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: Background : Use of nonvitamin , nonmineral “ specialty ” supplements has increased substantially over recent decades . Several supplements may have anti-inflammatory or anticancer properties . Additionally , supplements taken for symptoms of menopause have been associated with reduced risk of breast cancer in two case-control studies . However , there have been no prospect i ve studies of the association between the long-term use of these supplements and breast cancer risk . Methods : Participants were female members of the VITamins And Lifestyle ( VITAL ) Cohort . Postmenopausal women , ages 50 to 76 years , who were residents of western Washington State , completed a 24-page baseline question naire in 2000 to 2002 ( n = 35,016 ) . Participants were queried on their recency ( current versus past ) , frequency ( days/week ) , and duration ( years ) of specialty supplement use .  Incident invasive breast cancers ( n = 880 ) from 2000 to 2007 were obtained from the Surveillance , Epidemiology , and End Results registry .  Multivariable-adjusted hazards ratios ( HR ) and 95 % confidence intervals ( 95 % CI ) were estimated by Cox proportional hazards models . Results : Current use of fish oil was associated with reduced risk of breast cancer ( HR , 0.68 ; 95 % CI , 0.50 - 0.92 ) . Ten-year average use was suggestive of reduced risk ( P trend = 0.09 ) . These results held for ductal but not lobular cancers . The remaining specialty supplements were not associated with breast cancer risk : Specifically , use of supplements sometimes taken for menopausal symptoms ( black cohosh , dong quai , soy , or St. John 's wort ) was not associated with risk . Conclusions : Fish oil may be inversely associated with breast cancer risk . Impact : Fish oil is a potential c and i date for chemoprevention studies . Until that time , it is not recommended for individual use for breast cancer prevention . Cancer Epidemiol Biomarkers Prev ; 19(7 ) ; 1696–708 . © 2010 AACR IMPORTANCE Breast cancer is the leading cause of female cancer burden , and its incidence has increased by more than 20 % worldwide since 2008 . Some observational studies have suggested that the Mediterranean diet may reduce the risk of  breast cancer .  OBJECTIVE To evaluate the effect of 2 interventions with Mediterranean diet vs the advice to follow a low-fat diet ( control ) on breast cancer incidence . DESIGN , SETTING , AND PARTICIPANTS The PREDIMED study is a 1:1:1 r and omized , single-blind , controlled field trial conducted at primary health care centers in Spain . From 2003 to 2009 , 4282 women aged 60 to 80 years and at high cardiovascular disease risk were recruited after invitation by their primary care physicians . INTERVENTIONS Participants were r and omly allocated to a Mediterranean diet supplemented with extra-virgin olive oil , a Mediterranean diet supplemented with mixed nuts , or a control diet ( advice to reduce dietary fat ) . MAIN OUTCOMES AND MEASURES Breast cancer incidence was a prespecified secondary outcome of the trial for women without a prior history of breast cancer ( n = 4152 ) . RESULTS After a median follow-up of 4.8 years , we identified 35 confirmed incident cases of breast cancer . Observed rates ( per 1000 person-years ) were 1.1 for the Mediterranean diet with extra-virgin olive oil group , 1.8 for the Mediterranean diet with nuts group , and 2.9 for the control group . The multivariable-adjusted hazard ratios vs the control group were 0.32 ( 95 % CI , 0.13 - 0.79 ) for the Mediterranean diet with extra-virgin olive oil group and 0.59 ( 95 % CI , 0.26 - 1.35 ) for the Mediterranean diet with nuts group . In analyses with yearly cumulative up date d dietary exposures , the hazard ratio for each additional 5 % of calories from extra-virgin olive oil was 0.72 ( 95 % CI , 0.57 - 0.90 ) . CONCLUSIONS AND RELEVANCE This is the first r and omized trial finding an effect of a long-term dietary intervention on breast cancer incidence . Our results suggest a beneficial effect of a Mediterranean diet supplemented with extra-virgin olive oil in the primary prevention of breast cancer . These results come from a secondary analysis of a previous trial and are based on few incident cases and , therefore , need to be confirmed in longer-term and larger studies . TRIAL REGISTRATION IS RCT N.org Identifier : IS RCT N35739639 There is current interest in fish consumption and marine omega‐3 ( n‐3 ) fatty acids and breast cancer risk . Some in vitro and animal studies have suggested an inhibitory effect of marine n‐3 fatty acids on breast cancer growth , but the results from epidemiological studies that have examined the association between fish consumption and breast cancer risk in humans are inconsistent . We examined fish consumption and breast cancer risk in 310,671 women aged between 25 and 70 yr at recruitment into the European Prospect i ve Investigation Into Cancer and Nutrition ( EPIC ) . The participants completed a dietary question naire between 1992–98 and were followed up for incidence of breast cancer for a median of 6.4 yr . Hazard ratio for breast cancer by intake of total and lean and fatty fish were estimated , stratified by study centre and adjusted for established breast cancer risk factors . During follow‐up , 4,776 invasive incident breast cancers were reported . No significant associations between intake of total fish and breast cancer risk were observed , hazard ratio ( HR ) 1.01 ( 95 % confidence interval [ CI ] 0.99–1.02 ; p = 0.28 per 10 g fish/day ) . When examining lean and fatty fish separately , we found a positive significant association only in the highest quintile for fatty fish ( HR 1.13 , 95 % CI 1.01–1.26 ) , but test for trend was not significant ( p = 0.10 ) . No associations with breast cancer risk were observed when the study participants were subdivided by menopausal status . Although the period of follow‐up is relatively short , the results provide no evidence for an association between fish intake and breast cancer risk . © 2006 Wiley‐Liss , BACKGROUND Current estimates of the costs of cancer care in the United States are based on data from 2003 and earlier . However , incidence , survival , and practice patterns have been changing for the majority of cancers . METHODS Cancer prevalence was estimated and projected by phase of care ( initial year following diagnosis , continuing , and last year of life ) and tumor site for 13 cancers in men and 16 cancers in women through 2020 . Cancer prevalence was calculated from cancer incidence and survival models estimated from Surveillance , Epidemiology , and End Results ( SEER ) Program data . Annualized net costs were estimated from recent SEER-Medicare linkage data , which included cl aims through 2006 among beneficiaries aged 65 years and older with a cancer diagnosis . Control subjects without cancer were identified from a 5 % r and om sample of all Medicare beneficiaries residing in the SEER areas to adjust for expenditures not related to cancer . All cost estimates were adjusted to 2010 dollars . Different scenarios for assumptions about future trends in incidence , survival , and cost were assessed with sensitivity analysis . RESULTS Assuming constant incidence , survival , and cost , we projected 13.8 and 18.1 million cancer survivors in 2010 and 2020 , respectively , with associated costs of cancer care of 124.57 and 157.77 billion 2010 US dollars . This 27 % increase in medical costs reflects US population changes only . The largest increases were in the continuing phase of care for prostate cancer ( 42 % ) and female breast cancer ( 32 % ) . Projections of current trends in incidence ( declining ) and survival ( increasing ) had small effects on 2020 estimates . However , if costs of care increase annually by 2 % in the initial and last year of life phases of care , the total cost in 2020 is projected to be $ 173 billion , which represents a 39 % increase from 2010 . CONCLUSIONS The national cost of cancer care is substantial and expected to increase because of population changes alone . Our findings have implication s for policy makers in planning and allocation of re sources BACKGROUND The Mediterranean dietary pattern is thought to reduce the risk of cancer in addition to being cardioprotective . However , no trial has been conducted so far to prove this belief . METHODS We compared overall survival and newly diagnosed cancer rate among 605 patients with coronary heart disease r and omized in the Lyon Diet Heart Study and following either a cardioprotective Mediterranean-type diet or a control diet close to the step 1 American Heart Association prudent diet . RESULTS During a follow-up of 4 years , there were a total of 38 deaths ( 24 in controls vs 14 in the experimental group ) , including 25 cardiac deaths ( 19 vs 6 ) and 7 cancer deaths ( 4 vs 3 ) , and 24 cancers ( 17 vs 7 ) . Exclusion of early cancer diagnoses ( within the first 24 months after entry into the trial ) left a total of 14 cancers ( 12 vs 2 ) . After adjustment for age , sex , smoking , leukocyte count , cholesterol level , and aspirin use , the reduction of risk in experimental subjects compared with control subjects was 56 % ( P=.03 ) for total deaths , 61 % ( P=.05 ) for cancers , and 56 % ( P=.01 ) for the combination of deaths and cancers . The intakes of fruits , vegetables , and cereals  were significantly higher in experimental subjects , providing larger amounts of fiber and vitamin C ( P<.05 ) . The intakes of cholesterol and saturated and polyunsaturated fats were lower and those of oleic acid and omega-3 fatty acids were higher ( P<.001 ) in experimental subjects . Plasma levels of vitamins C and E ( P<.05 ) and omega-3 fatty acids ( P<.001 ) , measured 2 months after r and omization , were higher and those of omega-6 fatty acids were lower ( P<.001 ) in experimental subjects . CONCLUSIONS This r and omized trial suggests that patients following a cardioprotective Mediterranean diet have a prolonged survival and may also be protected against cancer . Further studies are warranted to confirm the data and to explore the role of the different lipids and fatty acids in this protection 
    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: Background : Use of nonvitamin , nonmineral “ specialty ” supplements has increased substantially over recent decades . Several supplements may have anti-inflammatory or anticancer properties . Additionally , supplements taken for symptoms of menopause have been associated with reduced risk of breast cancer in two case-control studies . However , there have been no prospect i ve studies of the association between the long-term use of these supplements and breast cancer risk . Methods : Participants were female members of the VITamins And Lifestyle ( VITAL ) Cohort . Postmenopausal women , ages 50 to 76 years , who were residents of western Washington State , completed a 24-page baseline question naire in 2000 to 2002 ( n = 35,016 ) . Participants were queried on their recency ( current versus past ) , frequency ( days/week ) , and duration ( years ) of specialty supplement use .  Incident invasive breast cancers ( n = 880 ) from 2000 to 2007 were obtained from the Surveillance , Epidemiology , and End Results registry .  Multivariable-adjusted hazards ratios ( HR ) and 95 % confidence intervals ( 95 % CI ) were estimated by Cox proportional hazards models . Results : Current use of fish oil was associated with reduced risk of breast cancer ( HR , 0.68 ; 95 % CI , 0.50 - 0.92 ) . Ten-year average use was suggestive of reduced risk ( P trend = 0.09 ) . These results held for ductal but not lobular cancers . The remaining specialty supplements were not associated with breast cancer risk : Specifically , use of supplements sometimes taken for menopausal symptoms ( black cohosh , dong quai , soy , or St. John 's wort ) was not associated with risk . Conclusions : Fish oil may be inversely associated with breast cancer risk . Impact : Fish oil is a potential c and i date for chemoprevention studies . Until that time , it is not recommended for individual use for breast cancer prevention . Cancer Epidemiol Biomarkers Prev ; 19(7 ) ; 1696–708 . © 2010 AACR IMPORTANCE Breast cancer is the leading cause of female cancer burden , and its incidence has increased by more than 20 % worldwide since 2008 . Some observational studies have suggested that the Mediterranean diet may reduce the risk of  breast cancer .  OBJECTIVE To evaluate the effect of 2 interventions with Mediterranean diet vs the advice to follow a low-fat diet ( control ) on breast cancer incidence . DESIGN , SETTING , AND PARTICIPANTS The PREDIMED study is a 1:1:1 r and omized , single-blind , controlled field trial conducted at primary health care centers in Spain . From 2003 to 2009 , 4282 women aged 60 to 80 years and at high cardiovascular disease risk were recruited after invitation by their primary care physicians . INTERVENTIONS Participants were r and omly allocated to a Mediterranean diet supplemented with extra-virgin olive oil , a Mediterranean diet supplemented with mixed nuts , or a control diet ( advice to reduce dietary fat ) . MAIN OUTCOMES AND MEASURES Breast cancer incidence was a prespecified secondary outcome of the trial for women without a prior history of breast cancer ( n = 4152 ) . RESULTS After a median follow-up of 4.8 years , we identified 35 confirmed incident cases of breast cancer . Observed rates ( per 1000 person-years ) were 1.1 for the Mediterranean diet with extra-virgin olive oil group , 1.8 for the Mediterranean diet with nuts group , and 2.9 for the control group . The multivariable-adjusted hazard ratios vs the control group were 0.32 ( 95 % CI , 0.13 - 0.79 ) for the Mediterranean diet with extra-virgin olive oil group and 0.59 ( 95 % CI , 0.26 - 1.35 ) for the Mediterranean diet with nuts group . In analyses with yearly cumulative up date d dietary exposures , the hazard ratio for each additional 5 % of calories from extra-virgin olive oil was 0.72 ( 95 % CI , 0.57 - 0.90 ) . CONCLUSIONS AND RELEVANCE This is the first r and omized trial finding an effect of a long-term dietary intervention on breast cancer incidence . Our results suggest a beneficial effect of a Mediterranean diet supplemented with extra-virgin olive oil in the primary prevention of breast cancer . These results come from a secondary analysis of a previous trial and are based on few incident cases and , therefore , need to be confirmed in longer-term and larger studies . TRIAL REGISTRATION IS RCT N.org Identifier : IS RCT N35739639 There is current interest in fish consumption and marine omega‐3 ( n‐3 ) fatty acids and breast cancer risk . Some in vitro and animal studies have suggested an inhibitory effect of marine n‐3 fatty acids on breast cancer growth , but the results from epidemiological studies that have examined the association between fish consumption and breast cancer risk in humans are inconsistent . We examined fish consumption and breast cancer risk in 310,671 women aged between 25 and 70 yr at recruitment into the European Prospect i ve Investigation Into Cancer and Nutrition ( EPIC ) . The participants completed a dietary question naire between 1992–98 and were followed up for incidence of breast cancer for a median of 6.4 yr . Hazard ratio for breast cancer by intake of total and lean and fatty fish were estimated , stratified by study centre and adjusted for established breast cancer risk factors . During follow‐up , 4,776 invasive incident breast cancers were reported . No significant associations between intake of total fish and breast cancer risk were observed , hazard ratio ( HR ) 1.01 ( 95 % confidence interval [ CI ] 0.99–1.02 ; p = 0.28 per 10 g fish/day ) . When examining lean and fatty fish separately , we found a positive significant association only in the highest quintile for fatty fish ( HR 1.13 , 95 % CI 1.01–1.26 ) , but test for trend was not significant ( p = 0.10 ) . No associations with breast cancer risk were observed when the study participants were subdivided by menopausal status . Although the period of follow‐up is relatively short , the results provide no evidence for an association between fish intake and breast cancer risk . © 2006 Wiley‐Liss , BACKGROUND Current estimates of the costs of cancer care in the United States are based on data from 2003 and earlier . However , incidence , survival , and practice patterns have been changing for the majority of cancers . METHODS Cancer prevalence was estimated and projected by phase of care ( initial year following diagnosis , continuing , and last year of life ) and tumor site for 13 cancers in men and 16 cancers in women through 2020 . Cancer prevalence was calculated from cancer incidence and survival models estimated from Surveillance , Epidemiology , and End Results ( SEER ) Program data . Annualized net costs were estimated from recent SEER-Medicare linkage data , which included cl aims through 2006 among beneficiaries aged 65 years and older with a cancer diagnosis . Control subjects without cancer were identified from a 5 % r and om sample of all Medicare beneficiaries residing in the SEER areas to adjust for expenditures not related to cancer . All cost estimates were adjusted to 2010 dollars . Different scenarios for assumptions about future trends in incidence , survival , and cost were assessed with sensitivity analysis . RESULTS Assuming constant incidence , survival , and cost , we projected 13.8 and 18.1 million cancer survivors in 2010 and 2020 , respectively , with associated costs of cancer care of 124.57 and 157.77 billion 2010 US dollars . This 27 % increase in medical costs reflects US population changes only . The largest increases were in the continuing phase of care for prostate cancer ( 42 % ) and female breast cancer ( 32 % ) . Projections of current trends in incidence ( declining ) and survival ( increasing ) had small effects on 2020 estimates . However , if costs of care increase annually by 2 % in the initial and last year of life phases of care , the total cost in 2020 is projected to be $ 173 billion , which represents a 39 % increase from 2010 . CONCLUSIONS The national cost of cancer care is substantial and expected to increase because of population changes alone . Our findings have implication s for policy makers in planning and allocation of re sources BACKGROUND The Mediterranean dietary pattern is thought to reduce the risk of cancer in addition to being cardioprotective . However , no trial has been conducted so far to prove this belief . METHODS We compared overall survival and newly diagnosed cancer rate among 605 patients with coronary heart disease r and omized in the Lyon Diet Heart Study and following either a cardioprotective Mediterranean-type diet or a control diet close to the step 1 American Heart Association prudent diet . RESULTS During a follow-up of 4 years , there were a total of 38 deaths ( 24 in controls vs 14 in the experimental group ) , including 25 cardiac deaths ( 19 vs 6 ) and 7 cancer deaths ( 4 vs 3 ) , and 24 cancers ( 17 vs 7 ) . Exclusion of early cancer diagnoses ( within the first 24 months after entry into the trial ) left a total of 14 cancers ( 12 vs 2 ) . After adjustment for age , sex , smoking , leukocyte count , cholesterol level , and aspirin use , the reduction of risk in experimental subjects compared with control subjects was 56 % ( P=.03 ) for total deaths , 61 % ( P=.05 ) for cancers , and 56 % ( P=.01 ) for the combination of deaths and cancers . The intakes of fruits , vegetables , and cereals  were significantly higher in experimental subjects , providing larger amounts of fiber and vitamin C ( P<.05 ) . The intakes of cholesterol and saturated and polyunsaturated fats were lower and those of oleic acid and omega-3 fatty acids were higher ( P<.001 ) in experimental subjects . Plasma levels of vitamins C and E ( P<.05 ) and omega-3 fatty acids ( P<.001 ) , measured 2 months after r and omization , were higher and those of omega-6 fatty acids were lower ( P<.001 ) in experimental subjects . CONCLUSIONS This r and omized trial suggests that patients following a cardioprotective Mediterranean diet have a prolonged survival and may also be protected against cancer . Further studies are warranted to confirm the data and to explore the role of the different lipids and fatty acids in this protection 
    Output:
    