***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: Mammography , physical examination by a health care professional , and breast self-examination ( BSE ) may increase the probability of detection of breast cancer at an early stage and thus increase long-term survivor rates . The purpose of this study was to investigate the effectiveness of supportive coaching as an intervention to enhance compliance with these breast cancer screening guidelines . The following research questions were identified : ( a ) what are the attitudes of women toward breast cancer screening ? ( b ) what are the barriers to compliance identified by women in breast cancer screening ? and ( c ) what are the effects of supportive interventions by a professional nurse and of compliance with breast cancer screening in women ? A quasi-experimental design was used to study the research questions . The population chosen for the study included female employees in a state university setting . Participants were r and omly assigned to one of two groups . All participants were asked to complete a pre study question naire measuring attitudes and beliefs , gathering demographic and health information , and surveying breast cancer screening practice s. The experimental group then received coaching and supportive interventions over the course of the academic year . The remainder of the sample served as a control group . A post study question naire was then sent to the entire sample to identify behaviors related to breast cancer screening . A variety of beliefs and attitudes were observed in the groups . No significant difference was found between the experimental and control groups on compliance with mammography and the clinical breast examination . A difference was noted on compliance with BSE by the experimental group evidencing more compliance In 1987 , the Division of Cancer Prevention and Control , National Cancer Institute ( NCI ) , funded a r and omized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service ( CIS ) . This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography ;  this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief ( 6-minute ) proactive telephone-counseling protocol . The screening-mammography counseling intervention was tested in two regional CIS offices using a r and omized two-group design . Callers were r and omly assigned to the intervention or control group based on the week of their call to the CIS ( n = 1831 eligible female callers ) .  Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months ' follow-up ( 87 % response rate ) . Among all CIS callers enrolled in this study , self-reported adherence to screening-mammography guidelines at 12 months ' follow-up was 63.5 % . The most frequently cited barriers to screening mammography reported by CIS callers were inconvenience/being too busy ( 52 % ) , cost ( 36 % ) , lack of physician referral ( 34 % ) , no symptoms ( 34 % ) , and fear of radiation ( 29 % ) . A significant intervention effect on adherence behavior was found but only in one of the two test sites and only among CIS callers reporting total family income of $ 30,000 or more ( odds ratio = 1.38 , P = .04 ) . The vast majority ( 90 % ) of CIS callers ( both intervention and control subjects ) endorsed the concept of  proactive counseling  by the CIS . The implication s of these findings for the CIS and future research are discussed Two theory-based programs to increase mammography screening rates among asymptomatic women were implemented and evaluated in the community . One program ( E ) was based on the Health Belief Model ( HBM ) ; the second program ( EP ) added exercises adapted from the social psychology of compliance . Program impact on screening among 295 primarily Caucasian , middle-class women was evaluated against untreated controls ( C ) over a 6-month period . Both programs led to increases in HBM components ( Perceived Susceptibility , and Perceived Benefits ) and Intentions to obtain a mammogram . Screening rates 2 to 3 times higher were observed in the EP and E over C conditions ; EP and E did not differ . A mediational model of compliance illustrated the interplay of HBM components in the compliance process OBJECTIVES Message tailoring , based on individual needs and circumstances , is commonly used to enhance face-to-face patient counseling . Only recently has individual tailoring become feasible for printed messages . This study sought to determine whether printed tailored recommendations addressing women 's specific screening and risk status and perceptions about breast cancer and mammography are more effective than st and ardized printed recommendations . METHODS Computer-assisted telephone interviews were conducted with 435 women , aged 40 to 65 years , who had visited family practice groups within the previous 2 years . Subjects were r and omly allocated to receive individually tailored or st and ardized mammography recommendation letters mailed from physicians to patients ' homes . Follow-up interviews were conducted 8 months later . RESULTS Tailored letter recipients were more likely to remember and to have read more of their letters than st and ardized version recipients . After controlling for baseline status , tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $ 26,000 and for Black women . CONCLUSIONS Tailored messages are a more effective medium for physicians ' mammography recommendations ; tailoring may be especially important for women of low socioeconomic status BACKGROUND Although rates of mammography screening among women in the general population have been increasing they still fall short of national goals . This study evaluated the effects on rates of participation in mammography screening of obtaining risk factor information and providing general or personalized risk information through direct mailed correspondence . METHODS Women enrollees in a health maintenance organization ( N = 2,076 ) , age 50 and above , were r and omized to one of the following four groups : ( a ) no risk factor question naire + generic invitation , ( b ) no risk factor question naire + general risk invitation , ( c ) risk factor question naire + general risk invitation , and ( d ) risk factor question naire + personal risk invitation . Computerized visit records were monitored for 12 months following a mailed invitation to assess whether a mammogram had been obtained . RESULTS Overall participation was 37.5 % and the rate of participation did not differ significantly across groups ( P = 0.26 ) . Participation was related to age ( P < 0.02 ) , with rates highest for women ages 60 - 69 years ( 42.7 % ) compared with those for women ages 50 - 59 ( 35.5 % ) and those age 70 + ( 33.7 % ) . Among women with a family history of breast cancer , the personalized risk invitation was associated with significantly higher participation compared with general risk invitation ( 66.7 versus 42.9 % , respectively ; P < 0.003 ) . CONCLUSIONS Women with a family history of breast cancer are more likely to obtain a mammogram if that fact is reinforced as a risk factor . Research on environmental barriers to mammography screening may suggest alternative strategies for increasing participation BACKGROUND The five-year survival rate for African American women with breast cancer is notably lower than the rate for white women ; thus , appropriate cancer education and screening efforts are needed to increase mammography and breast self-examination practice s by African American women . METHODS The Witness Project is a theory-based intervention design ed to provide culturally sensitive messages , from African American breast cancer survivors , in churches and community organizations . These messages emphasize the importance of early detection to improve survival . RESULTS Intervention research in eastern Arkansas with 204 African American women demonstrated a significant increase in the practice of breast self-examination  ( p < 0.001 ) and  mammography  ( p < 0.001 ) after participation in the Witness Project . There was no significant difference between the pre- and postintervention scores for scaled items for the health-belief model and locus of control . CONCLUSIONS Results demonstrate that culturally appropriate cancer education programs are able to change behavior by meeting the beliefs of participants rather than attempting to change their beliefs The Singapore Breast Screening Project was a nationwide study inviting a r and om sample of women between the ages of 50 and 64 years for mammography at one of two hospital-based screening centres over two years . The current study was undertaken to determine if ( 1 ) mailed health educational material alone , or ( 2 ) the same material delivered during a home visit made to the subject and her family would increase the uptake among Singapore women who had not responded to two previous invitations for mammographic screening as part of the Project . This r and omized trial employed a st and ard second reminder letter ( R ) , the same letter packaged with health education material design ed for the project ( RP ) and the addition of a home visit to make contact with the woman and her family ( RV ) . The outcome measure of interest was the proportion of women in each group subsequently attending for screening .  The study population comprised 1500 non-attenders whose names appeared consecutively in the data base of the larger screening centre in this Project . These were r and omized into three groups of 500 each . In total , they broadly resembled the national population in ethnic composition ( 72.3 % Chinese , 17.8 % Malays , 9.0 % Indians and 0.8 % Others ) . By the end of the project , 7.0 % of women in group R and 7.6 % in group RP responded to the invitation . In group RV , 428 homes were visited at least once and contact was made with the subject and her family member in 306 ( 71.5 % ) cases . Subsequently , 13.3 % of the women visited attended for screening . The rate ratio for attendance in group RP compared with group R was 1.09 ( 95 % CI 0.70 to 1.70 ) and for group RV compared with R , 1.90 ( 1.27 to 2.84 ) . When analyzed by groups originally assigned to , women in group RV remained significantly more likely to attend than those in groups R or RP . The marginal cost of a home visit , based on this study , was $ 25.04 per additional woman screened . Our results suggest that the response to a second reminder is generally low and that additional print material does not improve screening attendance in this group of initial non-attenders . Personal contact with the family through a home visit appears to increase uptake , and may be helpful particularly among women who have less frequent contact with the health care system OBJECTIVE --To discover whether systematic methods of call and recall are more effective than a non- systematic method and to see which of the two systematic methods was more effective . DESIGN -- Prospect i ve r and omised controlled trial over a year . SETTING --One group general practice . PATIENTS --416 Women over 35 eligible for a smear test who had never had a cervical smear test or in whom a smear test was overdue ( previous test more than five years before ) . INTERVENTIONS --One group received written invitations to have a smear taken . The second group had their notes tagged so that the doctor would remind them ( when they attended for another reason ) to have a smear test . No special intervention was made in the third group . MAIN OUTCOME MEASURE -- Performance of a cervical smear test during the year of the study . RESULTS --32 % ( 45/140 ) of the screened group , 27 % ( 39/142 ) of the tagged group , and 15 % ( 20/134 ) of the control group had a smear test during the year . The percentage of women having a smear test in the screened group was not significantly different from that in the tagged group , but the percentages in the two groups were significantly different from that in the control group . Whether a woman had had a previous smear test significantly affected the uptake of the invitation to have a smear test independently of the method of invitation . CONCLUSIONS --The systematic methods of call and recall were more effective than a non- systematic method . There was no significant difference between the two systematic methods ( sending letters or tagging the notes ) at one year OBJECTIVES This study assessed whether the Learn , Share & Live breast cancer education program result ed in favorable , replicable , and sustainable outcomes . METHODS The program was implemented at index ( year 1 ) and replication ( year 2 ) sites . Baseline interviews ( year 1 ; n = 240 ) and 2 follow-up telephone interviews ( years 2 and 3 ; n = 337 and 323 ) were used to assess postintervention changes . RESULTS From baseline to year 2 , mammography adherence and stage of adoption improved at the index site relative to the replication site . Knowledge scores and percentages of respondents reporting that a friend had spoken with them about mammography improved significantly . Improvements were sustained through year 3 ( 2 years postintervention ) . In year 3 , replication participants showed improvements in regard to knowledge and perceived mammography benefits , and there was a trend toward increased adherence . Site differences in postintervention adherence may have stemmed from respective choices of follow-up activities . CONCLUSIONS The study outcomes affirm the impact of Learn , Share & Live , indicating a replicated and sustained program effect . Future studies should continue longer follow-up and explore the importance of providing mammography opportunities along with education The recent decrease in breast cancer mortality has been linked in part to increased breast cancer screening . Although the percentage of women screened once is rising , rate of continued adherence is poor . The purpose of this article is to assess the effects of tailored mammography interventions implemented prospect ively in a factorial design contrasting groups receiving either ( a ) usual care ( no intervention ) , ( b ) tailored telephone counseling for mammography , ( c ) tailored mailed material s promoting mammography , or ( d ) a combination of tailored mail and telephone counseling . This prospect i ve , r and omized study with a 2 x 2 factorial design included women 51 years and older ( N = 1,367 ) who were not adherent with mammography at baseline . The intervention is based on integration of the Transtheoretical and Health Belief 
    Output:
    
Evidence from these review s indicates that screening for breast cancer ( mammography ) and cervical cancer ( Pap test ) has been effectively increased by use of client reminders , small media , and one-on-one education .
Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media .