***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 : Most reports on postoperative ( OP ) morbidity and mortality following breast cancer surgery ( BCS ) are limited by relatively small sample size result ing in a lack of national benchmarks for quality of care . This paper reports the 30-day morbidity and mortality following BCS in women using a large prospect i ve multi-institutional data base . Methods : The National Surgical Quality Improvement Program Patient Safety in Surgery , prospect ively collected inpatient and outpatient 30 day postoperative morbidity and mortality data on patients undergoing surgery at 14 university and 4 community centers . Using the procedure CPT code , the data base was queried for all women undergoing mastectomy ( MT ) or lumpectomy with an axillary procedure ( L-ANP ) .  Morbidity and mortality were categorized as mortality , wound , cardiac , renal , pulmonary , and central nervous system . Logistic regression models for the prediction of wound complications were developed . Preoperative variables having bivariate relationships with postoperative wound complications with P ≤ 0.20 were su bmi tted for consideration . Results : We identified 1660 and 1447 women who underwent MT and l-ANP , respectively . The mean age was 55.9 years . The majority of procedures were under general anesthesia . The 30-day postoperative mortality for MT and l-ALNP were 0.24 % and 0 % , respectively . The most frequent morbid complication was wound infection , more commonly occurring in the mastectomy ( 4.34 % ) group versus the lumpectomy group ( 1.97 % ) . Cardiac and pulmonary complications occurred infrequently in the mastectomy group ( cardiac : MT , 0.12 % ; and pulmonary : MT , 0.66 % ) . There were no cardiac or pulmonary complications in the lumpectomy group . CNS morbidities were rare in both surgical groups ( MT , 0.12 % ; and l-ALNP , 0.07 % ) . Development of a UTI was more common in women who underwent a mastectomy ( 0.66 % ) when compared with women that had a lumpectomy ( 0.14 % ) . The only significant predictors of a wound complication were morbid obesity ( BMI > 30 ) , having had a MT , low preoperative albumin and hematocrit greater than 45 % . Conclusion : Morbidity and mortality rates following BCS in women are low , limiting their value in assessing quality of care . Mastectomy carries higher complication rate than l-ANP with wound infection being the most common 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 OBJECTIVE : To examine how the weight of a patient affects both the attitudes that physicians hold as well as the treatments that they intend to prescribe . DESIGN : In a six-cell r and omized design , physicians evaluated a medical chart of a male or female patient , depicted as either average weight , overweight or obese , who presented with a migraine headache . SUBJECTS : A total of 122 physicians affiliated with one of three hospitals located in the Texas Medical Center of Houston completed the experiment . MEASUREMENTS : Using a st and ard medical procedure form , physicians indicated how long they would spend with the patient and which of 41  medical tests and procedures they would conduct . They also indicated their affective and behavioral reactions to the patient . RESULTS : The weight of a patient significantly affected how physicians viewed and treated them . Although physicians prescribed more tests for heavier patients , F(2 , 107)=3.65 , P<0.03 , they simultaneously indicated that they would spend less time with them , F(2 , 107)=8.38 , P<0.001 , and viewed them significantly more negatively on 12 of the 13 indices . CONCLUSION : This study reveals that physicians continue to play an influential role in lowering the quality of healthcare that overweight and obese patients receive . As the girth of America continues to increase , continued research and improvements in the quality of such healthcare deserve attention Objective To examine the relation between body mass index ( kg/m2 ) and  cancer incidence and mortality . Design Prospect i ve cohort study . Participants 1.2 million UK women recruited into the Million Women Study , aged 50 - 64 during 1996 - 2001 , and followed up , on average , for 5.4 years for cancer incidence and 7.0 years for cancer mortality . Main outcome measures Relative risks of incidence and mortality for all cancers , and for 17 specific types of cancer , according to body mass index , adjusted for age , geographical region , socioeconomic status , age at first birth , parity , smoking status , alcohol intake , physical activity , years since menopause , and use of hormone replacement therapy . Results 45 037 incident cancers and 17 203 deaths from cancer occurred over the follow-up period . Increasing body mass index was associated with an increased incidence of endometrial cancer ( trend in relative risk per 10 units=2.89 , 95 % confidence interval 2.62 to 3.18 ) , adenocarcinoma of the oesophagus ( 2.38 , 1.59 to 3.56 ) , kidney cancer ( 1.53 , 1.27 to 1.84 ) , leukaemia ( 1.50 , 1.23 to 1.83 ) , multiple myeloma ( 1.31 , 1.04 to 1.65 ) , pancreatic cancer ( 1.24 , 1.03 to 1.48 ) , non-Hodgkin 's lymphoma ( 1.17 , 1.03 to 1.34 ) , ovarian cancer ( 1.14 , 1.03 to 1.27 ) , all cancers combined ( 1.12 , 1.09 to 1.14 ) , breast cancer in postmenopausal women ( 1.40 , 1.31 to 1.49 ) and colorectal cancer in premenopausal women ( 1.61 , 1.05 to 2.48 ) . In general , the relation between body mass index and mortality was similar to that for incidence . For colorectal cancer , malignant melanoma , breast cancer , and endometrial cancer , the effect of body mass index on risk differed significantly according to menopausal status . Conclusions Increasing body mass index is associated with a significant increase in the risk of cancer for 10 out of 17 specific types examined . Among postmenopausal women in the UK , 5 % of all cancers ( about 6000 annually ) are attributable to being overweight or obese . For endometrial cancer and adenocarcinoma of the oesophagus , body mass index represents a major modifiable risk factor ; about half of all cases in postmenopausal women are attributable to overweight or obesity The association between anthropometric indices and the risk of breast cancer  was analyzed using pooled data from seven prospect i ve cohort studies . Together , these cohorts comprise 337,819 women and 4,385 incident invasive breast cancer cases . In multivariate analyses controlling for reproductive , dietary , and other risk factors , the pooled relative risk ( RR ) of breast cancer per height increment of 5 cm was 1.02 ( 95 % confidence interval ( CI ) : 0.96 , 1.10 ) in premenopausal women and 1.07 ( 95 % CI : 1.03 , 1.12 ) in postmenopausal women . Body mass index ( BMI ) showed significant inverse and positive associations with breast cancer among pre- and postmenopausal women , respectively ; these associations were nonlinear . Compared with premenopausal women with a BMI of less than 21 kg/m2 , women with a BMI exceeding 31 kg/m2 had an RR of 0.54 ( 95 % CI : 0.34 , 0.85 ) . In postmenopausal women , the RRs did not increase further when BMI exceeded 28 kg/m2 ; the RR for these women was 1.26 ( 95 % CI : 1.09 , 1.46 ) . The authors found little evidence for interaction with other breast cancer risk factors . Their data indicate that height is an independent risk factor for postmenopausal breast cancer ; in premenopausal women , this relation is less clear . The association between BMI and breast cancer varies by menopausal status . Weight control may reduce the risk among postmenopausal women Purpose : Obesity is associated with adverse outcomes in postmenopausal women with breast cancer . In premenopausal women , the association is less clear . Methods : A population -based sample of 1,360 Australian women with breast cancer before the age of 60 years , 47 % diagnosed before age 40 , and 74 % premenopausal , was studied prospect ively for a median of 5 years ( range , 0.2 - 10.8 years ) . Obesity was defined as a body mass index of ≥30 kg/m2 . The hazard ratio ( HR ) for adverse clinical outcome associated with obesity was estimated using Cox proportional hazard survival models . Results : Obesity increased with age ( P < 0.001 ) and was associated with increased breast cancer recurrence ( P = 0.02 ) and death ( P = 0.06 ) , larger tumors ( P = 0.002 ) , and more involved axillary nodes ( P = 0.003 ) but not with hormone receptor status ( P ≥ 0.6 ) or with first cycle adjuvant chemotherapy dose reductions ( P = 0.1 ) . Adjusting for number of axillary nodes , age at diagnosis , tumor size , grade , and hormone receptor status , obese women of all ages were more likely than nonobese women to have disease recurrence [ HR , 1.57 ; 95 % confidence interval ( 95 % CI ) , 1.11 - 2.22 ; P = 0.02 ] and to die from any cause during follow-up ( HR , 1.56 ; 95 % CI , 1.01 - 2.40 ; P = 0.05 ) . In premenopausal women , the adjusted HRs were 1.50 ( 95 % CI , 1.00 - 2.26 ; P = 0.06 ) and 1.71 ( 95 % CI , 1.05 - 2.77 ; P = 0.04 ) , respectively . Conclusions : Obesity is independently associated with poorer outcomes in premenopausal women , as it is in postmenopausal women , and this is not entirely explained by differences in tumor size or nodal status . Given the 
    Output:
    
Morbidly obese women are significantly less likely to report  recent mammography .
This relationship appears stronger in white women .
Lower screening rates may partly explain the higher breast cancer mortality in morbidly obese women