The use of epidemiology for screening and early detection of cancer: examples from Austria

Reduction of mortality rates and the costs of screening programs have sometimes been discussed on basis of certain therapeutic nihilism especially concerning the treatment of some cancer localizations. Interest of an epidemiological institute should, however, concern specific regions with high cancer risk and in these areas, well defined by epidemiological investigations, screening projects should be performed. A screening program initiated in Oberpullendorf, a district in the federal country of Burgenland in Austria resulted in a rate of 53% Dukes A colorectal cancer stages (0% Dukes D) compared to 27% Dukes A stage (19% Dukes D) without screening. As regards the lung cancer screening programs, these are controversial, due to high costs and no evident influence on mortality rates. The mortality rate for Vienna is about 20% above the Austrian average. In women the discrepancy between the capital and the federal countries is especially high, as in Vienna 44% more women die on lung cancer as compared to the Austrian average. Some promising results in the treatment of lung cancer, especially in small cell carcinoma and combined treatment by chemo- and radiotherapy might justify a screening program for lung cancer. The highest increase of mortality in lung cancer is found in patients at the age of 75 and older. Those patients, however, suffer from other diseases too, therefore "screening programs for polymorbidity" should be discussed.