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: RATIONALE AND OBJECTIVES The specific aim of the study was to determine which of several cost-effective interventions is best able to improve the breast cancer knowledge of women who present for screening mammography . MATERIAL S AND METHODS A total of 198 English-speaking women , with no personal or family history of breast cancer , were recruited and r and omized to four groups when they presented to the clinic for a screening mammogram . All women filled in a demographic data form and answered a question naire containing nine questions about breast cancer , risk , and screening to assess their knowledge and perception . Three educational interventions were tested in this study . The first consisted of a brochure , which provided answers to the question naire items and addressed the issues in more depth . The second intervention was an educational conversation with a specially trained mammography technologist . She review ed the subject 's answers to the question naire items correcting and /or clarifying them . The third intervention consisted of the brochure together with the conversation with a trained technologist . There was also a control group that just filled in the study question naire but did not receive an educational intervention . The same question naire was administered by telephone 4 to 6 weeks after the screening experience to all study subjects . Changes in their knowledge and perceptions of breast cancer were measured and compared . RESULTS A statistically significant increase in knowledge was found in all of the three investigated groups compared to the control group . There were no statistically significant differences in the amount of increase between women who underwent different interventions . CONCLUSIONS All three interventions result ed in increased knowledge about breast cancer and screening . No differences in the amount of knowledge increase were found between three interventions tested . The educational brochure seems to represent the most convenient and least costly method to increase knowledge about breast cancer and screening among women who present for screening mammography BACKGROUND Breast cancer is the number one cancer of women in the world . More than 90 % of breast cancers can be cured with early diagnosis followed by effective multimodality treatment . The efficacy of screening by breast self-examination ( BSE ) and breast physical examination ( BPx ) is best evaluated using r and omized screening trials . METHOD A total of 12,660 women aged 35 - 64 years , 6330 in the intervention group and 6330 in the control group , were r and omly selected from four areas of Yazd city , I.R. of Iran . The number of detected cancers along with kind of cancer , staging of cancer , the route of detected cancer and the number of deaths during the first 5 years of the study were collected and analyzed . RESULTS No significance difference between the two groups was seen in respect to socio-demographic and socio-economic variables ( P > 0.05 ) . Subjects in the intervention group had a response rate of 83.5 % for attending the health center and 80.2 % for visiting the assigned surgeon . A total of 31 and 13 new cases of breast cancer were identified in the intervention and control groups , respectively , of which 48.5 % of cases in the intervention group were < 50 yr of age . A significant difference between the cumulative incidence of breast cancer in the two groups with a ratio of 2.4 was observed . CONCLUSION  BSE & BPx  have a significant effect in detecting breast cancers at early stages ( <3 ) suggesting they are effective screening tests with high availability and low costs that can be applied at the community level Background : We have developed the Promoting Early Presentation ( PEP ) Intervention to equip older women with the knowledge , skills , confidence and motivation to present promptly with breast symptoms , and thereby improve survival from breast cancer . The PEP Intervention consists of a 10-min interaction between a radiographer and an  older woman  , supported by a booklet . Our previous report showed that at 1 year , the PEP intervention increased the proportion who were breast cancer aware compared with usual care . Methods : We r and omised 867 women aged 67–70 years attending for their final routine appointment on the National Health Service Breast Screening Programme to receive the PEP Intervention , a booklet alone or usual care . The primary outcome was breast cancer awareness measured using a vali date d question naire asking about knowledge of breast cancer symptoms , knowledge that the risk of breast cancer increases with age and breast checking behaviour . Results : At 2 years , the PEP Intervention increased the proportion who were breast cancer aware compared with usual care ( 21 vs 6 % ; odds ratio 8.1 , 95 % confidence interval 2.7–25.0 ) . Conclusions : The uniquely large and sustained effect of the PEP Intervention on breast cancer awareness increases the likelihood that a woman will present promptly should she develop breast cancer symptoms up to many years later PURPOSE To estimate the effects of a tablet-based , breast cancer risk education intervention for use in primary care setting s ( BreastCARE ) on patients ' breast cancer knowledge , risk perception and concern . METHODS From June 2011-August 2012 , we enrolled women from two clinics , aged 40 - 74 years with no personal breast cancer history , and r and omized them to the BreastCARE intervention group or to the control group .  All patients completed a baseline telephone survey and risk assessment ( via telephone for controls , via tablet computer in clinic waiting room prior to visit for intervention ) . All women were categorized as high or average risk based on the Referral Screening Tool , the Gail model or the Breast Cancer Surveillance Consortium model . Intervention patients and their physicians received an individualized risk report to discuss during the visit . All women completed a follow-up telephone survey 1 - 2 weeks after risk assessment . Post-test comparisons estimated differences at follow-up in breast cancer knowledge , risk perception and concern . RESULTS 580 intervention and 655 control women completed follow-up interviews . Mean age was 56 years ( SD = 9 ) . At follow-up , 73 % of controls and 71 % of intervention women correctly perceived their breast cancer risk and 22 % of controls and 24 % of intervention women were very concerned about breast cancer . Intervention patients had greater knowledge ( ≥75 % correct answers ) of breast cancer risk factors at follow-up ( 24 % vs. 16 % ; p = 0.002 ) . In multivariable analysis , there were no differences in correct risk perception or concern , but intervention patients had greater knowledge ( [ OR ] = 1.62 ; 95 % [ CI ] = 1.19 - 2.23 ) . CONCLUSIONS A simple , practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern . TRIAL REGISTRATION Clinical Trials.gov identifier NCT01830933 Background The purpose of this study was to explore women 's views of the design of a large pragmatic cost-effectiveness r and omised controlled trial of the policy of offering a health professional-delivered intervention to promote early presentation with breast symptoms in older women and thereby improve survival , with a view to informing protocol development . The trial will recruit over 100,000 healthy women aged 67 + , and outcome data will be collected on those who develop breast cancer . The scale of the trial and the need for long-term follow-up presented a number of design challenges in relation to obtaining consent , ascertaining and contacting participants who developed breast cancer , and collecting outcome data . Methods Qualitative study involving 69 women participating in 7 focus groups and 17 in-depth interviews . 15 women had a previous diagnosis of breast cancer and 54 did not . Results The women held strong views and had a good underst and ing of the rationale of the design of clinical trials . The women recognised that in a very large trial with long-term follow-up it was necessary to incorporate design features to make the trial feasible and efficient . Most strikingly , they supported the idea of opt-out consent and identifying women with breast cancer using routine data sets . Conclusions This model of user involvement engaged women well with the design challenges of the trial and led to improvements to the protocol . The study strengthens the case for user involvement , in particular through focus groups and in-depth interviews , in the design of trials BACKGROUND We evaluated a r and omized controlled treatment , utilizing Community Health Workers ( CHW ) to deliver breast and cervical cancer education intervention to African American , Latina , and Arab women in Detroit and Dearborn , Michigan . The main objectives of the study are to : ( 1 ) examine fidelity and consistency of treatment delivery and ( 2 ) assess qualitative elements of the intervention . METHODS We surveyed 305 women who received the intervention and 16 CHWs Survey included questions regarding the treatment integrity , treatment received , and training provided . Surveys included both quantitative and questions . RESULTS The intervention group ( n = 305 ) was made up of 48 % Black , 11 % Latina , and 41 % Arab women . Almost all ( ≥ 90 % ) women agreed that they received the treatment in the way that it was intended . Sixteen CHWs responded affirmatively as well . CONCLUSIONS Both participants and CHWs indicated that the program was mutually rewarding , indicating that there was " cross fertilization and cross benefit " of working with each other . These benefits served to endorse and confirm that CHWs are a very important mechanism in increasing health literacy in the community and referring underserved individuals to health providers . Second , with strong treatment fidelity the Kin Keeper(SM ) program and has the potential to be replicated for a number of diseases in a variety of venues especially for those facing health disparities Background : There is virtually no evidence for the effectiveness of interventions to promote early presentation in breast cancer . We aim ed to test the efficacy of an intervention to equip older women with the knowledge , skills , confidence and motivation to detect symptoms and seek help promptly , with the aim of promoting early presentation with breast cancer symptoms . Methods : We r and omised 867 women aged 67–70 years attending for their final routine appointment on the UK NHS Breast Screening Programme to receive : a scripted 10-min interaction with a radiographer plus a booklet , a booklet alone or usual care . The primary outcome was whether or not a woman was breast cancer aware based on knowledge of breast cancer symptoms and age-related risk , and reported breast checking . Results : At 1 month , the intervention increased the proportion who were breast cancer aware compared with usual care ( interaction arm : 32.8 % vs 4.1 % ; odds ratio ( OR ) : 24.0 , 95 % confidence interval ( CI ) : 7.7–73.7 ; booklet arm : 12.7 % vs 4.1 % ; OR : 4.4 , 95 % CI : 1.6–12.0 ) . At 1 year , the effects of the interaction plus booklet , and the booklet , on breast cancer awareness were largely sustained , although the interaction plus booklet remained much more effective . Conclusions : An intervention to equip older women with the knowledge , skills , confidence and motivation to detect breast cancer symptoms and seek help promptly increases breast cancer awareness at 1 year . Future research will evaluate whether the intervention promotes early presentation and reduces breast cancer mortality Background . Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women . Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis . After examining efficacy in a r and omised controlled trial , we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms , as an integral part of the final invited mammogram at age ~70 , in the English National Health Service Breast Screening Programme . Methods . We trained  mammographers  , who then offered the intervention to older women in four breast screening services . We examined breast cancer awareness at baseline and one month in women receiving the intervention , and also in a service where the intervention was not offered . Results . We trained 27 mammographers to deliver the intervention confidently to a high st and ard . Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service ( odds ratio 15.2 , 95 % confidence interval 10.0 to 23.2 ) . Conclusions . The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a r and omised controlled trial . It has the potential to reduce delay in diagnosis for breast cancer in older women BACKGROUND Breast cancer is one of the most common types of cancer prevalent among women worldwide . Preventive behaviors such as early diagnosis through screening tests play an important role in prevention and control of the disease . This study aim ed to determine the effects of educational intervention using a health belief model on breast cancer preventive behaviors . METHODS This interventional study was conducted on 130 female employees of Zahedan University of Medical Sciences who were r and omly divided into  intervention and control groups .  A question naire , made and vali date d by the research er , was completed before and one month after training by the study subjects . Data were analysed using regression analysis , independent sample T-test , chi-square and Pearson 's correlation coefficient using the SPSS software 18 . RESULTS There were significant changes in the training group , following educational intervention in the awareness construct and in some constructs of the model including perceived susceptibility , perceived benefits , and perceived barriers , as well as in practice compared to the control group ( P < 0.05 ) . Nevertheless , perceived barriers remained as the only predictor in the model , such that for every unit increase in this variable , the behavior score increased by 18 % . CONCLUSION The use of educational intervention based on Health Belief Model had positive effect on knowledge of breast cancer preventive behaviors among participants BACKGROUND Although breast and cervical cancer deaths have declined due to early screening , detection , and more effective treatment , racial and ethnic disparities persist . This paper describes the study design and baseline characteristics of a r and omized controlled trial ( RCT ) evaluating the effectiveness of the Kin Keeper(SM ) Cancer Prevention Intervention , a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities . METHODS Female public health community health workers ( CHWs ) were trained 
    Output:
    
agent
***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: RATIONALE AND OBJECTIVES The specific aim of the study was to determine which of several cost-effective interventions is best able to improve the breast cancer knowledge of women who present for screening mammography . MATERIAL S AND METHODS A total of 198 English-speaking women , with no personal or family history of breast cancer , were recruited and r and omized to four groups when they presented to the clinic for a screening mammogram . All women filled in a demographic data form and answered a question naire containing nine questions about breast cancer , risk , and screening to assess their knowledge and perception . Three educational interventions were tested in this study . The first consisted of a brochure , which provided answers to the question naire items and addressed the issues in more depth . The second intervention was an educational conversation with a specially trained mammography technologist . She review ed the subject 's answers to the question naire items correcting and /or clarifying them . The third intervention consisted of the brochure together with the conversation with a trained technologist . There was also a control group that just filled in the study question naire but did not receive an educational intervention . The same question naire was administered by telephone 4 to 6 weeks after the screening experience to all study subjects . Changes in their knowledge and perceptions of breast cancer were measured and compared . RESULTS A statistically significant increase in knowledge was found in all of the three investigated groups compared to the control group . There were no statistically significant differences in the amount of increase between women who underwent different interventions . CONCLUSIONS All three interventions result ed in increased knowledge about breast cancer and screening . No differences in the amount of knowledge increase were found between three interventions tested . The educational brochure seems to represent the most convenient and least costly method to increase knowledge about breast cancer and screening among women who present for screening mammography BACKGROUND Breast cancer is the number one cancer of women in the world . More than 90 % of breast cancers can be cured with early diagnosis followed by effective multimodality treatment . The efficacy of screening by breast self-examination ( BSE ) and breast physical examination ( BPx ) is best evaluated using r and omized screening trials . METHOD A total of 12,660 women aged 35 - 64 years , 6330 in the intervention group and 6330 in the control group , were r and omly selected from four areas of Yazd city , I.R. of Iran . The number of detected cancers along with kind of cancer , staging of cancer , the route of detected cancer and the number of deaths during the first 5 years of the study were collected and analyzed . RESULTS No significance difference between the two groups was seen in respect to socio-demographic and socio-economic variables ( P > 0.05 ) . Subjects in the intervention group had a response rate of 83.5 % for attending the health center and 80.2 % for visiting the assigned surgeon . A total of 31 and 13 new cases of breast cancer were identified in the intervention and control groups , respectively , of which 48.5 % of cases in the intervention group were < 50 yr of age . A significant difference between the cumulative incidence of breast cancer in the two groups with a ratio of 2.4 was observed . CONCLUSION  BSE & BPx  have a significant effect in detecting breast cancers at early stages ( <3 ) suggesting they are effective screening tests with high availability and low costs that can be applied at the community level Background : We have developed the Promoting Early Presentation ( PEP ) Intervention to equip older women with the knowledge , skills , confidence and motivation to present promptly with breast symptoms , and thereby improve survival from breast cancer . The PEP Intervention consists of a 10-min interaction between a radiographer and an  older woman  , supported by a booklet . Our previous report showed that at 1 year , the PEP intervention increased the proportion who were breast cancer aware compared with usual care . Methods : We r and omised 867 women aged 67–70 years attending for their final routine appointment on the National Health Service Breast Screening Programme to receive the PEP Intervention , a booklet alone or usual care . The primary outcome was breast cancer awareness measured using a vali date d question naire asking about knowledge of breast cancer symptoms , knowledge that the risk of breast cancer increases with age and breast checking behaviour . Results : At 2 years , the PEP Intervention increased the proportion who were breast cancer aware compared with usual care ( 21 vs 6 % ; odds ratio 8.1 , 95 % confidence interval 2.7–25.0 ) . Conclusions : The uniquely large and sustained effect of the PEP Intervention on breast cancer awareness increases the likelihood that a woman will present promptly should she develop breast cancer symptoms up to many years later PURPOSE To estimate the effects of a tablet-based , breast cancer risk education intervention for use in primary care setting s ( BreastCARE ) on patients ' breast cancer knowledge , risk perception and concern . METHODS From June 2011-August 2012 , we enrolled women from two clinics , aged 40 - 74 years with no personal breast cancer history , and r and omized them to the BreastCARE intervention group or to the control group .  All patients completed a baseline telephone survey and risk assessment ( via telephone for controls , via tablet computer in clinic waiting room prior to visit for intervention ) . All women were categorized as high or average risk based on the Referral Screening Tool , the Gail model or the Breast Cancer Surveillance Consortium model . Intervention patients and their physicians received an individualized risk report to discuss during the visit . All women completed a follow-up telephone survey 1 - 2 weeks after risk assessment . Post-test comparisons estimated differences at follow-up in breast cancer knowledge , risk perception and concern . RESULTS 580 intervention and 655 control women completed follow-up interviews . Mean age was 56 years ( SD = 9 ) . At follow-up , 73 % of controls and 71 % of intervention women correctly perceived their breast cancer risk and 22 % of controls and 24 % of intervention women were very concerned about breast cancer . Intervention patients had greater knowledge ( ≥75 % correct answers ) of breast cancer risk factors at follow-up ( 24 % vs. 16 % ; p = 0.002 ) . In multivariable analysis , there were no differences in correct risk perception or concern , but intervention patients had greater knowledge ( [ OR ] = 1.62 ; 95 % [ CI ] = 1.19 - 2.23 ) . CONCLUSIONS A simple , practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern . TRIAL REGISTRATION Clinical Trials.gov identifier NCT01830933 Background The purpose of this study was to explore women 's views of the design of a large pragmatic cost-effectiveness r and omised controlled trial of the policy of offering a health professional-delivered intervention to promote early presentation with breast symptoms in older women and thereby improve survival , with a view to informing protocol development . The trial will recruit over 100,000 healthy women aged 67 + , and outcome data will be collected on those who develop breast cancer . The scale of the trial and the need for long-term follow-up presented a number of design challenges in relation to obtaining consent , ascertaining and contacting participants who developed breast cancer , and collecting outcome data . Methods Qualitative study involving 69 women participating in 7 focus groups and 17 in-depth interviews . 15 women had a previous diagnosis of breast cancer and 54 did not . Results The women held strong views and had a good underst and ing of the rationale of the design of clinical trials . The women recognised that in a very large trial with long-term follow-up it was necessary to incorporate design features to make the trial feasible and efficient . Most strikingly , they supported the idea of opt-out consent and identifying women with breast cancer using routine data sets . Conclusions This model of user involvement engaged women well with the design challenges of the trial and led to improvements to the protocol . The study strengthens the case for user involvement , in particular through focus groups and in-depth interviews , in the design of trials BACKGROUND We evaluated a r and omized controlled treatment , utilizing Community Health Workers ( CHW ) to deliver breast and cervical cancer education intervention to African American , Latina , and Arab women in Detroit and Dearborn , Michigan . The main objectives of the study are to : ( 1 ) examine fidelity and consistency of treatment delivery and ( 2 ) assess qualitative elements of the intervention . METHODS We surveyed 305 women who received the intervention and 16 CHWs Survey included questions regarding the treatment integrity , treatment received , and training provided . Surveys included both quantitative and questions . RESULTS The intervention group ( n = 305 ) was made up of 48 % Black , 11 % Latina , and 41 % Arab women . Almost all ( ≥ 90 % ) women agreed that they received the treatment in the way that it was intended . Sixteen CHWs responded affirmatively as well . CONCLUSIONS Both participants and CHWs indicated that the program was mutually rewarding , indicating that there was " cross fertilization and cross benefit " of working with each other . These benefits served to endorse and confirm that CHWs are a very important mechanism in increasing health literacy in the community and referring underserved individuals to health providers . Second , with strong treatment fidelity the Kin Keeper(SM ) program and has the potential to be replicated for a number of diseases in a variety of venues especially for those facing health disparities Background : There is virtually no evidence for the effectiveness of interventions to promote early presentation in breast cancer . We aim ed to test the efficacy of an intervention to equip older women with the knowledge , skills , confidence and motivation to detect symptoms and seek help promptly , with the aim of promoting early presentation with breast cancer symptoms . Methods : We r and omised 867 women aged 67–70 years attending for their final routine appointment on the UK NHS Breast Screening Programme to receive : a scripted 10-min interaction with a radiographer plus a booklet , a booklet alone or usual care . The primary outcome was whether or not a woman was breast cancer aware based on knowledge of breast cancer symptoms and age-related risk , and reported breast checking . Results : At 1 month , the intervention increased the proportion who were breast cancer aware compared with usual care ( interaction arm : 32.8 % vs 4.1 % ; odds ratio ( OR ) : 24.0 , 95 % confidence interval ( CI ) : 7.7–73.7 ; booklet arm : 12.7 % vs 4.1 % ; OR : 4.4 , 95 % CI : 1.6–12.0 ) . At 1 year , the effects of the interaction plus booklet , and the booklet , on breast cancer awareness were largely sustained , although the interaction plus booklet remained much more effective . Conclusions : An intervention to equip older women with the knowledge , skills , confidence and motivation to detect breast cancer symptoms and seek help promptly increases breast cancer awareness at 1 year . Future research will evaluate whether the intervention promotes early presentation and reduces breast cancer mortality Background . Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women . Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis . After examining efficacy in a r and omised controlled trial , we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms , as an integral part of the final invited mammogram at age ~70 , in the English National Health Service Breast Screening Programme . Methods . We trained  mammographers  , who then offered the intervention to older women in four breast screening services . We examined breast cancer awareness at baseline and one month in women receiving the intervention , and also in a service where the intervention was not offered . Results . We trained 27 mammographers to deliver the intervention confidently to a high st and ard . Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service ( odds ratio 15.2 , 95 % confidence interval 10.0 to 23.2 ) . Conclusions . The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a r and omised controlled trial . It has the potential to reduce delay in diagnosis for breast cancer in older women BACKGROUND Breast cancer is one of the most common types of cancer prevalent among women worldwide . Preventive behaviors such as early diagnosis through screening tests play an important role in prevention and control of the disease . This study aim ed to determine the effects of educational intervention using a health belief model on breast cancer preventive behaviors . METHODS This interventional study was conducted on 130 female employees of Zahedan University of Medical Sciences who were r and omly divided into  intervention and control groups .  A question naire , made and vali date d by the research er , was completed before and one month after training by the study subjects . Data were analysed using regression analysis , independent sample T-test , chi-square and Pearson 's correlation coefficient using the SPSS software 18 . RESULTS There were significant changes in the training group , following educational intervention in the awareness construct and in some constructs of the model including perceived susceptibility , perceived benefits , and perceived barriers , as well as in practice compared to the control group ( P < 0.05 ) . Nevertheless , perceived barriers remained as the only predictor in the model , such that for every unit increase in this variable , the behavior score increased by 18 % . CONCLUSION The use of educational intervention based on Health Belief Model had positive effect on knowledge of breast cancer preventive behaviors among participants BACKGROUND Although breast and cervical cancer deaths have declined due to early screening , detection , and more effective treatment , racial and ethnic disparities persist . This paper describes the study design and baseline characteristics of a r and omized controlled trial ( RCT ) evaluating the effectiveness of the Kin Keeper(SM ) Cancer Prevention Intervention , a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities . METHODS Female public health community health workers ( CHWs ) were trained 
    Output:
    