Study Shows Inequalities Between Types Of Cancer And Incidence According To Regions Of The Country

Premature cancer mortality in Brazil is expected to drop between 2026 and 2030. This is the forecast made by researchers from the National Cancer Institute (Inca), based on the premature mortality observed in the previous period, from 2011 to 2015, for the range aged 30 to 69 years, based on data from the National Mortality Information System (SIM). The study, titled Can the Sustainable Development Goals for cancer be met in Brazil? and published in early January, indicates inequalities between types of cancer and incidence according to the regions of the country.

Even if the forecast is for a decrease in premature mortality, there is still an increase in cases of cancer and, in some cases, even an increase in mortality. This is even worse according to gender and region: women are the most affected, with an overall reduction of 4.6%, compared to 12% for men, while the Northeast has the highest mortality rates. This increase is directly related to changes in eating habits, sedentary lifestyle, population aging and living standards due to increased urbanization.

The study was motivated by Target 3.4 of the Sustainable Development Goals of the United Nations (UN), which aims to “by 2030 reduce by one third premature mortality from chronic non-communicable diseases through prevention and treatment and promote mental health and well-being”.

Life expectancy
The people hit by these premature deaths are in the most productive age group. This is also very motivated thanks to the increase in life expectancy, in which there is an increase in non-communicable chronic diseases. These people are expected to live to be 70 years old. The reduction foreseen for Brazil, however, is far below this target of 30%.

“It is far from the 30% reduction. I think it’s important data, it’s good news that we think there may be a reduction, but a 30% reduction won’t be possible. The expectation is that it will reach something in the order of magnitude of 12%”, explains Maria Del Pilar Estevez Diz, an oncologist and director of the Clinical Staff of the Cancer Institute of the State of São Paulo.

Among the incidence of types of cancer, prostate cancer still leads among men, while cervical and breast cancer lead among women. Overall, lung, stomach and bowel cancers are the most diagnosed in the general population. The latter is also the one that should present the greatest increase in the risk of premature death, around 10%. The study also estimates that about 46,000 new cases of bowel cancer will be diagnosed each year between 2023 and 2025.

In comparison, lung cancer presents alarming data. He has a very high mortality due to a difficulty in treatment and diagnosis. The expected reduction among men is almost 30%, while for women there is a prediction of an increase in premature death of 1.1%. This demonstrates the success of the work – which has taken decades – to reduce smoking, in which men adhered more than women.

“This shows the need for specific campaigns for women. To see this reduction in the coming decades, we will need to discourage smoking among girls and women”, says Maria. She also adds that it is necessary “to change the campaign a little bit, we have to work to sensitize this population so that it is not exposed to cigarettes”.

Prevention
“A reduction in the order of magnitude of at least 20% of prostate cancer is foreseen”, says the doctor. In most regions, this reduction is noted, which is very positive. This is due to a greater search by men for the diagnosis and the search for treatment. Prostate cancer, which still has the highest incidence among men, is curable if diagnosed early.

In the case of breast cancer, the scenario is quite different. Projections indicate a drop in the Southeast, stability in the South and, on the contrary, an increase in the North, Northeast and Midwest. This increase is due to the fact that women choose to get pregnant later and motivated by eating habits and sedentary lifestyle. “We have almost stability in breast cancer mortality over the next few decades, a reduction of just over 10%. In the North and Northeast regions, we do not have this reduction, while in the Southeast region we have a reduction of about 20%”, explains the doctor.

This type of cancer has prevention strategies. As Maria explains, the early detection of breast cancer depends on the population’s adherence to mammography, regular visits to the gynecologist, but also a certain speed in the diagnosis. “It’s not enough for a woman to go to the doctor, she needs to have access to the exam at the right time, access to the doctor when she has something, when she notices something abnormal. We see this important disparity in Brazil”, she explains. “Encouraging the population to look for the test and, once the diagnosis is made, access to treatment as quickly as possible”, she adds.

The doctor still draws attention to cervical cancer. This type of cancer is completely preventable, provided it is discovered early. The idea is to have this cancer eradicated. However, there is still a very large inequality between regions: while the national reduction is expected, the North region has a very high mortality rate, outside the national average. In 2015, 28 people per 100,000 died, and the forecast is for a decrease to 24 people per 100,000. The national average is 11 deaths per 100,000.

increase in cases
Intestinal cancer should have an increase of about 10% , in men and women, until 2030. The doctor recalls that this has to do with the epidemiological transition that the country is going through, that is, we are assuming a profile of death by cancer similar to that of developed countries.

A diet low in fiber influences the appearance of bowel cancer as well. The bad news is that prevention is less structured in the country. Stool examinations are required annually, or less accessible tests such as air etosigmoidoscopy and colonoscopy. Maria recalls that there is no nationally structured network for carrying out these exams, in addition to prejudice in relation to them.

“Unfortunately, we do see an increase, both in men and women, in mortality from colorectal cancer. In fact, when we look at Brazil as a whole, it is the only cancer that is expected to increase by the end of the decade”, says Maria. Again, the Northeast leads an increase of 52% of cases for men and 38% for women. For comparison purposes, the increase is 4.5% for men and 7.3% for women in the Southeast.“It points to the need for a very specific and urgent policy”, says the oncologist. This is a preventable type of cancer, with changes in habits, but also with tests and the removal of the pre-malignant lesion or through early diagnosis. “The population needs to be enlightened about the risk and the Ministry of Health needs to be developing a specific campaign for this. We know today that at least 75% of the population is served by the public health network, so to change this situation, effective public health policies are needed ”, she concludes.