those with no family history of breast cancer ( t= 1.53 ; p= 0.03 ) ; that the depression scores of the patients who underwent mastectomy were significantly higher than those who underwent breast conserving surgery ( t= 1.75 ; p= 0.04 ) . Additionally , it was found that low income was an important risk factor for anxiety ; whereas a history of breast cancer in the family and mastectomy was an important risk factor for depression . These results indicate the importance of determining psychiatric problems and appropriate approaches in addition to medical treatment in breast cancer patients 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 BACKGROUND Depression is common in breast cancer patients . The aim of this paper was to make a systematic review of its prevalence and associated factors oin breast cancer survivors . MATERIAL S AND METHODS An extensive systematic electronic review ( PUBMED , CINAHL , PsyINFO and Ovid ) and h and search were carried out to retrieve published articles up to November 2012 , using Depression OR Dysthymia AND ( Cancer OR Tumor OR Neoplasms as the keywords . Information about the design of the studies , measuring scale , characteristics of the participants , prevalence of depression and its associated factors from the included studies were extracted and summarized . RESULTS We identified 32 eligible studies that recruited 10,826 breast cancer survivors . Most were cross-sectional or prospect i ve design ed . The most frequent instrument used to screen depression was the  Center for Epidemiological Studies for Depression  
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Conclusions Our study showed that there were no statistically significant differences concerning the occurrence of depressive symptoms in breast cancer patients as a consequence of TM , BCS or BR at mean time more than 1-year term postoperatively