Time Trends in Male Breast Cancer Incidence, Mortality, and Survival in Austria (1983-2017).

Background: Male breast cancer (MBC) comprises less than 1% of all breast cancer cases globally and remains understudied with persisting sex-specific survival disadvantages. We aim to contribute to better understanding of MBC with a comprehensive analysis of time-trends over several decades in Austria. Methods: We used Austrian National Cancer Registry data on 1648 cases of MBC cases diagnosed between 1983 and 2017 in Austria. Overall incidence, mortality, and survival rates, as well as age-, stage-, and period-specific incidence and survival rates were calculated. Joinpoint regression was performed to assess trends. Results: MBC incidence rates increased throughout the whole observation period (1983-2017) with an annual percent change (APC) of 1.44% (95% confidence interval, CI: 0.77 to 2.11). During the same period, morality rates were stable (APC: -0.25, 95% CI: -0.53 to 0.60). Ten-year survival rates showed three phases of decreasing increases with an average APC of 2.45%, 1983-2009 (95% CI: 2.1 to 2.74). Five-year survival rates improved until 2000 (APC: 2.31, 95% CI: 1.34 to 3.30) and remained stable thereafter (APC: 0.10, 95% CI: -0.61 to 0.80). Stage-specific analyses showed a single trend of stable incidence rates of distant disease MBC (APC: -0.03, 95% CI: -1.67 to 1.65). Further, we observed increases in localised, regional, and unknown stage cancer incidence and increases in incidence rates across all age groups over the whole observation period. However, the estimates on these subgroup-specific trends (according to age- and stage) show wider 95% CIs and lower bounds closer to zero or negative in comparison to our findings on overall incidence, mortality, and survival. Conclusion: Despite improvements in survival rates, MBC mortality rates remained largely stable between 1983 and 2017 in Austria, possibly resulting from a balance between increasing overall incidence and stable incidence rates of distant disease MBC.

Trends in female breast cancer incidence, mortality, and survival in Austria, with focus on age, stage, and birth cohorts (1983-2017).

Breast cancer (BC) is the most commonly diagnosed malignant disease and the leading cause of cancer death in women in Austria. We investigated overall and subgroup-specific female breast cancer rates to provide a comprehensive analysis of trends over several decades. Incidence, mortality, and survival, as well as age-, stage-, and birth cohort-specific incidence were analysed using nationwide cancer registry data on 163,694 cases of female breast cancer in Austria (1983-2017). Annual percentage changes were estimated using joinpoint regression. BC incidence underwent linear increases until 1997 and reversed with statistically non-significant declines until 2017. After initial increases in BC-specific mortality, rates were stable from 1989 through 1995 and started declining thereafter, although statistically non-significantly after 2011. Overall BC-specific survivals, as well as survivals according to the calendar period of diagnosis, increased throughout the observation period. Incidence in younger women (aged 44 and lower) showed linear increases, whereas for women aged 45 and higher mostly stable or decreasing rates were observed. Localised BC incidence increased markedly and started declining only in 2012. Distant disease-BC incidence decreased through the whole observation period and incidence of regionalised BC started declining in 2000. Birth cohort-specific incidence peaked in women born between 1935 and 1949 (ages 45-74). In conclusion, the incidence of BC in younger women is increasing, while overall female BC incidence and mortality are stable with non-significant declines. Further, increases in the incidence of early-stage BC (localised) seem disproportionately high in comparison to more modest decreases in late-stage BC incidence (regionalised and distant disease).

The first 8 weeks of the Austrian SARS-CoV-2 epidemic.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV­2) reached Austria in February 2020. This study aims to describe the first 8 weeks of the Austrian epidemic and reflect on the potential mental health consequences as known at that time. METHODS: Data on Austrian Coronavirus Disease 19 (COVID-19) epidemiological indicators and number of tests were obtained from official registers. Relative risks (RRs) of infection and death from COVID-19 were calculated for sex and age groups (< 65 years and ≥ 65 years). Public health measures introduced to reduce the spread of COVID-19 were identified via online media research. A rapid review of initial evidence on mental health consequences of the pandemic was performed in PubMed and medRxiv. RESULTS: By 21 April 2020 the case count in Austria was 14,810 after a peak of new daily infections mid-March. The RR of death for age ≥ 65 years was 80.07 (95% confidence interval, CI 52.64-121.80; p < 0.0001) compared to those aged < 65 years. In men the RR of death was 1.44 (95% CI 1.20-1.73; p < 0.0001) compared to women. Wide-ranging public health measures included avoidance of case importation, limitation of social contacts, hygiene measures, testing, case tracking, and the call for COVID-19-related research. International rates of psychiatric symptoms during the initial lockdowns exceeded typical levels: anxiety (6%-51%), depression (17%-48%) and posttraumatic stress (5%-54%). CONCLUSION: Data show great vulnerability of older people also in Austria. Severe mental health impacts can be expected with need for proper assessment of the long-term consequences of this pandemic.

Impact of gender on tumor stage and survival of upper urinary tract urothelial cancer : A population-based study.

BACKGROUND: The aim of this study was to analyze the impact of gender on tumor stage, overall and cancer-specific mortality of upper urinary tract urothelial cancer (UTUC) in a population-based, nationwide analysis. METHODS: All Austrian patients with UTUC diagnosed between 1983 and 2010 were included in this study. Overall mortality was estimated by the Kaplan-Meier method. Cancer-specific (UTUC) mortality was estimated by cumulative incidence with mortality due to other causes as a competing risk. The effect of age was adjusted in a descriptive as well as a statistical inferential way. RESULTS: This study included 2066 patients (men n = 1169, mean age 68.3 ±11.5 years, women n = 897, 72.6 ±10.4 years). Tumor stage distribution was as follows: pT1: men n = 411, women n = 268, pT2: men n = 263, women n = 187, pT3: men n = 382, women n = 328 and pT4: men n = 113, women n = 114. The male:female ratio continuously declined from 1.5 for pT1 tumors to 1.4 for pT2 tumors, 1.2 for pT3 tumors and 1.0 for pT4-tumors. In the entire cohort the 5­year cumulative overall mortality was 57 % for women versus 50 % for men (p = 0.0002). For pT1 (women 33 %, men 31 %) and pT2 stage tumors (women 45 %, men 45 %) the 5­year overall mortality was comparable between both sexes. In pT3 (women 68 %, men 62 %) and pT4 (women 95 %, men 87 %) tumors women had a higher overall mortality rate. The 5­year cancer-specific mortality (CSM) of the entire cohort was 12 % for women and 10 % for men (p = 0.067): pT1 women 5 % men 3 %, pT2 women 9 % men 10 %, pT3 women 14 % men 11 % and pT4 women 29 % men 27 %. CONCLUSIONS: In this population-based nationwide analysis, sex differences were notable for UTUC. Women tended to have more advanced tumor stages at diagnosis and a higher overall and cancer-specific mortality in advanced tumor stages.

Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project.

BACKGROUND: Stillbirth and neonatal mortality rates declined in Europe between 2004 and 2010. We hypothesised that declines might be greater for countries with higher mortality in 2004 and disproportionally affect very preterm infants at highest risk. METHODS: Data about live births, stillbirths and neonatal deaths by gestational age (GA) were collected using a common protocol by the Euro-Peristat project in 2004 and 2010. We analysed stillbirths at ≥28 weeks GA in 22 countries and live births ≥24 weeks GA for neonatal mortality in 18 countries. Per cent changes over time were assessed by calculating risk ratios (RR) for stillbirth, neonatal mortality and preterm birth rates in 2010 vs 2004. We used meta-analysis techniques to derive pooled RR using random-effects models overall, by GA subgroups and by mortality level in 2004. RESULTS: Between 2004 and 2010, stillbirths declined by 17% (95% CI 10% to 23%), with a range from 1% to 39% by country. Neonatal mortality declined by 29% (95% CI 23% to 35%) with a range from 9% to 67%. Preterm birth rates did not change: 0% (95% CI -3% to 3%). Mortality declines were of a similar magnitude at all GA; mortality levels in 2004 were not associated with RRs. CONCLUSIONS: Stillbirths and neonatal deaths declined at all gestational ages in countries with both high and low levels of mortality in 2004. These results raise questions about how low-mortality countries achieve continued declines and highlight the importance of improving care across the GA spectrum.

Sex Differences of ≥ pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients.

INTRODUCTION: In recent days, the relationship between gender, tumour stage and survival of bladder cancer has attracted interest. MATERIALS AND METHODS: The Austrian cancer registry was linked to the national death statistics. All patients with urothelial cancer of the urinary bladder with stages pT1, pT2, pT3 and pT4 diagnosed between 1983 until 2012 were followed for up to 15 years. Overall and cancer-specific mortality were estimated by cumulative incidence. RESULTS: A total of 27,773 patients were analysed. The male:female ratio declined from 3:1 for stage pT1-tumours (n = 16,416) to 2.6:1 for pT2 (n = 6,548), 2.1:1 for pT3 (n = 3,111) and 1.9:1 for pT4 (n = 1,698). The 5 years cumulative overall death rate for pT1 tumours was slightly lower for women (0.31 vs. 0.32; p = 0.016). The opposite was observed for more advanced tumour stages: pT2: women 0.66, men: 0.60 (p = 0.0001); pT3: women 0.76, men 0.72 (p = 0.0004) and for pT4: women 0.90, men 0.85 (p = 0.0001). Cancer-specific survival was identical for pT1-tumours in both sexes, while women had a worse cancer-specific survival in both age cohorts (<70 years and ≥70 years) with higher tumour stages. CONCLUSIONS: This population-based study demonstrates that (1) a rise of advanced bladder cancer stages in women and (2) that women with tumour stages >pT1 have a shorter cancer-specific and overall survival.

Smoking and lung cancer: current trends in Austria.

BACKGROUND: Despite a recent decline in smoking behavior in many European countries, lung cancer rates remain high, especially in Central and Eastern Europe. This paper aims to describe trends in smoking behavior and lung cancer incidence and mortality, including histopathological classification of lung cancer, in a Central European country: Austria. METHODS: Using data from the Austrian Central Cancer Registry, we calculated age-standardized incidence, histopathology-specific incidence, and age-standardized and birth cohort-specific mortality rates for all lung cancer cases in Austria. Using national survey data, we estimated prevalence of smoking in the Austrian population. Our analysis covers the time period from 1970 to 2009. RESULTS: In 2009, lung cancer incidence rates were 41.3/100,000 and 18.5/100,000 and mortality rates were 36.3/100,000 and 14.5/100,000, for males and females, respectively. Male lung cancer rates declined but increased steadily in females over the past three decades. In 2009, the most common histological type is adenocarcinoma, which reflects a shift from predominantly squamous cell carcinoma and large cell carcinoma in the mid 1980s. In 2009, 27 % of men and 19 % of women were smokers, which represent a rise of smoking rates in women, especially in younger women, and a decline in the men. CONCLUSIONS: While in Austrian men the lung cancer rates, in accordance with their decreasing prevalence of smoking, declined over the past 30 years, the increasing smoking prevalence and lung cancer rates in women remain a public health concern. Antismoking laws and public health initiatives to curtail smoking habits are needed in Austria, especially targeting younger women.

[Prediction of the final degree in the 2002 reformed curriculum at the Medical University of Vienna]. / Prädiktoren des Studienabschlusses im 2002 reformierten Curriculum der Medizinischen Universität Wien.

In 2002 a reform curriculum was implemented at Medical University of Vienna. At the end of each study-year students have to pass a summative integrative examination consisting of single choice questions. We examined the study success of 674 students (50.8% of the cohort) who were surveyed at the beginning of their studies. The questionnaire used consisted of 67 items concerning the main success factors taken from the literature. Success was most predicted by schoolmarks, study-motivation ("keen to acquire knowledge"), the importance of study success, self-confidence to reach this goal, not too specific ideas about future employment, high learning capacity, and low test anxiety. Some aspects having predictive power for the first-year exam (sex, German mother tongue) showed no more impact on study success. Other aspects described to be predictive in retrospective studies could not be verified in this prospective study.

Prevalence of lower urinary tract symptoms in Austrian males: update 2009.

INTRODUCTION: The prevalence of lower urinary tract symptoms (LUTS) in a representative sample of Austrian males aged 15-89 years was assessed in 2009. The results were compared with the findings of a similar study conducted in 1995. MATERIALS AND METHODS: A population-based cross-sectional survey on LUTS was conducted in 2009 in Austria. A quota sample of 1,926 Austrians was selected. The sample comprised 0.03% of the population and was representative in terms of age, sex, occupational status and area of residence. RESULTS: Some degree of LUTS is reported by 64.6% of the male population in Austria aged 15-89 years. IPSS correlates significantly with age. In all age groups storage symptoms are more prevalent than voiding symptoms. The prevalence of voiding symptoms (IPSS >0) among Austrian males is 35.5% and the prevalence of storage symptoms is 61.6%. In both groups the prevalence increases with age. Compared to 1995, the prevalence of dissatisfaction declined significantly. An extrapolated number of more than 35,000 men are 'terribly' dissatisfied with their current urinary condition. CONCLUSIONS: The prevalence of LUTS in Austria meliorated in Austria significantly between 1995 and 2009. This in part may be attributed to intensified contact of males with urologists in the past.

[Commentary on the planned restructuring of mammography screening in Austria]. / Zur geplanten Neustrukturierung des Mammografie-Screenings in Österreich.

With regards to the planned reorganisation of screening mammography in Austria - from an opportunistic to an organised system - the problems related with such a change are depicted from an epidemiological point of view. We were able to demonstrate earlier that opportunistic screening mammography matches the results of controlled screening mammography in Finland and Sweden. Switching to a controlled system in Austria would - besides the need for a change in legislation - lead to enormous expenditures in terms of resources needed and moreover, it could be not evaluated for years.

Potent protection of gallic acid against DNA oxidation: results of human and animal experiments.

Gallic acid (3,4,5-trihydroxybenzoic acid, GA) is a constituent of plant derived foods, beverages and herbal remedies. We investigated its DNA protective properties in a placebo controlled human intervention trial in single cell gel electrophoresis experiments. Supplementation of drinking water with GA (12.8 mg/person/d) for three days led to a significant reduction of DNA migration attributable to oxidised pyrimidines (endonuclease III sensitive sites) and oxidised purines (formamidopyrimidine glycosylase sensitive sites) in lymphocytes of healthy individuals by 75% and 64% respectively. Also DNA damage caused by treatment of the cells with reactive oxygen species (ROS) was reduced after GA consumption (by 41%). These effects were paralleled by an increase of the activities of antioxidant enzymes (superoxide dismutase, glutathione peroxidase and glutathion-S-transferase-π) and a decrease of intracellular ROS concentrations in lymphocytes, while no alterations of the total antioxidant capacity (TAC), of malondialdehyde levels in serum and of the urinary excretion of isoprostanes were found. Experiments with rats showed that GA reduces oxidatively damaged DNA in lymphocytes, liver, colon and lungs and protects these organs against γ-irradiation-induced strand breaks and formation of oxidatively damaged DNA-bases. Furthermore, the number of radiation-induced preneoplastic hepatic foci was decreased by 43% after oral administration of the phenolic. Since we did not find alterations of the TAC in plasma and lipid peroxidation of cell membranes but intracellular effects it is likely that the antioxidant properties of GA seen in vivo are not due to direct scavenging of radicals but rather to indirect mechanisms (e.g. protection against ROS via activation of transcription factors). As the amount of GA used in the intervention trial is similar to the daily intake in Middle Europe (18 mg/person/day), our findings indicate that it may contribute to prevention of formation of oxidatively damaged DNA in humans.

Trends in mortality from stroke in Austria, 1980-2008.

BACKGROUND: Worldwide, stroke is the third most common cause of death in developed countries with declining death rates. In 1997 Austria established a national system of acute-care stroke units; their impact on stroke mortality has not yet been determined. METHODS: We assessed stroke mortality using Austrian national statistical data from Statistics Austria for the period 1980-2008. Deaths were coded using ICD-9 (430-438) or ICD-10 (I60-I69). We stratified age-standardized results by sex and stroke subtype (hemorrhagic or ischemic stroke). We also used join-point regression models (joined linear segments from Poisson regression models) to identify changes in the slope of age-specific mortality trends in selected age groups (50-59 years, 60-69 years, 70-79 years, and 80+ years) for both stroke subtypes in both sexes. RESULTS: After adjustment for age, we found a decline in all strokes combined (-77.3% for males, -76.7% for females), and in hemorrhagic strokes and ischemic strokes considered separately, and for both sexes and all age groups. Mortality from ischemic stroke showed a steady rate of decline over the entire time period, while join-point analysis showed that, in general, for all age groups, both males and females showed differing patterns of changes in mortality from hemorrhagic strokes before 1997-2000 and a steeper decline after that period. CONCLUSIONS: Mortality from stroke declined in Austria between 1980 and 2008. Whether the establishment of acute stroke units had an impact on stroke mortality in this period remains unclear. Future studies should evaluate stroke-related changes in quality of life, as acute stroke units may have a greater impact on quality of life than on overall mortality.

The prevalence of atopic dermatitis in children is influenced by their parents' education: results of two cross-sectional studies conducted in Upper Austria.

Atopic dermatitis (AD) is an important health problem worldwide. Several studies have shown that a positive family history is a strong risk factor. We studied the prevalence of AD among 23,583 Austrian school children and examined the association between the prevalence of AD in children and their parents' education at two points in time. As part of the International Study of Asthma and Allergy in Childhood programme, two cross-sectional studies were conducted in Upper Austria (Federal State of Austria) between the years 1995-97 (Phase I) and 2001-03 (Phase III). All pupils of pre-school classes and of first and second grade of all elementary schools in seven districts of Upper Austria received standardized questionnaires, resulting in a total of 13,399 (Phase I) and 13,731 (Phase III) children. All variables examined concerning AD showed an increase in prevalence in the age group examined: During the first study, 9.6% of the children ever had eczema diagnosed by a doctor (Phase III: 13.3%), whereas 9.2% ever had symptoms of AD (Phase III: 11.0%). In Phase I, 6.0% of the children had an itchy rash in the past 12 months (Phase III: 6.7%). In both studies, high parental education (i.e. high school or university degree) was an independent statistically significant risk factor for eczema in the child, resulting in an adjusted Odds Ratio between 1.13 and 1.37. In a census-like-survey, we are able to demonstrate a statistically significant association between parental education and the prevalence of AD in their children, which is independent of a possible parental AD.

A study of trends in beliefs and attitudes toward cancer.

Understanding trends in population perceptions of cancer is essential in identifying groups that may benefit from more targeted strategies in cancer prevention and detection. We report the prevalence of knowledge and attitudes with respect to various aspects of cancer in two independent national probability samples of 4,073 Austrian adults aged 15 years or above, and we describe the association of these variables with age, gender, marital status, and education. In-home interviews were conducted in September 1995 and in August 2005. Perceptions of cancer causes, positive personal experiences with cancer cures, and knowledge of cancer cures and causes generally improved across all groups. Those with less education were less likely to believe that cancer could be cured in 1995, a difference that resolved in 2005. Less encouragingly, education-based disparities persisted for factors such as knowledge of the importance of early detection in cancer cure and experiences with cancer cures. Differences in other subgroups, although existent, were only modest. Prevention education strategies should consider targeted approaches that aim to reduce disparities in cancer perception among those with less formal education.

Attitudes about the use of complementary and alternative medicine in cancer treatment.

OBJECTIVES: The aim of this study was to achieve an understanding what determines the attitude of people toward complementary and alternative medicine (CAM) is essential in decisions about costly therapies in cancer treatment. DESIGN: This study involved population-based surveys conducted in 1995 and 2005. SETTING: In 1995 and 2005, a quota sample of 2400 Austrians ages > or =15 was selected and invited in writing to participate in a survey to study beliefs and attitudes about cancer, its risk factors, and treatment. The sample comprised 0.04% of the population > or =15 years of age and was representative in terms of age, sex, occupational status, and area of residence. SUBJECTS: The subjects included 4073 Austrian adults (2073 participants enrolled in the 1995 survey and 2000 participants of the 2005 survey). INTERVENTION: Respondents were visited in their homes by trained interviewers. The interview was face-to-face, using a standardized questionnaire. OUTCOME MEASURES: We used a dichotomized variable as the outcome, placing high value on CAM (rated as 1 or 2 on a 5-level Likert scale) versus everything else (rated 3-5). RESULTS: Positive personal experiences with people cured of cancer improved the likelihood of a positive perception of CAM (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.17-1.59 for those who reported knowing someone who was cured of cancer, compared to those who did not). In multivariate models adjusting for personal attitude toward mainstream medicine, subjects with more formal education were also more likely to believe that CAM is valuable (OR, 1.28; 95% CI, 1.02-1.61), as were women (OR, 1.40; 95% CI, 1.20-1.64) and people ages 70 and above (OR, 1.46; 95% CI, 1.02-2.08). A higher appreciation of mainstream medicine was inversely associated with the value placed on CAM in cancer therapy (OR, 0.43; 95% CI, 0.22-0.85). CONCLUSIONS: In this, to our knowledge, the first study to evaluate predictors of CAM preference in cancer treatment in a national probability sample, we found more formal education, female gender, and older age to be the strongest predictors of a person favoring CAM therapy in cancer treatment. Our data also suggest that people who are satisfied with conventional care were less inclined to value CAM, whereas a positive personal experience with cancer cures improved positive perception of CAM.

Self-reported screening for skin cancer in Austria.

Prevention is the target of the campaigns informing the public about skin cancer. For the first time for Austria we report on the prevalence of self-reported knowledge and participation in screening for skin cancer. In two population-based representative cross-sectional studies, conducted in 1995 and 2005 attitudes towards cancer in the Austrian population were evaluated. In total, 966 men and 1081 women in 1995, and 951 men and 1021 women in 2005, aged 15-79 years were surveyed. Knowledge about early detection of skin cancer by screening decreased in men from 59.4% in 1995 to 53.9% in 2005 but increased from 57.5% to 64.1% in women. Screening itself increased in men from 8.1% to 13.3% and in women from 11.2% to 22.4%. More than 70% of the screens were performed by dermatologists. The effectiveness of screening for skin cancer in Austria seems to be proven by a reduction of tumour thickness at time of treatment and by the trends in mortality, where a levelling-off in males and even a slight reduction in females can be observed.

PSA testing in Austria: induced morbidity and saved mortality.

Opportunistic screening of healthy men by prostate-specific antigen (PSA) testing led to a steep increase of prostate cancer incidence in Austria. The objective of this study was to quantify how many additional men are diagnosed with prostate cancer by PSA testing, to save one man from prostate cancer death. Regression models for incidence and mortality for the time periods 1983-1991 and 1992-2003 by age groups 50-59 and 60-69 years were estimated. For 1992-2003, expected numbers of incidence and mortality were calculated. The first estimates for the years 1992-2003 were calculated using the regression model including the years 1983-1991. The second estimates were also calculated using the regression model, but including only the years 1992-2003. The difference between estimates was then summed up for 1992-2003. The corresponding sums of incidence and mortality were compared to provide estimates for the effect of the introduction of PSA screening on incidence/mortality ratio. According to our calculation for the time period 1992-2003, in age group 50-69 years, a total of 512 expected prostate cancer deaths were prevented because of opportunistic PSA screening, whereas PSA testing identified a total of 9648 additional men with asymptomatic prostate cancer. In conclusion, to save one man in the age group 50-69 years in the time period 1992-2003 from prostate cancer death by PSA testing, a total of 18.8 men with asymptomatic prostate cancer had to be identified. Although this study probably underestimates the benefit (reduced mortality) and overestimates excess incidence of prostate cancer, it is far from sure that in all of these additionally identified men prostate cancer would ever have surfaced as a clinical disease, if not screened for.

An accumulation of two independent selection factors decreases the success rate of female students at the MUV (Medical University of Vienna).

Inspired by the implementation of a reformed medical curriculum at the Medical University of Vienna (Austria, MUV), we have investigated predictors for success in the decisive exam at the end of the first study-year (SIE). In four consecutive cohorts of freshmen, we have found that female students show significantly lower success rates (Odds Ratio, OR=1.67, 95%CI 1.44-1.97). By the introduction of a pre-selection of applicants ("aptitude test for medical studies", EMS) in 2006, a new and additional significant hindrance for female students emerged. Their OR for not being accepted into the second study-year increased to OR=2.14 (95%CI 1.68-2.72), compared to male students.