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.

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.

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.

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.

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.

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.

Breast cancer trends: opportunistic screening in Austria versus controlled screening in Finland and Sweden.

The objective of the study was to compare the trends of incidence and of mortality of breast cancer in Austria, Finland and Sweden, where different mammography screening strategies (opportunistic versus controlled) are applied. Furthermore, to find out whether a change in screening strategies would be feasible for Austria. Age-standardized incidence rates (1983-2000) and mortality rates (1980-2001/2) were analysed. Furthermore, the annual per cent change and the annual rate change (annual rate change=+/-n/100,000 per year) and the 95% confidence interval were calculated. In all three countries, incidence rates increased significantly (Austria +26.4%, Finland +86.7%, Sweden +38.8%) during the period analysed (P<0.01). The annual per cent change and the annual rate change in Austria (1.57 and 1.56, respectively) are below the annual per cent change and the annual rate change in Finland (3.38 and 3.49, respectively) and in Sweden (1.80 and 2.19, respectively) for the period analysed. Total breast cancer mortality decreased significantly in Sweden since 1980 (-20.5%, P<0.01), in Finland since 1988 (-18.3%, P<0.05) and in Austria since 1990 (-19.8%, P<0.01). The annual per cent change and the annual rate change in Austria (-1.81 and -0.59, respectively) are below the annual per cent change and the annual rate change in Finland (-0.57 and -0.16, respectively) and in Sweden (-1.02 and -0.28, respectively) for the period analysed. In conclusion, despite its unsophisticated opportunistic screening, Austria does well in comparison with countries operating organized breast cancer screenings.

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.

Prostate cancer and prostate-specific antigen (PSA) screening in Austria.

The possible effect of prostate-specific antigen (PSA) testing on prostate cancer mortality has remained controversial, despite the test's widespread application. We examined age-specific mortality trends for prostate cancer in Austria before and after the introduction of (opportunistic) PSA testing, to ask whether PSA screening reduces prostate cancer mortality in a uniform cohort of men with equal access to health care. Prostate cancer mortality data covering all 9 federal states of Austria were analysed from 1970 to 2002. PSA testing became widely available in Austria not before 1989. Tyrol, one of the nine federal states of Austria, independently launched a mass prostate cancer prevention project in 1993. We applied join-point regression models to identify changes in the slope of age-specific mortality trends in selected age groups (50-59, 60-69, 70-79, and 80-89 years) and calculated the annual percent change (APC) in mortality between 1970 and 2002 for Tyrol and the rest of Austria separately. After 12 years of follow-up, we were not able to observe a significant reduction in prostate cancer mortality since the introduction of the PSA test in the age groups of 50-59, 60-69, and 80-89 years. A significant decrease was found in the age group of 70-79 (Austria without Tyrol 1989 through 2002: APC, -2.36; 95% CI, -3.38 to -1.34; Tyrol 1991 through 2002: APC, -6.42; 95% CI, -8.92 to -3.86). In this age group the join points 1989 and 1991 cannot be related to PSA testing. PSA screening does not appear to reduce prostate cancer mortality in a uniform cohort of men with equal access to health care. However, given the long lead-time for prostate cancer, even longer follow-up may still be needed to detect any important trends.

Trends in infant mortality in Austria between 1984 and 2002.

Infant mortality rate is an important medical indicator and is often used for comparing countries with respect to welfare and public health. Among other factors, effective medical technology, better access to pre- and postnatal care for all socioeconomic groups and better nutrition have decreased infant mortality in Austria from about 200 deaths per 1000 live births at the beginning of the 20th century to about 5 deaths per 1000 live births at the end. In this study we present the trends in infant mortality, based on 1,654,519 individual birth records, in Austria since 1984. The infant mortality rate dropped rapidly from about 12 per 1000 live births in 1985 to 4.6 per 1000 live births during the last two years of our study (2001/02). Infant mortality rates stratified by cause of death show somewhat differing trends. In particular, the number of deaths due to peripartal problems decreased as the result of improvements in obstetrics and neonatology, but in 1995 a change in the definition of live birth led to a rise of about 20% in the stillbirth rate. At present, Austria has one of the lowest infant mortality rates of all European countries; however, between 1999 and 2002 the mortality rate has been fairly static. A further reduction in mortality clearly cannot be achieved by advances in medicine alone. It remains a challenge for health politicians, physicians and society at large to reduce the prevalence of well-known risk factors such as alcohol abuse, heavy overweight and smoking during pregnancy.

Epidemiological aspects of hadron therapy: a prospective nationwide study of the Austrian project MedAustron and the Austrian Society of Radiooncology (OEGRO).

BACKGROUND: The planned MedAustron hadron therapy facility is designed to compare proton and carbon ion beam therapy under the same technical conditions. For the calculation of the number of potential patients for hadron therapy so far, only epidemiological estimations on cancer incidence are available without inclusion of the percentage of patients routinely referred to conventional radiotherapy. MATERIALS AND METHODS: Nationwide prospective survey to collect disease and treatment related data on patients receiving conventional radiotherapy at all 12 treatment facilities. Epidemiological cancer incidence (Statistic Austria 1999) were correlated with the number of patients receiving conventional radiotherapy. Based on published clinical and experimental results on proton and carbon ion therapy, a calculation of patient's subgroups suitable for hadron therapy was performed at five European University hospitals involved in the HICAT, CNAO, ETOILE and MEDAustron project. Using the mean values of the University specific percentages per tumour site, the number of potential patients was estimated. RESULTS: In Austria, a total of 3783 patients started radiotherapy during the study period of 3 months resulting in an approximated number of 15132 patients per year. The number of potential patients was estimated to 2044 per year, representing 5.6% of all newly diagnosed cancer patients and 13.5% of all irradiated cancer patients. CONCLUSION: There is a clear place for a hadron therapy facility in Austria, based on pattern of care in radiotherapy, cancer incidence and indications.

The med AUSTRON/OGRO patterns of care study on radiotherapy indications in Austria.

PURPOSE: In Austria a national survey was conducted by Med AUSTRON/Osterreichische Gesellschaft for Radio--Onkologie, Radiobiologie und Medizinische Radiophysik (OGRO) in order to estimate the indications, patient numbers and radiotherapy treatment planning procedures and performances at all Austrian radiotherapy institutes. Results were correlated with incidence rates (Austrian cancer registry) to determine patterns of radiotherapy practice in Austria. MATERIAL AND METHODS: At 12 radiotherapy departments of Austria data of all patients receiving irradiation within a 3 months (2002/2003) period were assessed. On the basis of a questionnaire number of treated patients, indications, and parameters of disease (stage, histology) and treatment modalities were evaluated. Results were analysed with regard to different tumour groups, according to academic and non academic hospitals, and correlated with epidemiological data on cancer incidence. RESULTS: In total, 3783 patients were registered within this period. According to the different tumour entities percentages of patients receiving radiotherapy within initial treatment varied from 3% to 90 % (e.g. brain tumours: 77%, breast cancer: 90%, prostate cancer: 35%). The most frequent indications to radiotherapy per radiotherapy department were breast cancer (range 22%-35%; mean 26%), urological tumours (range 6%-27%; mean 12%) and bone metastases (mean 10%, range 3%-17%). CONCLUSION: In Austria breast cancer, urological tumours and bone metastases are representing the most common indications to radiotherapy. Among the different departments variations in indications to radiotherapy were observed. Our study is the first evaluation of radiotherapeutic management in Austria.

Maternal health outcomes in Europe.

OBJECTIVES: To use PERISTAT data on indicators of maternal mortality and morbidity to explore maternal health outcomes in Europe, and to discuss the implications of variations in the data sources for these indicators. STUDY DESIGN: The PERISTAT feasibility study provides the source for this descriptive study, covering 15 European countries. Maternal mortality ratios are calculated, and data to describe maternal mortality by age, cause of death and mode of delivery are pooled for the countries that provided data. RESULTS: Data presented show an increased risk of maternal death among older mothers and for caesarean sections compared with other modes of delivery, and the three most prevalent causes of maternal deaths reported were embolism, hypertensive diseases of pregnancy, and haemorrhage. CONCLUSIONS: Variations in maternal mortality ratios reflect different data sources with varying levels of ascertainment in addition to differences in the number of maternal deaths. Further development is needed to construct comparable indicators of maternal morbidity.

Cancer mortality in Austria: 1970-2002.

PURPOSE: The aim of this study is to assess the overall progress against cancer in Austria by analyzing changes in age-adjusted mortality rates from 1970 to 2002. METHODS: For the years 1970 through 2002, age-adjusted rates for all malignant neoplasms together and for selected cancers individually were calculated for men and women according to year and age. The data were obtained from Statistik Austria. RESULTS: Age-adjusted mortality rates of all cancers decreased in men by 22% and in women by 27%. The annual decrease of cancer mortality was 0.8% per year in the time period analyzed and 1.7% per year from 1993 to 2002 in both sexes. Among older persons (> or = 55 years) the mortality decreased by 21% in men and by 25% in women; among younger persons (< or = 54 years) by 25% and 40%, respectively. In individual cancer sites, the highest mortality rates are observed before the year 1995 in both sexes, except for liver and brain cancer in men (with the most recent peaks in the year 2001) and lung and brain cancer in women (with the most recent peaks in the year 2002). CONCLUSIONS: The observed changes in cancer mortality are primarily related to changes in incidence and, in the last decade, to improved treatment and early detection, but neither of these contributions can be quantified. The strengthening of prevention research (primary and secondary prevention) and further implementation of preventive knowledge is urgently needed.

Survival of women with breast cancer in Austria by age, stage and period of diagnosis.

PURPOSE: To investigate survival of breast cancer patients by 1) age, 2) tumor stage and 3) period of diagnosis, also to determine the contribution of improvements in treatment and opportunistic mammography screening in Austria. METHODS: Survival was calculated overall and by 1) age groups (in years) < 50, 50-64, > 65; 2) stage I, II, IV, unknown 3) for 17,025 patients diagnosed 1988-92, compared with 19,284 patients diagnosed 1993-97. Odds ratios for being diagnosed as stage I in the period 1993-97 compared to 1988-92 were calculated by age group and for all ages. RESULTS: In the later period (1993-97) age-adjusted mortality rate decreased overall by 3.3% (age: < 50; 8.2%, 50-64; 5.1%, > 65; 1.6%). Overall, stage I cases increased from 46.5% to 51%. Five year relative survival rates improved significantly overall, 6.7% (p < 0.001), and within age groups (age: < 50; 4.5% (p < 0.05), 50-64; 7.2% (p < 0.05) and > 65; 7.3% (p < 0.001). This improvement is confined to patients with stage I tumors in age groups 50-64 (4.1%, p < 0.05) and > 65 (7.2%, p < 0.001) and to patients with stage II in age groups < 50 (7.7%, p < 0.01) and 50-64 (8.3%, p < 0.01). For patients younger than 50, in stage IV, diagnosed 1993-97, survival was significantly poorer (-16.9%, p < 0.05) compared to 1988-92. The odds ratio of being diagnosed as stage I in the later period was 1.19 (95% CI: 1.14, 1.24) for all ages, 1.13 (95% CI: 1.03, 1.24) and for women < 50, 1.3 (95% CI: 1.20, 1.40) 50-64 and 1.15 (95% CI: 1.09, 1.22) > 65 years old. CONCLUSION: We conclude that treatment improvements, which are accessible to all patients countrywide due to the compulsory state insurance system, had a major impact on positive trends in mortality and survival. Opportunistic screening should have contributed to some extent beginning in the early nineties.

Complementary therapies in cancer patients: prevalence and patients' motives.

BACKGROUND: Data relating to the use of complementary/alternative medicine (CAM) in cancer patients have been published for a number of European countries. No recent data are available for Austria. AIM: To ascertain the extent of CAM use by cancer patients, what patients' motives are, what methods are used and who the CAM providers are. DESIGN: Self-administered questionnaire; cross-sectional study. PATIENTS AND METHODS: A sample of 231 cancer patients who had consulted the Viennese Cancer League. Chi-square and Mantel-Haenszel tests were used for the statistical evaluation. RESULTS: 27.3% of the cancer patients had received CAM therapy: 33.1% of the female and 20.5% of the male participants (p = 0.045). Those who were below the median of the age categories (53.8 years) had used CAM to a statistically higher degree (35.5% vs. 21.1%; p = 0.023). The most important motives were the enhancement of "nature" and the GPs' recommendation. CAM was administered in 44.4% of cases by the family doctor, in 39.7% by patients themselves, in 6.3% by a hospital doctor, in 6.3% by a lay-practitioner or "non-medical practitioner against payment" and in 4.8% of cases by a practising oncologist. CONCLUSION: From the high percentage of patients who use CAM without consulting a physician or who follow the advice of others, it would seem highly probable that conventional and complementary methods are rarely effectively coordinated. To rectify this we conclude that oncologists and GPs should have a basic knowledge of CAM and address the issue when counselling their cancer patients.

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.