***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: BACKGROUND Data on the impact of abnormal cervical smear results on health-related quality of life ( HrQoL ) are scarce . We aim ed to ( i ) prospect ively assess the HrQoL of women who were informed of an abnormal smear result ; ( ii ) identify predictors of greater negative psychosocial impact of an abnormal result ; and ( iii ) prospect ively estimate the quality -adjusted life-years ( QALYs ) lost following an abnormal result . METHODS Between 08/2006 and 08/2008 , 492 women with an abnormal result and 460 women with a normal result , frequency matched for age and clinic , were recruited across Canada .  HrQoL was measured at recruitment and 4 and 12 weeks later with the  EuroQol , Short Form-12 , short Spielberg State-Trait Anxiety Inventory ( STAI ) and HPV Impact Profile .  Three blocks of potential predictors of higher psychosocial impact were tested by hierarchical modeling : ( i ) socio-demographics ; ( ii ) sexual activity ; and ( iii ) smear result severity , communication , and underst and ing . RESULTS Receiving an abnormal result significantly increased anxiety ( STAI mean difference between both groups = 8.3 ) . Initial anxiety decreased over time for the majority of women . However , 35 % of women had clinical ly meaningful anxiety at 12 weeks ( i.e. STAI scores ≥0.5 st and ard deviation of the controls ) . These women reported a lower socio-economic level , did not completely underst and the information about their result and perceived themselves at higher risk of cancer . QALY lost following an abnormal result were between 0.007 and 0.009 . CONCLUSIONS Receiving an abnormal smear has a statistically significant and clinical ly meaningful negative impact on mental health . However , this negative impact subsides after 12 weeks for the majority of women Abstract Background . As prostate cancer ( PC ) mortality reduction results are not unequivocal , a special emphasis has to be put on other aspects of the prostate-specific antigen ( PSA ) screening , including effects on quality of life . In the present study we describe the short-term effects of various phases of PC screening on health-related quality of life ( HRQL ) . Material and methods . The study participants were r and omized into the screening arm within the Finnish component of the European R and omized Study on Screening for Prostate Cancer ( ERSPC ) . The R AND 36-Item Health Survey on HRQL and question naires on sociodemographic and behavioral factors were delivered to participants at various phases of the first screening round : 1 ) 500 participants at invitation ; 2 ) 500 after screening ; 3 ) 500 after obtaining the PSA result ; 4 ) to 300 participants  after undergoing digital rectal examination ( DRE ) ( but prior to being informed of its result ) ; and 5 ) approximately 300 after prostate biopsy .  At each stage , a new sample of participants was recruited . Results . Response rates were 59 % at invitation , 77 % after PSA blood test , 54 % after PSA result and 69 % after DRE . The men recruited at each stage were comparable in respect to socioeconomic variables . The HRQL scores in R AND -36 subscales showed little variation in the different phases of the screening process . Compared with the previous phase , the social function score was slightly lower after obtaining the PSA result than after blood test , the emotional role score lower after DRE than after PSA result and the pain-related score lower after DRE than after TRUS and biopsy . The screening participants were comparable to the general population as their HRQL scores were similar to an age-stratified general Finnish male population . Conclusion . Short-term HRQL effects of prostate cancer screening appear minor and transient State anxiety ( S-STAI-6 ) , distress ( GHQ-12 ) , concern and quality of life ( EuroQoL-EQ-5D ) 6 months after human papillomavirus ( HPV ) testing in women with borderline or mildly dyskaryotic smear test results were assessed based on a prospect i ve question naire study , with 6-month follow-up after the smear test result . Two centres participated in an English pilot study of HPV testing . Participants included two groups of women receiving abnormal smear test results : ( tested for HPV and found to be ( a ) HPV positive ( n=369 ) or ( b ) HPV negative ( n=252 ) ) and two groups not tested for HPV ( those receiving ( c ) abnormal smear test results ( n=102 ) or ( d ) normal smear test results ( n=288 ) ) . There were no differences in anxiety , distress or health-related quality of life between the four study groups at 6 months . Levels of concern about the smear test result remained elevated in all groups receiving an abnormal smear test result , and were highest in the group untested for HPV . Predictors of concern across all groups receiving an abnormal smear test were perceived risk of developing cancer , being HPV positive or untested for HPV , sexual health worries and the smear being a woman 's first smear test . The raised anxiety and distress observed in women immediately after being informed of an abnormal smear test result and that they are HPV positive was no longer evident at 6 months . Concern about the smear test result was however still raised in these women and those who tested negative for HPV , and particularly among those who did not undergo HPV testing 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 BACKGROUND Population -based screening for prostate cancer is currently being evaluated in r and omized clinical trials in the United States and in Europe . Side effects arising from the process of screening and from the earlier treatment of screen-detected prostate cancer may be important factors in the evaluation . To examine health-related quality of life ( or health status ) among men screened for prostate cancer , we conducted a longitudinal study of 626 attenders to the Rotterdam ( The Netherl and s ) prostate cancer screening program and of 500 non participants . METHODS Attenders of the screening program and non participants completed self- assessment question naires ( SF-36 [ i.e. , Medical Outcomes Study 36-Item Short-Form Health Survey ] and EQ-5D [ i.e. , EuroQol measure for health-related quality of life ] health surveys ) to measure generic health status , as well as an additional question naire for anxiety and items relating to prostate cancer screening . RESULTS Physical discomfort during digital rectal examination and during transrectal ultrasound was reported by 181 ( 37 % ) of 491 men and by 139 ( 29 % ) of 487 men , respectively ; discomfort during prostate biopsy was reported by 64 ( 55 % ) of 116 men . Mean scores for health status and anxiety indicated that the participants did not experience relevant changes in physical , psychological , and social functioning during the screening procedure . However , high levels of anxiety were observed throughout the screening process among men with a high predisposition to anxiety . Similar scores for anxiety predisposition were observed among attenders and non participants . CONCLUSIONS At the group level , we did not find evidence that prostate cancer screening induced important short-term health-status effects , despite the short-lasting side effects related to the biopsy procedure . However , subgroups may experience high levels of anxiety . The implication is that unfavorable health-status effects of prostate cancer screening occur mainly in the treatment phase Background With human papillomavirus ( HPV ) vaccination introduced in a number of countries , there is considerable interest in evaluating the cost-effectiveness of HPV testing as the primary cervical screening test in these setting s. However , the availability of utility scores for these newer interventions is limited . Our aim in this paper is to present utility scores for HPV vaccination , HPV testing and cytology based screening states among women targeted for cervical screening . Methods We invited a r and om sample of women targeted for cervical screening ( aged 20 - 69 years ) living in Sydney , Australia , to participate in a face-to-face interview . Participants were asked to indicate preferences ( rank and utility scores ) for 10 hypothetical health states relating to HPV vaccination , cytology and primary HPV screening , cervical precursor disease and early stage cervical cancer . Preferences for hypothetical health states were measured through ranking then a two-stage st and ard gamble . Each participant ’s own health state was measured as a utility score using the EQ5D . Potential differences by age were assessed using the Wilcox Rank Sum test . Results A maximum of 276 women were contacted , of which 43 ( mean age 49 years ) agreed to be interviewed ( 15.6 % ) .  The overall health state of women as measured by the EQ5D was 0.86 ( 95 % CI : 0.83 - 0.89 ) . Of the 10 health states , the highest ranked were ‘ normal cytology ’ and ‘ HPV vaccination ’ ( equal 1st ) . States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result ( ranks 3 - 4 vs. 4 - 5 ) . However , mean utility scores were broadly similar for all health states , except cervical cancer . No significant differences in scores were identified between age groups . Conclusion Our survey suggests health states relating to HPV testing are ranked below ‘ low grade cytology ’ disease abnormalities . However , this difference was minimal on the utility scale , as most values for health states were largely clustered . These results provide a preliminary set of non-clinic population -based utilities that may be used with other values to explore the economic implication s of introducing HPV testing as a primary screening tool in the context of HPV vaccination Objective To estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening . Design Cost analysis within multicentre individually r and omised controlled trial . Setting Grampian , Tayside , and Nottingham . Participants 4201 women with low grade abnormalities . Interventions Cytological surveillance or referral to colposcopy for biopsy and recall if necessary or referral to colposcopy with immediate treatment based on colposcopic appearance . Main outcome measures Data on re source use collected from participants throughout the duration of the trial ( 36 months ) , enabling the estimation of both the direct ( health care ) and indirect ( time and travel ) costs of management . Quality of life assessed at recruitment and at 12 , 18 , 24 , and 30 months , using the EQ-5D instrument . Economic outcomes expressed as costs per case of cervical intraepithelial neoplasia ( grade II or worse ) detected , by trial arm , as confirmed at exit , and cost utility ratios ( cost per quality adjusted life year ( QALY ) gained ) for the three pairwise comparisons of trial arms . Results The mean three year discounted costs of surveillance , immediate treatment , and biopsy and 
    Output:
    
Conclusions Cancer screening programs led to low disutities related to screening phase , and low to moderate disutilities related to diagnostic work up and treatment phases .
The estimated disutility values comparing to the measured ones tended to overestimate the harms