Christian Vutuc

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. Im Mai dieses Jahres wird in Genf im Rahmen der Generalversammlung der WHO in einem Festakt der 30jährigen Wiederkehr der Deklaration der weltweiten Ausrottung der Pocken gedacht werden. Aus diesem Anlass wird in der vorliegenden Arbeit über dieses Programm berichtet, wobei wegen des großen Umfanges der Thematik nur einige wesentliche Punkte herausgegriffen werden.

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. Am Beginn der Blattern(Pocken)-Bekämpfung in Österreich stand die Inokulation von Kinderpocken (Variolation) auf die zu Schützenden, die mit dem Risiko der Erkrankung verbunden war. Die gegen 1798 von Edward Jenner propagierte Übertragung von Kuhpocken (Vakzination) zur Vermeidung dieser Komplikation wurde in Niederösterreich als dem ersten Land Kontinentaleuropas bereits 1799 erprobt und 1800 in der ersten Massenimpfung angewandt. Die bei der weiteren Übertragung der Impflymphe von der Impfpustel direkt auf den Arm des folgenden Impflings fallweise mitübertragene Syphilis veranlasste den Ersatz der durch Arm-zu-Arm-Impfung gewonnen "animalen Lymphe". Die Entwicklung all dieser Vorgänge in Österreich bis zur Auflassung der Pockenimpfung im Jahr 1981 wird beschrieben.

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).

Es wird erstmals von österreichischen Überlebensdaten von Patienten mit kolorektalem Karzinom, diagnostiziert im Zeitraum 1998 bis 2002, berichtet. Die Überlebenswahrscheinlichkeit wird nach dem Geschlecht, sowie für Altersgruppen und Stadien getrennt dargestellt. Beim Kolonkarzinom beträgt die 5-Jahres-Überlebenswahrscheinlichkeit für Männer 66 % und für Frauen 64 %, beim Rektumkarzinom für Männer 64 % und 67 % für Frauen. Verglichen mit Daten aus Tirol aus einem früheren Zeitraum (1990–1994) haben sich die Überlebenswahrscheinlichkeiten deutlich verbessert. Dies kann zumindest teilweise auf den positiven Effekt von Früherkennung und verbesserter Therapie zurückgeführt werden. 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.

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.

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 (≥55 years) the mortality decreased by 21% in men and by 25% in women; among younger persons (≤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.