Background: Mammography screening can reduce breast cancer mortality, but most women are unaware that it can cause overdetection of inconsequential disease, leading to overdiagnosis and overtreatment. Our objective was to determine whether including overdetection information in a decision aid improved informed choice about breast screening among women around age 50 years.

Two experiments investigated the relationship between masked form priming and individual differences in reading and spelling proficiency among university students. Experiment 1 assessed neighbor priming for 4-letter word targets from high- and low-density neighborhoods in 97 university students. The overall results replicated previous evidence of facilitatory neighborhood priming only for low-neighborhood words. However, analyses including measures of reading and spelling proficiency as covariates revealed that better spellers showed inhibitory priming for high-neighborhood words, while poorer spellers showed facilitatory priming. Experiment 2, with 123 participants, replicated the finding of stronger inhibitory neighbor priming in better spellers using 5-letter words and distinguished facilitatory and inhibitory components of priming by comparing neighbor primes with ambiguous and unambiguous partial-word primes (e.g., crow#, cr#wd, crown CROWD). The results indicate that spelling ability is selectively associated with inhibitory effects of lexical competition. The implications for theories of visual word recognition and the lexical quality hypothesis of reading skill are discussed.

Objective To elicit women’s responses to information about the nature and extent of overdiagnosis in mammography screening (detecting disease that would not present clinically during the woman’s lifetime) and explore how awareness of overdiagnosis might influence attitudes and intentions about screening.Design Qualitative study using focus groups that included a presentation explaining overdiagnosis, incorporating different published estimates of its rate (1–10%, 30%, 50%) and information on the mortality benefit of screening, with guided group discussionsSetting Sydney, AustraliaParticipants Fifty women aged 40–79 years with no personal history of breast cancer and with varying levels of education and participation in screening.Results Prior awareness of breast cancer overdiagnosis was minimal. Women generally reacted with surprise, but most came to understand the issue. Responses to overdiagnosis and the different estimates of its magnitude were diverse. The highest estimate (50%) made some women perceive a need for more careful personal decision making about screening. In contrast, the lower and intermediate estimates (1–10% and 30%) had limited impact on attitudes and intentions, with many women remaining committed to screening. For some women, the information raised concerns, not about whether to screen but whether to treat a screen detected cancer or consider alternative approaches (such as watchful waiting). Information preferences varied: many women considered it important to take overdiagnosis into account and make informed choices about whether to have screening, but many wanted to be encouraged to be screened.Conclusions Women from a range of socioeconomic backgrounds could comprehend the issue of overdiagnosis in mammography screening, and they generally valued information about it. Effects on screening intentions may depend heavily on the rate of overdiagnosis. Overdiagnosis will be new and counterintuitive for many people and may influence screening and treatment decisions in unintended ways, underscoring the need for careful communication.

There was limited evidence in support of healing touch, whereas information-based interventions seemed largely unable to provide meaningful benefits. Cognitive-behavioural interventions had some positive effects. Counselling appeared to be the most promising intervention strategy for addressing quality of life concerns for women with gynaecological cancers.

Communication that empowers the public, patients, clinicians, and policy makers to think differently about overdiagnosis will help support a more sustainable healthcare future for all, What are the key messages to be communicated?Understanding of overdiagnosis among the general public and health professionals is limited, so it is essential to communicate what it means for individuals, the health system, and society (box 1). By definition, overdiagnosis will not improve prognosis and will probably harm individuals (for example, by unnecessary intervention) or society (opportunity costs). For individuals, it is important to communicate the nature (physical or psychological), likelihood, and duration of the harms. For societies with free public healthcare, the financial strain and opportunity cost are usually at system level-resources wasted on unnecessary tests and treatments are unavailable for people in greater need. But in private healthcare systems, overdiagnosis can be a huge personal financial burden, even for those with insurance.Communication is further complicated because it is usually impossible to know whether an individual has been overdiagnosed or benefited from the diagnosis-overdiagnosis can only be observed at the aggregate level. Recent efforts to communicate the concept and likelihood of overdiagnosis in breast screening have had some success, albeit with much room for improvement. When given a patient decision aid including an infographic and icon array (figure⇓), 29% of women understood both the concept and quantitative outcomes of breast screening (including deaths avoided, false positive results, and overdiagnosis); 59% of women understood the conceptual information alone. Communication based strategies to mitigate overdiagnosisSeveral communication based strategies have been applied in the areas of overtesting and overtreatment and directed at individual, community, or policy levels (box 2). Strategies for individualsShared decision making is a consultation process where a clinician and patient jointly make a health decision. It changes Overdiagnosis occurs when a diagnosis is "correct" according to current professional standards but when the diagnosis or associated treatment has a low probability of benefiting the person diagnosed. 2 It is caused by a range of factors such as: • Use of increasingly sensitive tests that identify abnormalities that are indolent, non-progressive, or regressive (overdetection)• Expanded definitions of disease-for example, attention-deficit/hyperactivity disorder and dementia-and lowering of disease thresholds, such as osteoporosis (overdefinition)• Creation of pseudodiseases (also called disease mongering), such as low testosterone and restless leg syndrome• Clinicians' fear of missing a diagnosis or litigation• Public enthusiasm for screening or testing and desire for reassurance • Financial incentives Potential consequences of overdiagnosis• Psychological and behavioural effects of disease labelling• Physical harms and side effects of unnecessary tests or tr...

IntroductionWomen are largely unaware that mammography screening can cause overdetection of inconsequential disease, leading to overdiagnosis and overtreatment of breast cancer. Evidence is lacking about how information on overdetection affects women's breast screening decisions and experiences. This study investigates the consequences of providing information about overdetection of breast cancer to women approaching the age of invitation to mammography screening.Methods and analysisThis is a randomised controlled trial with an embedded longitudinal qualitative substudy. Participants are a community sample of women aged 48–50 in New South Wales, Australia, recruited in 2014. Women are randomly allocated to either quantitative only follow-up (n=904) or additional qualitative follow-up (n=66). Women in each stream are then randomised to receive either the intervention (evidence-based information booklet including overdetection, breast cancer mortality reduction and false positives) or a control information booklet (including mortality reduction and false positives only). The primary outcome is informed choice about breast screening (adequate knowledge, and consistency between attitudes and intentions) assessed via telephone interview at 2 weeks postintervention. Secondary outcomes measured at this time include decision process (decisional conflict and confidence) and psychosocial outcomes (anticipated regret, anxiety, breast cancer worry and perceived risk). Women are further followed up at 6 months, 1 and 2 years to assess self-reported screening behaviour and long-term psychosocial outcomes (decision regret, quality of life). Participants in the qualitative stream undergo additional in-depth interviews at each time point to explore the views and experiences of women who do and do not choose to have screening.Ethics and disseminationThe study has ethical approval, and results will be published in peer-reviewed journals. This research will help ensure that information about overdetection may be communicated clearly and effectively, using an evidence-based approach, to women considering breast cancer screening.Trial registration numberAustralian New Zealand Clinical Trials Registry ACTRN12613001035718.

IMPORTANCEPatient-led surveillance is a promising new model of follow-up care following excision of localized melanoma.OBJECTIVE To determine whether patient-led surveillance in patients with prior localized primary cutaneous melanoma is as safe, feasible, and acceptable as clinician-led surveillance.DESIGN, SETTING, AND PARTICIPANTS This was a pilot for a randomized clinical trial at 2 specialist-led clinics in metropolitan Sydney, Australia, and a primary care skin cancer clinic managed by general practitioners in metropolitan Newcastle, Australia. The participants were 100 patients who had been treated for localized melanoma, owned a smartphone, had a partner to assist with skin self-examination (SSE), and had been routinely attending scheduled follow-up visits.

This research investigated whether spelling ability, an index of precise lexical representations, predicts the balance between bottom-up and top-down processing in online sentence processing among skilled readers, over and above contributions of reading ability, vocabulary, and working memory. The results showed that the combination of superior reading and spelling was associated with more accurate report of rapidly presented sentences and that spelling uniquely predicted reduced reliance on context to identify words. These findings support the lexical quality hypothesis by demonstrating that individual differences in the reading strategies used by skilled readers reflect differences in the precision of their lexical representations.