***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: Delay in follow-up after an abnormal mammogram is associated with advanced disease stage , poorer survival , and increased anxiety . Despite the implementation of many patient navigator programs across the country , there are few published , peer- review ed studies documenting its effectiveness . We tested the effectiveness of a patient navigator in improving timeliness to diagnosis , decreasing anxiety , and increasing satisfaction in urban minority women after an abnormal mammogram . Women with suspicious mammograms were r and omly assigned to usual care ( N = 50 ) or usual care plus intervention with a patient navigator ( N = 55 ) . There were no demographic differences between the two groups . Women in the intervention group had shorter times to diagnostic resolution ( mean 25.0 vs. 42.7 days ; p = .001 ) , with 22 % of women in the control group without a final diagnosis at 60 days vs. 6 % in the intervention group . The intervention group also had lower mean anxiety scores ( decrease of 8.0 in intervention vs. increase of 5.8 in control ; p < .001 ) , and higher mean satisfaction scores ( 4.3 vs. 2.9 ; p < .001 ) . Patient navigation is an effective strategy to improve timely diagnostic resolution , significantly decrease anxiety , and increase patient satisfaction among urban minority women with abnormal mammograms The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Objectives To assess the long term psychological impact on women who were recalled for further investigation after mammography screening  and to find any factors that might predict coping ability in order to identify those subjects who require additional support at an earlier stage . Setting Counties of Västerbotten and Västernorrl and , Sweden . Methods A prospect i ve design was used in which 252 recalled women completed  question naires twice — once within a week of having received the all-clear and again at follow up six months later . A group of 1104 r and omly selected , screen negative women were followed up in the same way for comparison . The question naire included the  Psychological Consequences Question naire ( PCQ ) and basic sociodemographic data . The main outcome measure was the total score on the PCQ at six months . Results Of the 252 women , 235 ( 93 % ) completed both question naires . In the control group , 987 ( 89.4 % ) women responded . Six months after the all-clear , recalled women were still significantly more anxious ( p<0.001 ) than those who had been screened but not recalled . The strongest predictor of psychological distress at six months was the PCQ score at the first measurement . Other predictors were a low level of education , living in high density urban areas , and having only one child or no children at all . Widows appeared to cope better than other women . Conclusions It is possible to define a group of women with false positive results who are already at risk of coping less effectively at the time of recall . Offering these women counselling or other types of support should be considered The aim was to investigate the psychological consequences of further investigation after breast cancer screening . Study participants include 509 women ( 61 % ) recalled due to suspicious findings on screening mammograms , and a matched control group of 285 women ( 68 % ) with normal mammograms .  Psychological distress was prospect ively assessed with the Hospital Anxiety and Depression Scale ( HADS ) . 46 % of the women reported borderline or clinical ly significant anxiety prior to the recall visit . A few days after the visit , anxiety and depression had decreased significantly ( P<0.01 ) in women informed about normal or benign results at the recall clinic , while reported distress remained at relatively high levels in women referred to surgical biopsy . The results demonstrate the adverse short-term effect of a delay in receiving false-positive results , but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women The purpose of this study was to evaluate a woman 's psychological and immunological response to  breast biopsy  before and after the procedure . Women were enrolled into the study when notified of the need for breast biopsy .  Psychological and immunological assessment s were made at enrollment , on the day of breast biopsy , as well as 1 month and 4 months after notification of biopsy results . Psychological assessment s demonstrated that perceived stress , anxiety , and mood disturbance were heightened before biopsy and remained elevated after biopsy regardless of the diagnosis . Immunologically , the women exhibited reduced natural killer cell activity and INF gamma production before biopsy with reductions significant 1 month after the procedure . In contrast , IL-4 , IL-6 , and IL-10 production were increased before and after the procedure with most significant increases prior to the procedure and continuing 1 month after the procedure . These results demonstrate that undergoing biopsy of the breast for cancer diagnosis is an emotional experience , characterized by increased perceived stress , anxiety , and mood disturbance . This emotional distress is accompanied by reduced NK cell activity and cytokine dysregulation . The psychological and immunological impact of breast biopsy is not transient , but persists well beyond the actual experience of the biopsy procedure . Noteworthy is the observation that women with benign or malignant biopsy results experienced similar psycho-immune consequences . Hence , these observations are of relevance not only to women diagnosed with malignancy , who face the challenges of cancer treatment and adaptation to illness , but also to women with benign biopsy findings PURPOSE / OBJECTIVES To investigate distress and its association with immune function among women with suspected breast cancer . DESIGN Prospect i ve , descriptive , correlational study . SETTING An outpatient breast clinic at a tertiary urban hospital . SAMPLE A convenience sample of women who had either a fine needle aspiration or open breast biopsy for a suspicion of breast cancer . Thirty-five women comprised the study sample , 6 with malignant and 29 with benign tumors . METHODS Data were collected at three points in time . The first time ( T1 ) was after the physician visit when the need for breast biopsy was ascertained . The second time ( T2 ) was 7 - 10 days postbiopsy , and the third time ( T3 ) was 7 - 10 days after T2 . At T1 , T2 , and T3 , participants filled out the  Brief Symptom Inventory ( a measure of psychological distress ) and the Adapted Symptom Distress Scale ( a measure of symptom distress ) and provided a blood sample . Demographic data also were collected at T1 . Immune function was measured by serum cytokine levels of transforming growth factor beta ( TGF beta ) and tumor necrosis factor alpha ( TNF alpha ) . MAIN RESEARCH VARIABLES Psychological distress , symptom distress , and immune function . FINDINGS Psychological distress scores were moderate to high . Symptom distress was either nonexistent or slight . Significant correlations between psychological distress and symptom distress were found at T2 and T3 . At T2 , significant relationships between psychological distress and TNF alpha and between symptom occurrence and TNF alpha were found . Psychological and symptom distress scores were significantly different between women with malignant versus benign tumors at all three times . No differences in cytokine levels were found between the groups . CONCLUSIONS These results suggest the strong effect that the diagnostic process has on psychological distress and its potential effects on immune functioning . Distress was significantly greater for women with malignant disease ; however , women with benign disease continued to have elevated levels of distress . IMPLICATION S FOR NURSING PRACTICE Nurses should be aware of the extremely stressful nature of the diagnostic phase and should continue to provide support , knowing that this distress continues throughout this phase , particularly for women diagnosed with malignancy The objective of this study was to evaluate and document pain and psychological distress related to  imaging-guided core needle biopsy ( CNB ) of the breast . This prospect i ve study of 52 consecutive patients undergoing CNB of the breast assessed anxiety , pain , acute stress disorder , and activities of daily living  both preprocedure and at 24 hours , 5 days , and 30 days postprocedure . Survey instruments included the  State-Trait Anxiety Inventory ( STAI ) , a visual analog pain scale , the SF-36 Physical Functioning Scale , and DSM IV criteria for acute stress disorder . Preprocedure the mean scores for self-reported levels of state and trait anxiety were 47.11 ( SD = 13.53 ) and 37.71 ( SD = 11.24 ) , respectively . At 24 hours postprocedure , the mean score for self-reported state anxiety was 38.74 ( SD = 17.77 ) , a significant reduction from the preprocedure level reported by patients ( p < 0.005 ) . Further reductions in state anxiety levels were reported at 5 and 30 days postprocedure . The mean scores for state anxiety fell within the normal range at 30 days postprocedure ( mean 32.75 , SD = 10.97 ) . However , at 5 days post-CNB , patients with confirmed malignancies reported significantly more anxiety than patients without malignancies ( p = 0.002 ) . This difference was not present at 30 days post-CNB ( p = 0.17 ) . Patients reported average pain scores of 2.0 ( on a scale of 0 - 10 ) during the biopsy . This decreased to 1.3 at 24 hours , 0.3 at 5 days , and 0.2 at 30 days . Reported symptoms of acute stress related to the procedure significantly increased over the period between the 5-day interview and the 30-day interview . One ( 2 % ) patient reported avoidance of thoughts about CNB 5 days postprocedure and 5 ( 12 % ) patients reported this at 30 days postprocedure ( p < 0.05 ) . Patients undergoing CNB reported significant levels of state anxiety which were greatest at the time of biopsy . A significant decrease was observed at 24 hours postprocedure , despite the fact that biopsy results were not available to the patients . Self-reported levels of anxiety for the group , regardless of biopsy results , fell within the normal range by 30 days . Further research and interventions are recommended to address the management of anxiety for patients undergoing CNB Five community- design ed pilot projects were undertaken to reduce the time to diagnosis following an abnormal mammogram . One thous and five hundred and seventy-eight women with abnormal mammograms completed a self-administered question naire ( 71 % response ) which inquired about experiences and satisfaction with time delay from screening to diagnosis , the information received and support given by health professionals , and measures of anxiety and stress during this time interval . Four of the five pilot project initiatives shortened the time interval from screening to diagnosis , the greatest improvement occurring with facilitated referral from screening to diagnostic breast imaging . There was little difference among the pilot projects and control for most measures of client satisfaction and anxiety . Differences were found between biopsied and nonbiopsied women for several of these measures . Shortening the time to diagnosis positively influenced the client 's perception of unnecessary delay 
    Output:
    
In a small cohort of women , distress levels are heightened to worrying levels that may have long-term implication s. There was strong evidence for relationships among medical history , education and trait anxiety with distress .
There was no substantiation of the association between younger age and increased psychological distress that has been consistently reported with other cancers .