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.

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.

N-terminal pro B-type natriuretic peptide (NT pro-BNP) is a predictor of long-term survival in male patients of 75 years and older with high-grade asymptomatic internal carotid artery stenosis.

BACKGROUND: Carotid endarterectomy (CEA) is commonly performed for asymptomatic high-grade internal carotid artery (ICA) stenosis to prevent stroke. However, despite advancing age of the society, for patients older than 75 years, there is no recommendation by the European guidelines for CEA, as this age group might not benefit from this intervention due to a limited life expectancy. OBJECTIVE: We assessed N-terminal pro B-type natriuretic peptide (NT pro-BNP) as a predictive marker for long-term survival in this particular patient population in order to stratify patients for an improved surgical outcome. METHODS: In a nonrandomized single-center clinical trial, we prospectively studied mortality rates of 205 consecutive patients (80 women, 125 men; mean age, 75 ± 10 years) with asymptomatic high-grade ICA stenosis in relation to preoperative plasma NT pro-BNP levels. We estimated cumulative survival over 5 years by Kaplan-Meier curves and established a proportional hazard-model by Cox regression. RESULTS: In male patients, higher levels of preoperative NT pro-BNP levels were associated with a significantly increased long-term mortality. Those 75 years or older had the same survival rate as younger patients, if NT pro-BNP levels were low, making them thus eligible for CEA. CONCLUSIONS: The results of our study suggest that preoperative plasma levels of NT pro-BNP are a valuable tool for the stratification of male patients. Male patients older than 75 years with low levels of NT pro-BNP should be referred for carotid revascularization, as they will most likely enjoy the benefit of surgery.

Cancer patients' perception of information exchange between hospital-based doctors and their general practitioners.

RATIONALE, AIMS AND OBJECTIVES: The quality of communication between health care professionals is a key issue determining health outcomes in cancer care. This study aims to find out what importance cancer patients in Austria attach to information exchange between hospital-based doctors and their general practitioners (GPs) and how patients perceive this flow of information. METHODS: In this cross-sectional study, cancer patients seeking help at a community-based organization in the voluntary sector (Viennese Cancer League) were polled with a 16-item questionnaire. Contingency tables were evaluated by means of the chi-squared and Mantel-Haenszel test. RESULTS: The mean age of the 252 respondents - 92.6% of those polled (272) - was 51.9 years (SD ± 13.6). 87.5% [female (f): 92.1%, male (m): 80.2%] considered the exchange of information between the hospital-based specialists and their GP 'very important' or 'important'; 12.5% (f: 8.0%, m: 19.8%) 'not so important' or 'not at all important'; 28.1% (f: 26.0%, m: 31.2%) of patients considered the flow of information as 'very good' or 'fairly good', but 50.9% (f: 58.7, m: 40.0%) as 'rather poor' or 'poor'. Some 34.8% of patients thought that their cancer disease was first suspected by a hospital-based specialist; 42.1% thought that it was first suspected by a doctor outside the hospital. Even when patients were counselled elsewhere they gave high importance to the provision of appropriate information to their GP. CONCLUSIONS: Cancer patients in Austria attach high importance to the provision of appropriate information to their GP by hospitals and perceive this exchange of information as insufficient, a finding that could well be prevalent in other European health systems.

Long-term survival after venous thromboembolism: a retrospective selected cohort study among young women.

Few data are available on long-term survival following venous thromboembolism. We performed a retrospective survival analysis covering the period January 1985 to December 2006 in 728 young women (median age 28.7 years; interquartile range 21.6-36.3 years) with a history of venous thromboembolism who visited our clinic between 1985 and 1998. Mortality information was obtained from the Austrian Central Death Register. Survival of our patients was compared to the general Austrian female population after adjustment for age and calendar period. Overall, 23 patients (3.2%) died, the cumulative relative survival was 1.03 (95% CI 0.99-1.04). Site of venous thromboembolism or triggering factors had no significant influence. Venous thromboembolism does not reduce long-term survival in young women considering our median follow up of 14 years. The risk of fatal bleeding and quality of life should be assessed versus that of fatal recurrent venous thromboembolism when deciding on long-term anticoagulation in young women.

[The battle against smallpox in Austria]. / Geschichte der Pocken-Bekämpfung in Osterreich.

In Austria activities against smallpox started with variolation, the artificial infection with the smallpox virus, which bore the risk of contracting the disease. In 1800, Lower Austria was the first country in continental Europe to implement Edward Jenner's invention of vaccination with cowpox for mass vaccination. In the beginning vaccination was practised by inoculation from one human being to another. In this paper development of smallpox vaccination from the beginning to it's cessation in 1981 is described.

[Thirtieth anniversary of world health organization's world wide smallpox eradication]. / Dreissig Jahre weltweite Ausrottung der Pocken durch die Weltgesundheits-Organisation.

This year in May, the World Health Assembly will celebrate the thirtieth anniversary of world wide Smallpox eradication. For this reason we report on this program's vertices.

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.

Breaking bad news to cancer patients: survey and analysis.

PURPOSE: To find out how patients perceived the disclosure of news about their cancer as regards the physician counselling and how they perceived the flow of information between hospital-based and family physicians. METHODS: 272 cancer patients were polled with a 16-item questionnaire. RESULTS: 252 cancer patients, 92.6% of those asked, completed the questionnaire. 37.7% (f:35.4%, m:41.8%) stated that the fact that they had cancer was presented to them 'very empathically' or 'empathically'. 62.3% (f:64.7%, m:58.3%) stated that it was presented to them 'not so empathically' or ' not at all empathically'. When patients had been counselled by family physicians they were more likely to state that it had been done 'very empathically' or 'empathically', in contrast to when they had been counselled by hospital-oncologists or self-employed specialists (81.8% vs. 41.2% vs. 41.2%; p=0.001). Significantly more patients thought that they had been given adequate opportunity to ask the questions they considered important when counselled by a family physician (81.8%) as compared to counselling by a hospital-oncologist (43.5%; p=0.002) or a self-employed specialist (44.3%; p=0.001). 56.8% preferred to discuss the suggested cancer therapies with an oncologist. 87.5% of patients considered the exchange of information between the hospital-based specialists and their family physician 'very important' or 'important'; more than half of all patients stated that this exchange of information was 'rather poor' or 'poor'. CONCLUSIONS: Oncologists should involve family physicians in disclosing bad news to patients. There are considerable deficiencies regarding information-exchange in cancer care in Austria.

Radical prostatectomies in Austria, 1997-2004.

BACKGROUND: The introduction of PSA testing in Austria led to a steep increase of the incidence of prostate cancer. We want to present the course of the number of newly diagnosed cases of prostate cancer in Austria since 1997, and set these numbers in relation to the total of radical prostatectomies (with resection of lymph nodes) in the same time period. All numbers were retrieved from health statistics of Statistics Austria. The report period of cancer cases and of RPE comprises the years 1997-2004. All calculations were performed for totals as well as for 5-year age groups (40-89 years of age). FINDINGS: The number of prostate cancer cases rose from 1997 to 2004 by 35%, while the number of RPE rose by 94% in the same time period. The proportion of RPE in relation to new cases rose from 41% in 1997 to 59% in 2004. CONCLUSION: A slight decrease of prostate cancer mortality can already be observed in Austria, but the question of over-treatment still awaits analysis.

Self-reported colonoscopy screening in Austria.

In Austria, since the early 1980s, the faecal-occult blood test is freely available within the annual health check-up system (> or =40 years of age/once a year). Since 2005 colonoscopy is recommended by the health authorities as a primary screening tool for asymptomatic persons older than 50 years (every 7-10 years). We report on the prevalence of self-reported participation and frequency of colonoscopy screening in Austrian men and women aged 40-79 years. The data analysed were extracted from a nationwide population-based cross-sectional study conducted in 2005. The study population consisted of 502 men and 553 women, which then was analysed by 10-year age groups. The questionnaire explicitly asked about a screening colonoscopy in asymptomatic persons and not for diagnostic examination in patients with symptoms. The survey revealed that of men 79.1% (n=397) knew about early detection of colorectal cancer in asymptomatic persons by screening colonoscopy and of women 82.1% (n=454). Of the 502 male respondents, 24.5% (n=123) were screened at least once and 9.8% were screened twice or more. Of the 553 female respondents, 23.7% (n=131) were screened at least once and 8.0% were screened twice or more often. The main location of colonoscopy screening was the hospital (men: 65.1%, women: 74.8%). Approximately a quarter of the respondents reported having had at least one screening colonoscopy. Compared with mammography screening (82%) and prostate cancer screening by digital rectal examination alone or combined with a prostate-specific antigen test (56%) the participation is low.

Self-reported Pap smear screening in Austria.

BACKGROUND: In Austria, screening for cervical cancer is performed opportunistically since its introduction in the late 1960s and is free of charge. We report the results of a representative cross-sectional nation-wide population study, performed in 2005. METHODS: Women aged 20-69 years were asked about knowledge, attitudes and behaviour with respect to cervical cancer. The results were compared to data of an identical study performed in 1995. RESULTS: In 2005, 95.7 % of all women aged 20-69 years knew about Pap smear screening (1995: 94.0 %), and 88.0 % were screened at least once (1995: 76.2 %). 52.6 % of all women can be classified to be screened optimally. The participation rate was lower in women living in rural areas and the proportion of never screened rises with increase of education. Significantly more PAP smears were taken by gynaecologists in 2005 as compared with 1995. CONCLUSIONS: Overall, compared to 1995, the participation rate has increased significantly. Future anti-cancer screening campaigns should contain messages especially targeted at young and well-educated women.

Survival of patients with colorectal cancer in Austria by sex, age, and stage.

This paper for the first time presents Austrian data on survival of patients, diagnosed from 1998 through 2002, with colon cancer and with rectal cancer. Cumulative relative survival rates were calculated by age, standardized for all ages and stages combined, and by age groups (< 50 years, 50-64 years, and =65 years) according to stages (localized, regional metastases and distant metastases). In carcinoma of the colon 5-year relative survival was 66 % in males and 64 % in females. In carcinoma of the rectum 5-year relative survival was 64 % in males and 67 % in females. Compared to the earlier results from the Tyrol (based on patients diagnosed from 1990 through 1994) the 5-year survival of patients with colon cancer increased from 55 % to 66 % in males and from 58 % to 64 % in females. In patients with rectal cancer 5-year survival increased from 44 % to 64 % in males and from 46 % to 67 % in females. This increase in part can be explained by a positive effect of early detection and of better treatment.

Self-reported prostate cancer screening in Austria.

OBJECTIVES: The prevalence of self-reported participation and frequency of prostate cancer screening (digital rectal examination (DRE), prostate-specific antigen (PSA)) in Austrian men aged 40-79 years in the year 2005 is reported. METHODS: In a population-based cross-sectional study, a representative sample of 500 men was asked whether they ever had heard of early detection of prostate cancer by DRE or PSA test and, if so, whether they had ever had a prostate cancer screening test during their life, and if so the number of tests and the type of physician. RESULTS: Overall, the prevalence of self-reported prostate cancer screening was 55.8% (23.7% DRE only). The highest prevalence was observed in the age group of 60-69 years with 68.8% (28.1% DRE only). The highest prevalence of PSA tests was observed in the age group 70-79 years (40.9%). About 75% of the screening tests were performed by urologists. CONCLUSIONS: More than half of the target population (men aged 40-79 years) have had at least one prostate cancer screening test. Nearly one-third of men have already had one or more PSA tests. One-fifth of the PSA tests were requested by general practitioners or internists.