Disparities in cervical and breast cancer mortality in Brazil.

Vania Reis Girianelli,Gulnar Azevedo E Silva,Carmen Justina Gamarra

doi:10.1590/s0034-8910.2014048005214

Abstract

OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators.METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state.RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities.CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.

Highlights

Breast and cervical cancer are the most common malignant neoplasms in women worldwide
Patterns in mortality rates for the two types of cancer in Brazil differed over the 30 years: a clear fall in cervical cancer, more pronounced in state capitals, and an increase in breast cancer
In the North, cervical cancer mortality was higher than that of breast cancer throughout the period, and there was a fall in deaths among women living in the state capitals and an increase in those in the interior

Summary

Introduction

Breast and cervical cancer are the most common malignant neoplasms in women worldwide. Increased incidence of breast cancer in various countries can be partially explained by demographic and lifestyle changes affecting reproductive factors, such as delayed first pregnancy, having fewer children and shorter duration of breastfeeding.[17] Over the last few decades, mortality has declined in developed countries such as the USA, the United Kingdom, France and Australia. The introduction of cervical cancer screening in developed countries proved that this measure significantly reduces incidence of, and mortality from, this disease and prolongs patient survival. This has not been observed in low income countries where access to primary and specialized care is limited.[16]

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