***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: R and omised controlled trials have shown that the policy of mammographic screening confers a substantial and significant reduction in breast cancer mortality . This has often been accompanied , however , by an increase in breast cancer incidence , particularly during the early years of a screening programme , which has led to concerns about overdiagnosis , that is to say , the diagnosis of disease that , if left undetected and therefore untreated , would not become symptomatic . We used incidence data from two r and omised controlled trials of mammographic screening , the Swedish Two-county Trial and the Gothenburg Trial , to establish the timing and magnitude of any excess incidence of invasive disease and ductal carcinoma in situ ( DCIS ) in the study groups , to ascertain whether the excess incidence of DCIS reported early in a screening trial is balanced by a later deficit in invasive disease and provide explicit estimates of the rate of ' real ' and non-progressive ' overdiagnosed ' tumours from the study groups of the trials . We used a multistate model for overdiagnosis and used Markov Chain Monte Carlo methods to estimate the parameters . After taking into account the effect of lead time , we estimated that less than 5 % of cases diagnosed at prevalence screen and less than 1 % of cases diagnosed at incidence screens are being overdiagnosed . Overall , we estimate overdiagnosis to be around 1 % of all cases diagnosed in screened population s. These estimates are , however , subject to considerable uncertainty . Our results suggest that overdiagnosis in mammography screening is a minor phenomenon , but further studies with very large numbers are required for more precise estimation Background : The benefits and harms of population -wide mammography screening have been long debated . This study evaluated the impact of screening frequency and age range on breast cancer mortality reduction and overdiagnosis . Methods : We developed a Markov simulation model for the evaluation of mammography screening in a cohort of British women born in 1935–40 . Results : For triennial screening in women aged 47–73  , breast cancer mortality reduction and overdiagnosis was 18.1 % ( 95 % confidence interval : 17.3 % , 19.0 % ) and 5.6 % ( 5.1 % , 6.1 % ) , of all breast cancer deaths and diagnoses , respectively , from age 40 to 85 years . For annual screening in the same age range , estimates for both outcomes increased considerably to 35.0 % ( 34.2 % , 35.7 % ) and 7.6 % ( 7.1 % , 8.1 % ) , respectively . For the age extension of triennial screening from 50–70 to 47–73 , we estimated 5 ( 3 , 7 ) incremental breast cancer deaths avoided and 14 ( 9 , 19 ) incremental cases overdiagnosed per 10 000 women invited for screening . Conclusions : Estimates of mortality reduction and overdiagnosis were highly dependent on screening frequency , age range , and uptake , which may explain differences between some previous estimates obtained from r and omised trials and from service screening IMPORTANCE False-positive mammograms , a common occurrence in breast cancer screening programs , represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force . OBJECTIVE To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety , health utility , and attitudes toward future screening . DESIGN , SETTING , AND PARTICIPANTS The Digital Mammographic Imaging Screening Trial ( DMIST ) quality -of-life sub study telephone survey was performed shortly after screening and 1 year later at 22 DMIST sites and included r and omly selected DMIST participants with positive and negative mammograms . EXPOSURE Mammogram requiring follow-up testing or referral without a cancer diagnosis . MAIN OUTCOMES AND MEASURES The 6- question short form of the Spielberger State-Trait Anxiety Inventory state scale ( STAI-6 ) and the EuroQol EQ-5D instrument with US scoring . Attitudes toward future screening as measured by women 's self-report of future intention to undergo mammographic screening and willingness to travel and stay overnight to undergo a hypothetical new type of mammography that would identify as many cancers with half the false-positive results . RESULTS Among 1450 eligible women invited to participate , 1226 ( 84.6 % ) were enrolled , with follow-up interviews obtained in 1028 ( 83.8 % ) . Anxiety was significantly higher for women with false-positive mammograms ( STAI-6 , 35.2 vs 32.7 ) , but health utility scores did not differ and there were no significant differences between groups at 1 year . Future screening intentions differed by group ( 25.7 % vs 14.2 % more likely in false-positive vs negative groups ) ; willingness to travel and stay overnight did not ( 9.9 % vs 10.5 % in false-positive vs negative groups ) . Future screening intention was significantly increased among women with false-positive mammograms ( odds ratio , 2.12 ; 95 % CI , 1.54 - 2.93 ) , younger age ( 2.78 ; 1.5 - 5.0 ) , and poorer health ( 1.63 ; 1.09 - 2.43 ) . Women 's anticipated high-level anxiety regarding future false-positive mammograms was associated with willingness to travel overnight ( odds ratio , 1.94 ; 95 % CI , 1.28 - 2.95 ) . CONCLUSIONS AND RELEVANCE False-positive mammograms were associated with increased short-term anxiety but not long-term anxiety , and there was no measurable health utility decrement . False-positive mammograms increased women 's intention to undergo future breast cancer screening and did not increase their stated willingness to travel to avoid a false-positive result . Our finding of time-limited harm after false-positive screening mammograms is relevant for clinicians who counsel women on mammographic screening and for screening guideline development groups Objective - To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme . Setting - A pilot mammographic screening programme in Melbourne , Australia . Method — The psychological consequences question naire ( PCQ ; a reliable and valid measure of the psychological consequences of screening mammography ) was used to measure the emotional , social , and physical functioning of women in a mammographic screening programme and a control community sample . A screening group ( in whom no abnormality was detected at initial screen ; n=142 ) had four measurements : at screening clinic ; before results were received ; one week after all-clear results were received ; and eight months after initial visit . The recall group ( who were recalled for further investigation which showed the detected abnormality to be benign ; n = 58 ) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic . A r and omly selected community control group ( n = 52 ) had measurements one week , two weeks , three weeks ; and eight months after consenting to participate . Results - Emotional , social , and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls . The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups . The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic , and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer ( emotional P < 0·001 ; physical P < 0·05 ) . This difference had disappeared eight months after the screening visit , when the level of emotional and physical functioning was similar to that of the screening and control groups . Social dysfunction scores did not change significantly over time and were similar for all three groups . Conclusions - Given that up to 10 % of women are recalled for further investigations on first round screening , significant numbers of women may have psychological consequences . This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate , and for counselling services to be available at recall assessment centres Objective To compare breast cancer incidence and mortality up to 25 years in women aged 40 - 59 who did or did not undergo mammography screening .  Design Follow-up of r and omised screening trial by centre coordinators , the study ’s central office , and linkage to cancer registries and vital statistics data bases . Setting 15 screening centres in six Canadian provinces,1980 - 85 ( Nova Scotia , Quebec , Ontario , Manitoba , Alberta , and British Columbia ) . Participants 89 835 women , aged 40 - 59 , r and omly assigned to mammography  ( five annual mammography screens ) or control ( no mammography ) . Interventions Women aged 40 - 49 in the mammography arm and all women aged 50 - 59 in both arms received annual physical breast examinations . Women aged 40 - 49 in the control arm received a single examination followed by usual care in the community . Main outcome measure Deaths from breast cancer . Results During the five year screening period , 666 invasive breast cancers were diagnosed in the  mammography arm ( n=44 925 participants ) and 524 in the controls ( n=44 910 ) , and of these , 180 women in the mammography arm and 171 women in the control arm died of breast cancer during the 25 year follow-up period . The overall hazard ratio for death from breast cancer diagnosed during the screening period associated with mammography was 1.05 ( 95 % confidence interval 0.85 to 1.30 ) . The findings for women aged 40 - 49 and 50 - 59 were almost identical . During the entire study period , 3250 women in the mammography arm and 3133 in the control arm had a diagnosis of breast cancer , and 500 and 505 , respectively , died of breast cancer . Thus the cumulative mortality from breast cancer was similar between women in the mammography arm and in the control arm ( hazard ratio 0.99 , 95 % confidence interval 0.88 to 1.12 ) . After 15 years of follow-up a residual excess of 106 cancers was observed in the mammography arm , attributable to over-diagnosis . Conclusion Annual mammography in women aged 40 - 59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available . Overall , 22 % ( 106/484 ) of screen detected invasive breast cancers were over-diagnosed , representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial To assess how women regard having had a false positive mammogram screening exam  , and the influence that this had on their quality of life , 126 such women were interviewed . Their responses were compared to those of 152 women r and omly selected among screenees with a negative exam . Eighteen months after the screening the reported prevalence of anxiety about breast cancer was 29 % among women with a false positive and 13 % among women with a negative screening mammogram ( P = 0.001 ) . Of 30 women biopsied , 8 ( 27 % ) had pain in the breast and 10 ( 33 % ) had reduced sexual sensitivity . A false positive mammogram was described by 7 ( 5 % ) of the women as the worst thing they ever had experienced . However , most women with a false positive result regarded this experience , in retrospect , as but one of many minor stressful experiences creating a temporary decrease in quality of life . They report the same quality of life today as women with negative screening results and 98 % would attend another screening . Even so , false positive results are a matter of concern , and efforts should be made to minimise this cost whenever a screening programme is conducted PURPOSE To assess cancer detection rates , false-positive rates before arbitration , positive predictive values for women recalled after arbitration , and the type of cancers detected with use of digital mammography alone and combined with tomo synthesis in a large prospect i ve screening trial . MATERIAL S AND METHODS A prospect i ve , reader- and modality-balanced screening study of participants undergoing combined mammography plus tomo synthesis , the results of which were read independently by four different radiologists , is under way . The study was approved by a regional ethics committee , and all participants provided written informed consent . The authors performed a preplanned interim analysis of results from 12,631 examinations interpreted by using mammography alone and mammography plus tomo synthesis from November 22 , 2010 , to December 31 , 2011 . Analyses were based on marginal log-linear models for binary data , accounting for correlated interpretations and adjusting for reader-specific performance levels by using a two-sided significance level of .0294 . RESULTS Detection rates , including those for invasive and in situ cancers , were 6.1 per 1000 examinations for mammography alone and 8.0 per 1000 examinations for mammography plus tomo synthesis ( 27 % increase , adjusted for reader ; P = .001 ) . False-positive rates before arbitration were 61.1 per 1000 examinations with mammography alone and 53.1 per 1000 examinations with mammography plus tomo synthesis ( 15 % decrease , adjusted for reader ; P < .001 ) . After arbitration , positive predictive values for recalled patients with cancers verified later were comparable ( 29.1 % and 28.5 % , respectively , with mammography alone and mammography plus tomo synthesis ; P = .72 ) . Twenty-five additional invasive cancers were detected with mammography plus tomo synthesis ( 40 % increase , adjusted for reader ; P < .001 ) . The mean interpretation time was 45 seconds for mamm 
    Output:
    
Overdiagnosed women may be harmed by unnecessary procedures and treatments as well as by the burden of receiving a cancer diagnosis .