human
***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: Objective Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors A continuing challenge in weight loss treatment is attaining maintenance of weight loss . The goal of this study was to develop a counseling method that would assist African American breast cancer survivors with weight loss maintenance . In this pilot study , 31 obese breast cancer survivors were recruited .  Individualized , dietitian-led counseling by telephone and free Weight Watchers coupons were provided to all participants for 18 months . At the 6-month time point , women were r and omized to receive spirituality counseling or not in addition to the st and ard program . The spirituality counseling was delivered via telephone using an 8-step framework . Subjects were asked to utilize  daily meditation or prayer , daily readings  , and the recording of thoughts in a journal . Mean weight loss from baseline to 6 months was a modest 2.0 % of baseline weight . From 6 to 18 months , there was no further weight change in the spirituality arm and a gain of 0.7 % in the dietitian-only arm . Despite little effect on weight loss , it did appear that spirituality counseling positively affected spiritual well-being ( FACIT-Sp ) scores and dietary quality . The spirituality counseling framework therefore may be further refined and useful for other health promotion studies with African American population PURPOSE Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer . The Exercise and Nutrition to Enhance Recovery and Good Health for You ( ENERGY ) study is the largest weight loss intervention trial among survivors of breast cancer to date . METHODS In this multicenter trial , 692 overweight/obese women who were , on average , 2 years since primary treatment for early-stage breast cancer were r and omly assigned to either a group-based behavioral intervention , supplemented with telephone counseling and tailored newsletters , to support weight loss or a less intensive control intervention and observed for 2 years . Weight and blood pressure were measured at 6 , 12 , 18 , and 24 months . Longitudinal mixed models were used to analyze change over time . RESULTS At 12 months , mean weight loss was 6.0 % of initial weight in the intervention group and 1.5 % in the control group ( P<.001 ) . At 24 months , mean weight loss in the intervention and control groups was 3.7 % and 1.3 % , respectively ( P<.001 ) . Favorable effects of the intervention on physical activity and blood pressure were observed . The weight loss intervention was more effective among women older than 55 years than among younger women . CONCLUSION A behavioral weight loss intervention can lead to clinical ly meaningful weight loss in overweight/obese survivors of breast cancer . These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival PURPOSE Walking for health is recommended by health agencies , partly based on epidemiological studies of self-reported behaviors . Accelerometers are now replacing survey data , but it is not clear that intensity-based cut points reflect the behaviors previously reported . New computational techniques can help classify raw accelerometer data into behaviors meaningful for public health . METHODS Five hundred twenty days of triaxial 30-Hz accelerometer data from three studies ( n = 78 ) were employed as training data . Study 1 included prescribed activities completed in natural setting s. The other two studies included multiple days of free-living data  with SenseCam-annotated ground truth . The two population s in the free-living data sets were demographically and physical different . R and om forest classifiers were trained on each data set , and the classification accuracy on the training data set and that applied to the other available data sets were assessed . Accelerometer cut points were also compared with the ground truth from the three data sets . RESULTS The r and om forest classified all behaviors with over 80 % accuracy . Classifiers developed on the prescribed data performed with higher accuracy than the free-living data classifier , but these did not perform as well on the free-living data sets . Many of the observed behaviors occurred at different intensities compared with those identified by existing cut points . CONCLUSIONS New machine learning classifiers developed from prescribed activities ( study 1 ) were considerably less accurate when applied to free-living population s or to a functionally different population ( studies 2 and 3 ) . These classifiers , developed on free-living data , may have value when applied to large cohort studies with existing hip accelerometer data Background Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web , yet few Web-based studies exist in this population . Objective The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program , “ A Lifestyle Intervention Via Email ( ALIVE ) , ” delivered to a sample of racial and ethnic minority breast cancer survivors . Methods Survivors ( mean age : 52 years , 83 % [ 59/71 ] African American ) were recruited and r and omized to receive either the ALIVE program ’s 3-month physical activity track or its 3-month dietary track . The fully automated system provided tools for self-monitoring and goal setting , tailored content , and automated phone calls . Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study . Results Upon completion , 44 of 71 survivors completed the study . Our “ intention-to-treat ” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track ( + 97 vs. + 49 min/week , P<.001 ) . Similarly , reductions in total sedentary time among those in the physical activity track ( −304 vs. −59 min/week , P<.001 ) was nearly 5 times greater than that for participants in the dietary track . Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber ( + 4.4 g/day ) , fruits and vegetables ( + 1.0 cup equivalents/day ) , and reductions in saturated fat ( −2.3 g/day ) and trans fat ( −0.3 g/day ) ( all P<.05 ) . However , these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track ( all P>.05 ) . Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors ( 97 % ) , were satisfied with ALIVE ( 82 % ) , and felt that ALIVE was effective ( 73 % ) . However , survivors expressed concerns about the functionality of the interactive emails . Conclusions ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation . Although survivors favored the educational content , a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform . Trial Registration Clinical Trials.gov NCT02722850 ; https:// clinical trials.gov/ct2/show/NCT02722850 ( Archived by WebCite at http://www.webcitation.org/6tHN9VsPh Background : Given the disproportionately high incidence of early-onset breast cancer and aggressive subtypes , such as estrogen receptor (ER)-negative tumors , in African American ( AA ) women , elucidation of risk factors for early onset of specific subtypes of breast cancer is needed . Methods : We evaluated associations of reproductive , anthropometric , and other factors with incidence of invasive breast cancer  by age at onset ( < 45 , ≥45 ) in 57,708 AA women in the prospect i ve Black Women 's Health Study . From 1995 to 2013 , we identified 529 invasive breast cancers among women < 45 years of age ( 151 ER− , 219 ER+ ) and 1,534 among women ≥45 years ( 385 ER− , 804 ER+ ) . We used multivariable Cox proportional hazards regression to estimate hazard ratios ( HRs ) for associations by age and ER status . Results : Higher parity , older age at first birth , never having breastfed , and abdominal adiposity were associated with increased risk of early-onset ER− breast cancer : HRs were 1.71 for ≥3 births versus one birth ; 2.29 for first birth after age 25 versus < 20 years ; 0.61 for ever having breastfed versus never ; and 1.64 for highest versus lowest tertile of waist-to-hip ratio . These factors were not associated with ER− cancer in older women or with ER+ cancer regardless of age . Conclusions : Differences in risk factors by ER subtype were observed for breast cancer diagnosed before the age of 45 years . Impact : Etiological heterogeneity by tumor subtype in early-onset breast cancer , in combination with a higher prevalence of the risk factors in AA women , may explain , in part , racial disparities in breast cancer incidence . Cancer Epidemiol Biomarkers Prev ; 26(2 ) ; 270–7 . © 2016 AACR OBJECTIVE Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival . As Hispanic and black women have poorer breast cancer prognosis than non-Hispanic whites diagnosed at similar age and stage , and have higher rates of obesity , effective weight loss strategies are needed . We piloted a r and omized , waitlist-controlled , crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic , African American and Afro-Caribbean breast cancer survivors . DESIGN AND METHODS Women with stage 0-IIIa breast cancer ≥ 6 months posttreatment , sedentary , and BMI ≥ 25 kg/m(2 ) were r and omized to the immediate arm ( IA ) : 6 months of the Curves program followed by 6 months of observation ; or the waitlist control arm ( WCA ) : 6 months of observation followed by 6 months of the Curves program . The Curves program uses a 30-min exercise circuit and a high-vegetable/low-fat/calorie-restricted diet . RESULTS A total of 42 women enrolled ( 79 % Hispanic , 21 % black ) , mean age 51 ( range 32 - 69 ) and mean BMI 33.2(± 5.9 ) kg/m(2 ) ; 91 % were retained at month 12 . At month 6 , women in the IA lost an average 3.3 % ( ± 3.5 
    Output:
    
agent
Conclusions : The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes .
***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: Objective Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors A continuing challenge in weight loss treatment is attaining maintenance of weight loss . The goal of this study was to develop a counseling method that would assist African American breast cancer survivors with weight loss maintenance . In this pilot study , 31 obese breast cancer survivors were recruited .  Individualized , dietitian-led counseling by telephone and free Weight Watchers coupons were provided to all participants for 18 months . At the 6-month time point , women were r and omized to receive spirituality counseling or not in addition to the st and ard program . The spirituality counseling was delivered via telephone using an 8-step framework . Subjects were asked to utilize  daily meditation or prayer , daily readings  , and the recording of thoughts in a journal . Mean weight loss from baseline to 6 months was a modest 2.0 % of baseline weight . From 6 to 18 months , there was no further weight change in the spirituality arm and a gain of 0.7 % in the dietitian-only arm . Despite little effect on weight loss , it did appear that spirituality counseling positively affected spiritual well-being ( FACIT-Sp ) scores and dietary quality . The spirituality counseling framework therefore may be further refined and useful for other health promotion studies with African American population PURPOSE Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer . The Exercise and Nutrition to Enhance Recovery and Good Health for You ( ENERGY ) study is the largest weight loss intervention trial among survivors of breast cancer to date . METHODS In this multicenter trial , 692 overweight/obese women who were , on average , 2 years since primary treatment for early-stage breast cancer were r and omly assigned to either a group-based behavioral intervention , supplemented with telephone counseling and tailored newsletters , to support weight loss or a less intensive control intervention and observed for 2 years . Weight and blood pressure were measured at 6 , 12 , 18 , and 24 months . Longitudinal mixed models were used to analyze change over time . RESULTS At 12 months , mean weight loss was 6.0 % of initial weight in the intervention group and 1.5 % in the control group ( P<.001 ) . At 24 months , mean weight loss in the intervention and control groups was 3.7 % and 1.3 % , respectively ( P<.001 ) . Favorable effects of the intervention on physical activity and blood pressure were observed . The weight loss intervention was more effective among women older than 55 years than among younger women . CONCLUSION A behavioral weight loss intervention can lead to clinical ly meaningful weight loss in overweight/obese survivors of breast cancer . These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival PURPOSE Walking for health is recommended by health agencies , partly based on epidemiological studies of self-reported behaviors . Accelerometers are now replacing survey data , but it is not clear that intensity-based cut points reflect the behaviors previously reported . New computational techniques can help classify raw accelerometer data into behaviors meaningful for public health . METHODS Five hundred twenty days of triaxial 30-Hz accelerometer data from three studies ( n = 78 ) were employed as training data . Study 1 included prescribed activities completed in natural setting s. The other two studies included multiple days of free-living data  with SenseCam-annotated ground truth . The two population s in the free-living data sets were demographically and physical different . R and om forest classifiers were trained on each data set , and the classification accuracy on the training data set and that applied to the other available data sets were assessed . Accelerometer cut points were also compared with the ground truth from the three data sets . RESULTS The r and om forest classified all behaviors with over 80 % accuracy . Classifiers developed on the prescribed data performed with higher accuracy than the free-living data classifier , but these did not perform as well on the free-living data sets . Many of the observed behaviors occurred at different intensities compared with those identified by existing cut points . CONCLUSIONS New machine learning classifiers developed from prescribed activities ( study 1 ) were considerably less accurate when applied to free-living population s or to a functionally different population ( studies 2 and 3 ) . These classifiers , developed on free-living data , may have value when applied to large cohort studies with existing hip accelerometer data Background Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web , yet few Web-based studies exist in this population . Objective The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program , “ A Lifestyle Intervention Via Email ( ALIVE ) , ” delivered to a sample of racial and ethnic minority breast cancer survivors . Methods Survivors ( mean age : 52 years , 83 % [ 59/71 ] African American ) were recruited and r and omized to receive either the ALIVE program ’s 3-month physical activity track or its 3-month dietary track . The fully automated system provided tools for self-monitoring and goal setting , tailored content , and automated phone calls . Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study . Results Upon completion , 44 of 71 survivors completed the study . Our “ intention-to-treat ” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track ( + 97 vs. + 49 min/week , P<.001 ) . Similarly , reductions in total sedentary time among those in the physical activity track ( −304 vs. −59 min/week , P<.001 ) was nearly 5 times greater than that for participants in the dietary track . Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber ( + 4.4 g/day ) , fruits and vegetables ( + 1.0 cup equivalents/day ) , and reductions in saturated fat ( −2.3 g/day ) and trans fat ( −0.3 g/day ) ( all P<.05 ) . However , these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track ( all P>.05 ) . Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors ( 97 % ) , were satisfied with ALIVE ( 82 % ) , and felt that ALIVE was effective ( 73 % ) . However , survivors expressed concerns about the functionality of the interactive emails . Conclusions ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation . Although survivors favored the educational content , a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform . Trial Registration Clinical Trials.gov NCT02722850 ; https:// clinical trials.gov/ct2/show/NCT02722850 ( Archived by WebCite at http://www.webcitation.org/6tHN9VsPh Background : Given the disproportionately high incidence of early-onset breast cancer and aggressive subtypes , such as estrogen receptor (ER)-negative tumors , in African American ( AA ) women , elucidation of risk factors for early onset of specific subtypes of breast cancer is needed . Methods : We evaluated associations of reproductive , anthropometric , and other factors with incidence of invasive breast cancer  by age at onset ( < 45 , ≥45 ) in 57,708 AA women in the prospect i ve Black Women 's Health Study . From 1995 to 2013 , we identified 529 invasive breast cancers among women < 45 years of age ( 151 ER− , 219 ER+ ) and 1,534 among women ≥45 years ( 385 ER− , 804 ER+ ) . We used multivariable Cox proportional hazards regression to estimate hazard ratios ( HRs ) for associations by age and ER status . Results : Higher parity , older age at first birth , never having breastfed , and abdominal adiposity were associated with increased risk of early-onset ER− breast cancer : HRs were 1.71 for ≥3 births versus one birth ; 2.29 for first birth after age 25 versus < 20 years ; 0.61 for ever having breastfed versus never ; and 1.64 for highest versus lowest tertile of waist-to-hip ratio . These factors were not associated with ER− cancer in older women or with ER+ cancer regardless of age . Conclusions : Differences in risk factors by ER subtype were observed for breast cancer diagnosed before the age of 45 years . Impact : Etiological heterogeneity by tumor subtype in early-onset breast cancer , in combination with a higher prevalence of the risk factors in AA women , may explain , in part , racial disparities in breast cancer incidence . Cancer Epidemiol Biomarkers Prev ; 26(2 ) ; 270–7 . © 2016 AACR OBJECTIVE Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival . As Hispanic and black women have poorer breast cancer prognosis than non-Hispanic whites diagnosed at similar age and stage , and have higher rates of obesity , effective weight loss strategies are needed . We piloted a r and omized , waitlist-controlled , crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic , African American and Afro-Caribbean breast cancer survivors . DESIGN AND METHODS Women with stage 0-IIIa breast cancer ≥ 6 months posttreatment , sedentary , and BMI ≥ 25 kg/m(2 ) were r and omized to the immediate arm ( IA ) : 6 months of the Curves program followed by 6 months of observation ; or the waitlist control arm ( WCA ) : 6 months of observation followed by 6 months of the Curves program . The Curves program uses a 30-min exercise circuit and a high-vegetable/low-fat/calorie-restricted diet . RESULTS A total of 42 women enrolled ( 79 % Hispanic , 21 % black ) , mean age 51 ( range 32 - 69 ) and mean BMI 33.2(± 5.9 ) kg/m(2 ) ; 91 % were retained at month 12 . At month 6 , women in the IA lost an average 3.3 % ( ± 3.5 
    Output:
    