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: 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 A trial in the UK to study the effect on mortality from breast cancer of invitation for annual mammography from the age of 40–41 , has r and omised a total of 160 921 women in the ratio 1 : 2 to the intervention and control arms . All breast cancers diagnosed in the two arms have been identified , and the histology review ed . This paper presents the results of an interim analysis using surrogate outcome measures to compare predicted breast cancer mortality in the two arms based on 1287 cases diagnosed to 31.12.1999 . Due to earlier diagnosis , there is currently an 8 % excess of invasive breast cancers in the intervention arm . The ratio of predicted deaths at 10 years in the intervention arm relative to the control arm , adjusted for this excess diagnosis , ranges from 0.89 ( 95 % confidence interval ( CI ) 0.78–1.01 ) to 0.90 ( 95 % CI 0.80–1.01 ) . Screening from age 40 may result in a lower reduction in breast cancer mortality than that observed in other trials including women below age 50 . This analysis based on surrogate outcome measures suggests that a reduction in breast cancer mortality may be observed in this trial . However , a number of assumptions have been necessary and firm conclusions must await the analysis of observed mortality from breast cancer Purpose Digital breast tomo synthesis ( DBT ) has the potential to overcome limitations of conventional mammography . This study investigated the effects of addition of DBT on  interval and detected cancers in population -based screening . Methods Oslo Tomo synthesis Screening Trial ( OTST ) was a prospect i ve , independent double-reading trial inviting women 50–69 years biennially , comparing full-field digital mammography ( FFDM ) plus DBT with FFDM alone .  Performance indicators and characteristics of screen-detected and interval cancers were compared with two previous FFDM rounds . Results 24,301 consenting women underwent FFDM + DBT screening over a 2-year period . Results were compared with 59,877 FFDM examinations during prior rounds . Addition of DBT result ed in a non-significant increase in sensitivity ( 76.2 % , 378/496 , vs. 80.8 % , 227/281 , p = 0.151 ) and a significant increase in specificity ( 96.4 % , 57229/59381 vs. 97.5 % , 23427/24020 , p < .001 ) . Number of recalls per screen-detected cancer decreased from 6.7 ( 2530/378 ) to 3.6 ( 820/227 ) with DBT ( p < .001 ) . Cancer detection per 1000 women screened increased ( 6.3 , 378/59877 , vs. 9.3 , 227/24301 , p < .001 ) . Interval cancer rate per 1000 screens for FFDM + DBT remained similar to previous FFDM rounds ( 2.1 , 51/24301 vs. 2.0 , 118/59877 , p = 0.734 ) . Interval cancers post-DBT were comparable to prior rounds but significantly different in size , grade , and node status from cancers detected only using DBT . 39.6 % ( 19/48 ) of interval cancers had positive nodes compared with only 3.9 % ( 2/51 ) of additional DBT-only-detected cancers . Conclusions DBT-supplemented screening result ed in significant increases in screen-detected cancers and specificity . However , no significant change was observed in the rate , size , node status , or grade of interval cancers . Clinical Trials.gov : NCT01248546 Purpose To compare the performance of digital breast tomo synthesis ( DBT ) and two-dimensional synthetic mammography ( SM ) with that of digital mammography ( DM ) in a population -based mammographic screening program . Material s and Methods In this prospect i ve cohort study , data from 37 185 women screened with DBT and SM and from 61 742 women screened with DM as part of a population -based screening program in 2014 and 2015 were included . Early performance measures , including recall rate due to abnormal mammographic findings , rate of screen-detected breast cancer , positive predictive value of recall , positive predictive value of needle biopsy , histopathologic type , tumor size , tumor grade , lymph node involvement , hormonal status , Ki-67 level , and human epidermal growth factor receptor 2 status were compared in women who underwent DBT and SM screening  and in those who underwent DM screening  by using χ2 tests , two- sample unpaired t tests , and tests of proportions . Results Recall rates were 3.4 % for DBT and SM screening and 3.3 % for DM screening ( P = .563 ) . DBT and SM screening showed a significantly higher rate of screen-detected cancer compared with DM screening ( 9.4 vs 6.1 cancers per 1000 patients screened , respectively ; P < .001 ) . The rate of detection of tumors 10 mm or smaller was 3.2 per 1000 patients screened with DBT and SM and 1.8 per 1000 patients screened with DM ( P < .001 ) , and the rate of grade 1 tumors was 3.3 per 1000 patients screened with DBT and SM versus 1.4 per 1000 patients screened with DM ( P < .001 ) . On the basis of immunohistochemical analyses , rates of lymph node involvement and tumor subtypes did not differ between women who underwent DBT and SM screening and those who underwent DM screening . Conclusion DBT and SM screening increased the detection rate of histologically favorable tumors compared with that attained with DM screening . © RSNA , 2018 Online supplemental material is available for this article BACKGROUND Breast tomo synthesis ( pseudo-3D mammography ) improves breast cancer detection when added to 2D mammography . In this study , we examined whether integrating 3D mammography with either st and ard 2D mammography acquisitions or with synthetic 2D images ( reconstructed from 3D mammography ) would detect more cases of breast cancer than 2D mammography alone , to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions . METHODS The Screening with Tomo synthesis Or st and ard Mammography-2 ( STORM-2 ) study was a prospect i ve population -based screening study comparing integrated 3D mammography ( dual-acquisition 2D-3D mammography or 2D synthetic-3D mammography ) with 2D mammography alone . Asymptomatic women aged 49 years or older who attended population -based screening in Trento , Italy were recruited for the study . All participants underwent digital mammography with 2D and 3D mammography acquisitions , with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions . Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions . Recall based on a positive mammography result was defined as recall at any screen read . Primary outcome measures were a comparison between integrated ( 2D-3D or 2D synthetic-3D ) mammography and 2D mammography alone of the number of cases of screen-detected breast cancer , the cancer detection rate per 1000 screens , the incremental cancer detection rate , and the number and percentage of false-positive recalls . FINDINGS Between May 31 , 2013 , and May 29 , 2015 , 10 255 women were invited to participate , of whom 9672 agreed to participate and were screened . In these 9672 participants ( median age 58 years [ IQR 53 - 63 ] ) , screening detected 90 cases of breast cancer , including 74 invasive breast cancers , in 85 women ( five women had bilateral breast cancer ) . To account for these bilateral cancers in cancer detection rate estimates , the number of screens used for analysis was 9677 . Both 2D-3D mammography ( cancer detection rate 8·5 per 1000 screens [ 82 cancers detected in 9677 screens ] ; 95 % CI 6·7 - 10·5 ) and 2D synthetic-3D mammography ( 8·8 per 1000 [ 85 in 9677 ] ; 7·0 - 10·8 ) had significantly higher rates of breast cancer detection  than 2D mammography alone ( 6·3 per 1000 [ 61 in 9677 ] , 4·8 - 8·1 ; p<0·0001 for both comparisons ) . The cancer detection rate did not differ significantly between 2D-3D mammography and 2D synthetic-3D mammography ( p=0·58 ) . Compared with 2D mammography alone , the incremental cancer detection rate from 2D-3D mammography was 2·2 per 1000 screens ( 95 % CI 1·2 - 3·3 ) and that from 2D synthetic-3D mammography was 2·5 per 1000 ( 1·4 - 3·8 ) . Compared with the proportion of false-positive recalls from 2D mammography alone ( 328 of 9587 participants not found to have cancer at assessment ) [ 3·42 % ; 95 % CI 3·07 - 3·80 ] ) , false-positive recall was significantly higher for 2D-3D mammography ( 381 of 9587 [ 3·97 % ; 3·59 - 4·38 ] , p=0·00063 ) and for 2D synthetic-3D mammography ( 427 of 9587 [ 4·45 % ; 4·05 - 4·89 ] , p<0·0001 ) . INTERPRETATION Integration of 3D mammography ( 2D-3D or 2D synthetic-3D ) detected more cases of breast cancer  than 2D mammography alone , but increased the percentage of false-positive recalls in sequential screen-reading . These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening , including that significantly increased breast cancer detection from integrating 3D mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis . FUNDING None BACKGROUND & METHODS The prospect i ve ' screening with tomo synthesis or st and ard mammography ' ( STORM ) trial recruited women participating in biennial breast screening in Italy ( 2011 - 2012 ) , and compared sequential screen-readings based on 2D-mammography alone or based on tomo synthesis ( integrated 2D/3D-mammography ) . The STORM trial showed that tomo synthesis screen-reading significantly increased breast cancer detection compared to 2D-mammography alone . The present study completes reporting of the trial by examining interval breast cancers ascertained at two year follow-up . RESULTS 9 interval breast cancers were identified ; the estimated interval cancer rate was 1. 
    Output:
    
agent
For example , mammography screening does not seem to create anxiety in women who are given a clear result after a mammogram .
The incidence of breast cancer and mortality increases with age , and the GDG extrapolated that the absolute health benefits are greater in women aged 45 to 49 than those aged 40 to 44 years .
However , for the 45- to 49-year age group , the higher breast cancer incidence and mortality compared with women between the ages of 40 and 44 , as well as observational evidence showing a greater benefit in this age group ( 33 ) , led the GDG to judge that the balance of health effects probably favors screening , although the required re sources for screening likely differ across setting s ( 34 , 35 ) .
Other EtD criteria also were generally in favor of implementing organized mammography screening in this age group .
***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: 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 A trial in the UK to study the effect on mortality from breast cancer of invitation for annual mammography from the age of 40–41 , has r and omised a total of 160 921 women in the ratio 1 : 2 to the intervention and control arms . All breast cancers diagnosed in the two arms have been identified , and the histology review ed . This paper presents the results of an interim analysis using surrogate outcome measures to compare predicted breast cancer mortality in the two arms based on 1287 cases diagnosed to 31.12.1999 . Due to earlier diagnosis , there is currently an 8 % excess of invasive breast cancers in the intervention arm . The ratio of predicted deaths at 10 years in the intervention arm relative to the control arm , adjusted for this excess diagnosis , ranges from 0.89 ( 95 % confidence interval ( CI ) 0.78–1.01 ) to 0.90 ( 95 % CI 0.80–1.01 ) . Screening from age 40 may result in a lower reduction in breast cancer mortality than that observed in other trials including women below age 50 . This analysis based on surrogate outcome measures suggests that a reduction in breast cancer mortality may be observed in this trial . However , a number of assumptions have been necessary and firm conclusions must await the analysis of observed mortality from breast cancer Purpose Digital breast tomo synthesis ( DBT ) has the potential to overcome limitations of conventional mammography . This study investigated the effects of addition of DBT on  interval and detected cancers in population -based screening . Methods Oslo Tomo synthesis Screening Trial ( OTST ) was a prospect i ve , independent double-reading trial inviting women 50–69 years biennially , comparing full-field digital mammography ( FFDM ) plus DBT with FFDM alone .  Performance indicators and characteristics of screen-detected and interval cancers were compared with two previous FFDM rounds . Results 24,301 consenting women underwent FFDM + DBT screening over a 2-year period . Results were compared with 59,877 FFDM examinations during prior rounds . Addition of DBT result ed in a non-significant increase in sensitivity ( 76.2 % , 378/496 , vs. 80.8 % , 227/281 , p = 0.151 ) and a significant increase in specificity ( 96.4 % , 57229/59381 vs. 97.5 % , 23427/24020 , p < .001 ) . Number of recalls per screen-detected cancer decreased from 6.7 ( 2530/378 ) to 3.6 ( 820/227 ) with DBT ( p < .001 ) . Cancer detection per 1000 women screened increased ( 6.3 , 378/59877 , vs. 9.3 , 227/24301 , p < .001 ) . Interval cancer rate per 1000 screens for FFDM + DBT remained similar to previous FFDM rounds ( 2.1 , 51/24301 vs. 2.0 , 118/59877 , p = 0.734 ) . Interval cancers post-DBT were comparable to prior rounds but significantly different in size , grade , and node status from cancers detected only using DBT . 39.6 % ( 19/48 ) of interval cancers had positive nodes compared with only 3.9 % ( 2/51 ) of additional DBT-only-detected cancers . Conclusions DBT-supplemented screening result ed in significant increases in screen-detected cancers and specificity . However , no significant change was observed in the rate , size , node status , or grade of interval cancers . Clinical Trials.gov : NCT01248546 Purpose To compare the performance of digital breast tomo synthesis ( DBT ) and two-dimensional synthetic mammography ( SM ) with that of digital mammography ( DM ) in a population -based mammographic screening program . Material s and Methods In this prospect i ve cohort study , data from 37 185 women screened with DBT and SM and from 61 742 women screened with DM as part of a population -based screening program in 2014 and 2015 were included . Early performance measures , including recall rate due to abnormal mammographic findings , rate of screen-detected breast cancer , positive predictive value of recall , positive predictive value of needle biopsy , histopathologic type , tumor size , tumor grade , lymph node involvement , hormonal status , Ki-67 level , and human epidermal growth factor receptor 2 status were compared in women who underwent DBT and SM screening  and in those who underwent DM screening  by using χ2 tests , two- sample unpaired t tests , and tests of proportions . Results Recall rates were 3.4 % for DBT and SM screening and 3.3 % for DM screening ( P = .563 ) . DBT and SM screening showed a significantly higher rate of screen-detected cancer compared with DM screening ( 9.4 vs 6.1 cancers per 1000 patients screened , respectively ; P < .001 ) . The rate of detection of tumors 10 mm or smaller was 3.2 per 1000 patients screened with DBT and SM and 1.8 per 1000 patients screened with DM ( P < .001 ) , and the rate of grade 1 tumors was 3.3 per 1000 patients screened with DBT and SM versus 1.4 per 1000 patients screened with DM ( P < .001 ) . On the basis of immunohistochemical analyses , rates of lymph node involvement and tumor subtypes did not differ between women who underwent DBT and SM screening and those who underwent DM screening . Conclusion DBT and SM screening increased the detection rate of histologically favorable tumors compared with that attained with DM screening . © RSNA , 2018 Online supplemental material is available for this article BACKGROUND Breast tomo synthesis ( pseudo-3D mammography ) improves breast cancer detection when added to 2D mammography . In this study , we examined whether integrating 3D mammography with either st and ard 2D mammography acquisitions or with synthetic 2D images ( reconstructed from 3D mammography ) would detect more cases of breast cancer than 2D mammography alone , to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions . METHODS The Screening with Tomo synthesis Or st and ard Mammography-2 ( STORM-2 ) study was a prospect i ve population -based screening study comparing integrated 3D mammography ( dual-acquisition 2D-3D mammography or 2D synthetic-3D mammography ) with 2D mammography alone . Asymptomatic women aged 49 years or older who attended population -based screening in Trento , Italy were recruited for the study . All participants underwent digital mammography with 2D and 3D mammography acquisitions , with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions . Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions . Recall based on a positive mammography result was defined as recall at any screen read . Primary outcome measures were a comparison between integrated ( 2D-3D or 2D synthetic-3D ) mammography and 2D mammography alone of the number of cases of screen-detected breast cancer , the cancer detection rate per 1000 screens , the incremental cancer detection rate , and the number and percentage of false-positive recalls . FINDINGS Between May 31 , 2013 , and May 29 , 2015 , 10 255 women were invited to participate , of whom 9672 agreed to participate and were screened . In these 9672 participants ( median age 58 years [ IQR 53 - 63 ] ) , screening detected 90 cases of breast cancer , including 74 invasive breast cancers , in 85 women ( five women had bilateral breast cancer ) . To account for these bilateral cancers in cancer detection rate estimates , the number of screens used for analysis was 9677 . Both 2D-3D mammography ( cancer detection rate 8·5 per 1000 screens [ 82 cancers detected in 9677 screens ] ; 95 % CI 6·7 - 10·5 ) and 2D synthetic-3D mammography ( 8·8 per 1000 [ 85 in 9677 ] ; 7·0 - 10·8 ) had significantly higher rates of breast cancer detection  than 2D mammography alone ( 6·3 per 1000 [ 61 in 9677 ] , 4·8 - 8·1 ; p<0·0001 for both comparisons ) . The cancer detection rate did not differ significantly between 2D-3D mammography and 2D synthetic-3D mammography ( p=0·58 ) . Compared with 2D mammography alone , the incremental cancer detection rate from 2D-3D mammography was 2·2 per 1000 screens ( 95 % CI 1·2 - 3·3 ) and that from 2D synthetic-3D mammography was 2·5 per 1000 ( 1·4 - 3·8 ) . Compared with the proportion of false-positive recalls from 2D mammography alone ( 328 of 9587 participants not found to have cancer at assessment ) [ 3·42 % ; 95 % CI 3·07 - 3·80 ] ) , false-positive recall was significantly higher for 2D-3D mammography ( 381 of 9587 [ 3·97 % ; 3·59 - 4·38 ] , p=0·00063 ) and for 2D synthetic-3D mammography ( 427 of 9587 [ 4·45 % ; 4·05 - 4·89 ] , p<0·0001 ) . INTERPRETATION Integration of 3D mammography ( 2D-3D or 2D synthetic-3D ) detected more cases of breast cancer  than 2D mammography alone , but increased the percentage of false-positive recalls in sequential screen-reading . These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening , including that significantly increased breast cancer detection from integrating 3D mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis . FUNDING None BACKGROUND & METHODS The prospect i ve ' screening with tomo synthesis or st and ard mammography ' ( STORM ) trial recruited women participating in biennial breast screening in Italy ( 2011 - 2012 ) , and compared sequential screen-readings based on 2D-mammography alone or based on tomo synthesis ( integrated 2D/3D-mammography ) . The STORM trial showed that tomo synthesis screen-reading significantly increased breast cancer detection compared to 2D-mammography alone . The present study completes reporting of the trial by examining interval breast cancers ascertained at two year follow-up . RESULTS 9 interval breast cancers were identified ; the estimated interval cancer rate was 1. 
    Output:
    