***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: 12,987 invasive breast cancer cases were diagnosed in women aged 50 - 69 upto the year 2001 in nine Italian areas where a screening programme was active . Cases were followed up in 2005 for a total of 1921 breast cancer failures . The 10-year survival rates were 85.3 % for the invited group against 75.6 % for the non-invited . A time dependent analysis was performed using 5-year intervals . Crude hazard ratios for the invited group in comparison to the not invited group were 0.52 and 0.64 respectively in the ( 0 - 5 ) year and [ 5 - 10 ] year time windows . Hazard ratio adjusted for tumour characteristics was 0.96 in the [ 5 - 10 ] year time window , suggesting minimal or any length bias . Consistent with the results of r and omised trials , these analyses of service screening data document a mortality reduction of 36 % at 5 - 10 years after diagnosis Objective To evaluate the effectiveness of contemporary mammography screening using individual information about screening history and breast cancer mortality from public screening programmes . Design Prospect i ve cohort study of Norwegian women who were followed between 1986 and 2009 . Within that period ( 1995 - 2005 ) , a national mammography screening programme was gradually implemented , with biennial invitations sent to women aged 50 - 69 years . Participants All Norwegian women aged 50 - 79 between 1986 and 2009 . Main outcome measures Multiple Poisson regression analysis was used to estimate breast cancer mortality rate ratios comparing women who were invited to screening ( intention to screen ) with women who were not invited , with a clear distinction between cases of breast cancer diagnosed before ( without potential for screening effect ) and after ( with potential for screening effect ) the first invitation for screening . We took competing causes of death into account by censoring women from further follow-up who died from other causes . Based on the observed mortality reduction combined with the all cause and breast cancer specific mortality in Norway in 2009 , we used the CISNET ( Cancer Intervention and Surveillance Modeling Network ) Stanford simulation model to estimate how many women would need to be invited to biennial mammography screening in the age group 50 - 69 years to prevent one breast cancer death during their lifetime . Results During 15 193 034 person years of observation ( 1986 - 2009 ) , deaths from breast cancer occurred in 1175 women with a diagnosis after being invited to screening and 8996 women who had not been invited before diagnosis . After adjustment for age , birth cohort , county of residence , and national trends in deaths from breast cancer , the mortality rate ratio associated with being invited to mammography screening was 0.72 ( 95 % confidence interval 0.64 to 0.79 ) . To prevent one death from breast cancer , 368 ( 95 % confidence interval 266 to 508 ) women would need to be invited to screening . Conclusion Invitation to modern mammography screening may reduce deaths from breast cancer by about 28 % Abstract Objectives To compare double readings when interpreting full field digital mammography ( 2D ) and tomo synthesis ( 3D )  during mammographic screening . Methods A prospect i ve , Ethical Committee approved screening study is underway . During the first year 12,621 consenting women underwent both 2D and 3D imaging .  Each examination was independently interpreted by four radiologists under four reading modes : Arm A—2D ; Arm B—2D + CAD ; Arm C—2D + 3D ; Arm D— synthesis ed 2D + 3D . Examinations with a positive score by at least one reader were discussed at an arbitration meeting before a final management decision . Paired double reading of 2D ( Arm A + B ) and 2D + 3D ( Arm C + D ) were analysed . Performance measures were compared using generalised linear mixed models , accounting for inter-reader performance heterogeneity ( P < 0.05 ) . Results Pre-arbitration false-positive scores were 10.3 % ( 1,286/12,501 ) and 8.5 % ( 1,057/12,501 ) for 2D and 2D + 3D , respectively ( P < 0.001 ) . Recall rates were 2.9 % ( 365/12,621 ) and 3.7 % ( 463/12,621 ) , respectively ( P = 0.005 ) . Cancer detection was 7.1 ( 90/12,621 ) and 9.4 ( 119/12,621 ) per 1,000 examinations , respectively ( 30 % increase , P < 0.001 ) ; positive predictive values ( detected cancer patients per 100 recalls ) were 24.7 % and 25.5 % , respectively ( P = 0.97 ) . Using 2D + 3D , double-reading radiologists detected 27 additional invasive cancers ( P < 0.001 ) . Conclusion Double reading of 2D + 3D significantly improves the cancer detection rate in mammography screening . Key Points• Tomo synthesis -based screening was successfully implemented in a large prospect i ve screening trial . • Double reading of tomo synthesis -based examinations significantly reduced false-positive interpretations . • Double reading of tomo synthesis significantly increased the detection of invasive cancers Background . Imprecision in estimates of benefits and harms around treatment choices is rarely described to patients . Variation in sampling error between treatment alternatives ( e.g. , treatments have similar average risks , but one treatment has a larger confidence interval ) can result in patients failing to choose the option that is best for them . The aim of this study is to use a discrete choice experiment to describe how 2 methods for conveying imprecision in risk influence people ’s treatment decisions . Methods . We r and omized a representative sample of the Canadian general population to 1 of 3 surveys that sought choices between hypothetical treatments for rheumatoid arthritis based on different levels of 7 attributes : route and frequency of administration , chance of benefit , serious and minor side effects and life expectancy , and imprecision in benefit and side-effect estimates . The surveys differed in the way imprecision was described : 1 ) no imprecision , 2 ) quantitative description based on a range with a visual graphic , and 3 ) qualitative description simply describing the confidence in the evidence . Results . The analyzed data were from 2663 respondents . Results suggested that more people understood imprecision when it was described qualitatively ( 88 % ) versus quantitatively ( 68 % ) . Respondents who appeared to underst and imprecision descriptions placed high value on increased precision regarding the actual benefits and harms of treatment , equivalent to the value placed on the information about the probability of serious side effects . Both qualitative and quantitative methods led to small but significant increases in decision uncertainty for choosing any treatment . Limitations included some issues in defining underst and ing of imprecision and the use of an internet survey of panel members . Conclusions . These findings provide insight into how conveying imprecision information influences patient treatment choices Background Efficacy of breast screening may differ in practice from the results of r and omized trials . We report one of the largest case – control evaluations of a screening service . Methods Subjects included 491 breast-cancer deaths affecting 45–80-year-old South Australian females during 2002–2005 ( diagnosed after BreastScreen commencement ) and 1,473 live controls ( three per death ) r and omly selected from the State Electoral Roll after birth- date matching . Cancer Registry and BreastScreen records provided cancer and screening details . Risk estimates were calculated by BreastScreen participation , using conditional logistic regression . Interpretation was assisted by a population survey of risk factor prevalence by BreastScreen participation in 1,684 females aged ≥40 years . Results The relative odds ( OR ) ( 95 % confidence limits ) of breast-cancer death in BreastScreen participants compared with non- participants were 0.59 ( 0.47 , 0.74 ) . Compared with non- participants , the OR was 0.70 ( 0.47 , 1.05 ) for women last screened through BreastScreen more than 3 years before diagnosis of the index case , and 0.57 ( 0.44 , 0.72 ) for women screened more recently . The OR of 0.47 ( 0.34 , 0.65 ) for women screened more frequently in the pre-diagnosis phase was lower than the 0.64 ( 0.50 , 0.82 ) for other screened women . The overall OR of 0.59 approximated 0.70 when corrected for the screening self- selection bias observed in five r and omized trials . However , multivariable analysis of survey data did not indicate a lower prevalence of breast-cancer risk factors among BreastScreen participants , suggesting that this correction may be inappropriate . Conclusions Participation in screening was associated with a breast-cancer mortality reduction of between 30 and 41 % , depending on assumptions about screening self- selection bias . A downward mortality risk by recency of last screen prior to cancer diagnosis , and frequency of recent screening , is consistent with a screening effect Background : False-positive recall is a recognized disadvantage of mammographic breast screening , and the rate of such recalls may be higher in younger women , potentially limiting the value of screening below age 50 . Methods : Attendance and screening outcome data for 53,884 women in the intervention arm of the U.K. Age trial were analyzed to report observed false-positive recall rates during 13 years of trial fieldwork . The Age trial was a r and omized controlled trial of the effect of mammographic screening from age 40 on breast cancer mortality , conducted in 23 National Health Service screening centers between 1991 and 2004 . Women r and omized to the intervention arm were offered annual invitation to mammography from age 40 or 41 to age 48 . Results : Overall , 7,893 women ( 14.6 % of women the intervention arm and 18.1 % of women attending at least one routine screen ) experienced one or more false-positive screen during the trial . The rates of false-positive mammography at first and subsequent routine screens were 4.9 % and 3.2 % , respectively . The cumulative false-positive rate over seven screens was 20.5 % . Eighty-nine percent of women who had a false-positive recall at their previous screen attended their next invitation to routine screening . Conclusions : The rates of false-positive recall in the Age trial were comparable with the national screening program ; however , the positive predictive value of referral was lower . Experiencing a false-positive screen did not seem to lessen the likelihood of re-attendance in the trial . Impact : The question of greatly increased false-positive rates in this age group and of their compromising re-attendance is refuted by the findings of this study . Cancer Epidemiol Biomarkers Prev ; 19(11 ) ; 2758–64 . © 2010 AACR Objectives To estimate the absolute numbers of breast cancer deaths prevented and the absolute numbers of tumours overdiagnosed in  mammographic screening for breast cancer at ages 50–69 years . Setting The Swedish Two-County r and omized trial of mammographic screening for breast cancer , and the UK Breast Screening Programme in Engl and , ages 50–69 years . Methods We estimated the absolute numbers of deaths avoided and additional cases diagnosed in the study group ( active study population ) of the Swedish Two-County Trial , by comparison with the control group ( passive study population ) . We estimated the same quantities for the mortality and incidence rates in Engl and ( 1974–2004 and 1974–2003 , respectively ) . We used Poisson regression for statistical inference . Results A substantial and significant reduction in breast cancer mortality was associated with screening in both the Two-County Trial ( P < 0.001 ) and the screening programme in Engl and ( P < 0.001 ) . The absolute benefits were estimated as 8.8 and 5.7 breast cancer deaths prevented per 1000 women screened for 20 years starting at age 50 from the Two-County Trial and screening programme in Engl and , respectively . The corresponding estimated numbers of cases overdiagnosed per 1000 women screened for 20 years were , respectively , 4.3 and 2.3 per 1000 . Conclusions The benefit of mammographic screening in terms of lives saved is greater in absolute terms than the harm in terms of overdiagnosis . Between 2 and 2.5 lives are saved for every overdiagnosed case 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 elig 
    Output:
    
Although 10-year probabilities of false-positive biopsy results were similar for women beginning screening at age 50 years , indirect estimates of lifetime probability of false-positive results were lower .
AND RELEVANCE For women of all ages at average risk , screening was associated with a reduction in breast cancer mortality of approximately 20 % , although there was uncertainty about quantitative estimates of outcomes for different breast cancer screening strategies in the United States .