***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: INTRODUCTION Contrast-enhanced spectral mammography ( CESM ) may have similar diagnostic performance to Contrast-enhanced MRI ( CEMRI ) in the diagnosis and staging of breast cancer . To date , research has focused exclusively on diagnostic performance when comparing these two techniques . Patient experience is also an important factor when comparing and deciding on which of these modalities is preferable . The aim of this study is to compare patient experience of CESM against CEMRI during preoperative breast cancer staging . METHODS Forty-nine participants who underwent both CESM and CEMRI , as part of a larger trial , completed a Likert question naire about their preference for each modality according to the following criteria : comfort of breast compression , comfort of intravenous ( IV ) contrast injection , anxiety and overall preference . Participants also reported reasons for preferring one modality to the other . Quantitative data were analysed using a Wilcoxon sign-rank test and chi-squared test . Qualitative data are reported descriptively . RESULTS A significantly higher overall preference towards CESM was demonstrated ( n = 49 , P < 0.001 ) , with faster procedure time , greater comfort and lower noise level cited as the commonest reasons . Participants also reported significantly lower rates of anxiety during CESM compared with CEMRI ( n = 36 , P = 0.009 ) . A significantly higher rate of comfort was reported during CEMRI for measures of breast compression ( n = 49 , P = 0.001 ) and the sensation of IV contrast injection ( n = 49 , P = 0.003 ) . CONCLUSION Our data suggest that overall , patients prefer the experience of CESM to CEMRI , adding support for the role of CESM as a possible alternative to CEMRI for breast cancer staging Background Although guidelines recommend that clinicians consider life expectancy before screening older women for breast cancer , many older women with limited life expectancies are screened . We aim ed to identify factors important to mammography screening decisions among women aged 80 and older compared to women aged 65–79 . Methods Telephone surveys of 107 women aged 80 + and 93 women aged 65–79 r and omly selected from one academic primary care practice who were able to communicate in English ( 60 % response rate ) . The survey addressed the following factors in regards to older women 's mammography screening decisions : perceived importance of a history of breast disease , family history of breast cancer , doctor 's recommendations , habit , reassurance , previous experience , mailed reminder cards , family/friend 's recommendations or experience with breast cancer , age , health , and media . The survey also assessed older women 's preferred role in decision making around mammography screening . Results Of the 200 women , 65.5 % were non-Hispanic white and 82.8 % were in good to excellent health . Most ( 81.3 % ) had undergone mammography in the past 2 years . Regardless of age , older women ranked doctor 's recommendations as the most important factor influencing their decision to get screened . Habit and reassurance were the next two highly ranked factors influencing older women to get screened . Among women who did not get screened , women aged 80 and older ranked age and doctor 's counseling as the most influential factors and women aged 65–79 ranked a previous negative experience with mammography as the most important factor . There were no significant differences in preferred role in decision-making around mammography screening by age , however , most women in both age groups preferred to make the final decision on their own ( 46.6 % of women aged 80 + and 50.5 % of women aged 65–79 ) . Conclusion While a doctor 's recommendation is the most important factor influencing elderly women 's mammography screening decisions , habit and reassurance also strongly influence decision-making . Interventions aim ed at improving clinician counseling about mammography , which include discussion s around habit and reassurance , may result in better decision-making BACKGROUND The relative benefits and risks of screening programs for breast cancer have been extensively debated . OBJECTIVES To quantify and investigate heterogeneity in women 's preferences for the benefits and risks of a  national breast screening program ( NBSP ) and to underst and the effect of risk communication format on these preferences . METHODS An online discrete choice experiment survey was design ed to elicit preferences from female members of the public for an NBSP described by three attributes ( probability of detecting a cancer , risk of unnecessary follow-up , and out-of-pocket screening costs ) . Survey respondents were r and omized to one of two surveys , presenting risk either as percentages only or as icon arrays and percentages . Respondents were required to choose between two hypothetical NBSPs or no screening in 11 choice sets generated using a Bayesian D-efficient design . The trade-offs women made were analyzed using heteroskedastic conditional logit and scale-adjusted latent class models . RESULTS A total of 1018 women completed the discrete choice experiment ( percentages-only version = 507 ; icon arrays and percentages version = 511 ) . The results of the heteroskedastic conditional logit model suggested that , on average , women were willing-to-accept 1.72 ( confidence interval 1.47 - 1.97 ) additional unnecessary follow-ups and willing-to-pay £ 79.17 ( confidence interval £ 66.98-£91.35 ) for an additional cancer detected per 100 women screened . Latent class analysis indicated substantial heterogeneity in preferences with six latent classes and three scale classes providing the best fit . The risk communication format received was not a predictor of scale class or preference class membership . CONCLUSIONS Most women were willing to trade-off the benefits and risks of screening , but decision makers seeking to improve uptake should consider the disparate needs of women when configuring services 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 To determine if older women with early stage breast cancer have sufficient decisional support during their breast cancer journey , a question naire-based study was conducted at the Sunnybrook Odette Cancer Centre , in Toronto , Ontario , Canada . Women with stages I and II breast cancer , ≥60 years , were contacted upon completion of their adjuvant treatment . A question naire was developed based on focus groups , the literature , and consultation with patients and a multidisciplinary team of experts . The question naire was divided into six domains as follows : ( 1 ) information support surrounding diagnosis , ( 2 ) impact of cancer diagnosis on the patient , ( 3 ) quality of interaction with healthcare team , ( 4 ) decisional support from the healthcare team , ( 5 ) additional information needs surrounding treatment decision , and ( 6 ) information support during radiation treatment .  Ninety-two of 137 patients approached were included in the analysis . Ninety percent were > 60 years at the time of diagnosis and 65 % had stage I invasive breast cancer . The majority of women received adequate decisional support during their cancer journey . Approximately 90 % of women indicated that they received a high level of support during their cancer diagnosis . We found no significant differences in overall decisional support based on age at diagnosis , education level , ethnicity , or the presence of co-morbidities . However , participants desired additional educational re sources such as a worksheet , consultation summary , or workbook to assist in making a treatment decision . The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer PURPOSE The aim of this study was to evaluate patient anxiety and its association with perceived radiologist-patient communication in the setting of imaging-guided breast biopsy . METHODS After informed consent was obtained , 138 women recommended for imaging-guided breast procedures completed question naires  immediately before and after biopsies , measuring state anxiety using the State-Trait Anxiety Inventory ( range , 20 - 80 ) . Before biopsies , women also completed question naires regarding their perceived communication with the radiologists recommending the procedures ( modified Question naire on the Quality of Physician-Patient Interaction ) , demographic characteristics , and medical history ; immediately after the biopsies , they completed a measure of perceived communication with the radiologists performing the biopsies . Experience levels ( eg , attending radiologist , fellow ) of the radiologists recommending and performing the biopsies were recorded . Data were analyzed using paired and independent t tests , one-way analysis of variance , Pearson 's correlations , and multiple linear regression analyses . RESULTS Average prebiopsy anxiety was 44.5 ± 12.4 ( range , 20 - 77 ) on a scale ranging from 20 to 80 points . Perceived communication with radiologists recommending biopsies averaged 52.4 ± 11.5 ( range , 18 - 65 ) . Better communication with radiologists recommending biopsies was significantly associated with lower levels of prebiopsy anxiety ( r = -0.22 , P = .01 ) . After the biopsies , women 's anxiety significantly decreased ( paired t = -7.32 , P < .001 ) . Better communication with radiologists performing biopsies ( mean , 57.8 ± 8.4 ; range , 32 - 65 ) was associated with lower postbiopsy anxiety after accounting for patients ' baseline anxiety levels ( β = -0.17 , P = .04 ) . White women reported higher prebiopsy and postbiopsy anxiety ; nonwhite women reported poorer communication with recommending radiologists . CONCLUSIONS Patients ' perceptions of better communication with radiologists were associated with lower levels of anxiety before and after biopsies . These results have implication s for radiologist training and adherence to mammographic screening 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 OBJECTIVE The purpose of this study was to assess patient preferences about receiving radiology results and review ing the images and findings directly with a radiologist after completion of an examination . SUBJECTS AND METHODS A prospect i ve survey of English-speaking out patients undergoing either nononcologic CT of the chest , abdomen , and pelvis or nonobstetric ultrasound examinations was completed between December 2010 and June 2011 . Responses to survey items such as preferences regarding communication of results , knowledge of a radiologist , and anxiety level before and after radiologist-patient consultation were recorded . The average wait time between the end of the imaging examination and the consultation and the duration of consultation were documented . RESULTS Eighty-six patients ( 43 men , 4 
    Output:
    
Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false-positive mammography findings , in return for the benefit of earlier diagnosis .
The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden , emphasising the need for rapid and efficient screening services , and clear and efficient communication .
Women value more the possibility of an earlier diagnosis over the risks of a false-positive result or overdiagnosis .
Concerns remain that women may not underst and the concept of overdiagnosis .
Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide