Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

Introduction: Female breast cancer mortality has decreased considerably in developed nations. In contrast, an increase has been observed in developing countries. Objective: To describe the impact of social inequalities in female breast cancer mortality in Brazil, between the years of 1990 and 2011. Methods: Breast cancer mortality data and estimates for the resident population were obtained from the Brazilian National Health Service (SUS) database for the 1990-2011 period. Age-standardized mortality rates were calculated (20-39, 40-49, 50-69 and ≥70 years) by direct standardization using the 1960 standard world population. Trends were modeled using linear regression, with mortality rates as the dependent variable and the year of death as the independent variable. The Social Exclusion Index (SEI) and the Human Development Index (HDI) were used to classify the 27 Brazilian states. Pearson’s correlation was used to describe the association between the SEI and the HDI and the variations in mortality rates in each state. Results: Age-standardized mortality rates in Brazil were found to be stable (annual percent change [APC] = 0.32; 95%CI: -0.1 – 0.7). Statistically significant decreases in mortality rates were found in the states of Rio Grande do Sul, Rio de Janeiro and São Paulo. Increases in mortality rates were most notable in the states of Maranhão (APC = 11.2; 95%CI: 5.8 – 16.9), Piauí (APC = 9.8; 95%CI: 7.6 – 12.1) and Paraíba (APC = 9.3; 95%CI: 6.0 – 12.8). There was a statistically significant correlation between SEI and a change in female breast cancer mortality rates in the Brazilian states between 1990 and 2011 and between HDI and mortality between 2001 and 2011. This reduction was most notable in the Brazilian states with better socioeconomic conditions. Conclusions: It was observed a direct impact of social inequalities in female breast cancer mortality rates in Brazil. Reductions in these rates were found in the more developed states, possibly reflecting a better local healthcare. Citation Format: Ruffo Freitas-Junior, Carolina M Gonzaga, Maria-Paula Curado, Ana-Luiza L Sousa, Marta R Souza. The impact of social inequalities on breast cancer mortality in Brazil [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-08.

Scanty information, limited to selected areas of the country, is available on cancer mortality in Brazil. Age-standardized (world population) mortality rates between 1980 and 2004, derived from the WHO database, were computed for all cancers and 24 major cancer sites in Brazil. Joinpoint regression analyses were used to identify the significant changes in trends and estimate annual percent change (APC) in rates. Total cancer mortality rates increased over the last decade in men (APC = 0.5) to reach 101.2/100 000, and in women (APC = 0.3) to reach 71.3/100 000. In men, upward trends were observed for cancers of the oral cavity and pharynx with a rate of 5.9/100 000 in 2000-2004, intestines (whose rate, however was low, i.e. 7.6), prostate (12.2), and leukemias (3.4). Male lung cancer increased until 1993 (APC = 1.39) and decreased thereafter (APC = -0.29), with a relatively low rate of 16.2/100 000 in 2000-2004. In women, there were steady upward trends for cancers of the lung (APC = 2.3), reaching 6.2/100 000 in 2000-2004, and leukemias (2.5). Breast cancer mortality leveled off at around 10/100 000 in the last decade, whereas declines were observed for cancers of the uterus, whose rate (8.3) however, remained comparatively high. Declines were observed for stomach cancer in both sexes, with rates of 11.1 in men and 4.6 in women. In conclusion, the key issues of cancer mortality in Brazil are the high rates of head and neck cancers in men and (cervix) uterine cancer in women, that is, in principle cancers that are largely avoidable through prevention, screening, and early diagnosis.

BackgroundBreast cancer is the most common cause of death from cancer in women in less developed regions. Therefore, the objective of this study was to provide data on the temporal trends in female breast cancer mortality between 1990 and 2011 and to evaluate its association with the social inequalities present in Brazil.MethodsBreast cancer mortality data and estimates for the resident population were obtained from the Brazilian National Health Service database for the 1990–2011 period. Age-standardized mortality rates were calculated (20–39, 40–49, 50–69 and ≥70 years) by direct standardization using the 1960 standard world population. Trends were modeled using joinpoint regression model and linear regression. The Social Exclusion Index and the Human Development Index were used to classify the 27 Brazilian states. Pearson’s correlation was used to describe the association between the Social Exclusion Index and the Human DeveIopment and the variations in mortality rates in each state.ResultsAge-standardized mortality rates in Brazil were found to be stable (annual percent change [APC] = 0.3; 95% CI: −0.1 – 0.7) between 1994 and 2011. Considering the Brazilian states, significant decreases in mortality rates were found in Rio Grande do Sul, Rio de Janeiro and São Paulo. Increases in mortality rates were most notable in the states of Maranhão (APC = 11.2; 95 %CI: 5.8 – 16.9), Piauí (APC = 9.8; 95% CI: 7.6 – 12.1) and Paraíba (APC = 9.3; 95% CI: 6.0 – 12.8). There was a statistically significant correlation between Social Exclusion Index and a change in female breast cancer mortality rates in the Brazilian states between 1990 and 2011 and between Human Development Index and mortality between 2001 and 2011.ConclusionsFemale breast cancer mortality rates are stable in Brazil. Reductions in these rates were found in the more developed states, possibly reflecting better healthcare.

to analyze female breast cancer mortality trends in Brazil and its regions. female breast cancer mortality in Brazil and its regions was analyzed using mortality data from the Ministry of Health's Mortality Information System and the National Cancer Institute between 1991 and 2010. The variables analyzed were. proportional mortality from female breast cancer in relation to total deaths in women, mortality rates of the five primary locations of the neoplasms most common in women, and mortality rates for female breast cancer: Linear regression models were estimated to analyze mortality trends: a growth in proportional mortality due to female breast cancer in Brazil and its regions was observed: In relation to the mortality rates for the five primary types of cancer, breast cancer persisted in first place in Brazil and its regions, except the North region, where cervical cancer was the most frequent: Rising female breast cancer mortality rates were observed for Brazil (p = 0.017), Northeastern (p < 0.001), North (p < 0.001) and the Mid-West (p = 0.001), regions, and declining rates for the Southeast region (p = 0.047), and stable rates for the South region. the results emphasize the importance of the disease in terms of public health in the country, reinforcing the need for early detection and appropriate treatment.

Background: Breast cancer (BC) is the leading cause of cancer-related deaths among women worldwide. BC mortality rates have been decreasing over the past decades in the developed countries. In the United States, BC mortality declined on average 1.5% each year over 2008-2017. Given the paucity of BC mortality data in Brazil, we sought to characterize BC mortality trends in southeastern Brazil and its relationship with demographic variables. Methods: A cross-sectional registry-based analysis was conducted to describe BC mortality trends in the State of Sao Paulo (Brazil) from 2004 to 2017. Sao Paulo is the most populous state in Brazil, with 45.5 million inhabitants, corresponding to 21.8% of the country's total population. BC-related death records, including gender and age were collected from SEADE Foundation’s database, an official entity charged with generating statistical data for the State of Sao Paulo. Mortality rates are expressed in units of deaths per 100,000 individuals per year. The annual percentage change (APC) was calculated to identify mortality trends over the period. Trend analysis was carried out by linear regression and an increase or decrease in trend was considered statistically significant when p-value &amp;lt; 0.05. Results: From 2004 to 2017, 52,005 deaths from BC were recorded in the State of São Paulo, Brazil. Average annual mortality was 8.96/100,000 (17.38/100,000 for females and 0.11/100,000 for males). Average mortality rates were higher in the age group over 65 years-old (46.47/100,000). BC mortality rates remained stable during the period analyzed (APC 0, 95%CI -0.2% to +0.3%, P = 0.9) for both females (APC 0, 95%CI -0.3% to +0.2%, P = 0.7) and males (APC +2.4%, 95%CI -1.7% to +6.6%, P = 0.2). Among females, an increasing BC mortality trend was detected for patients under 40 years-old (APC +2.4%, 95%CI +1.6% to +3.2%, P &amp;lt; 0.0001) and remained stable for the age groups between 40 - 65 years-old (APC -0.3%, 95%CI -0.7% to +0.1%, P = 0.1) and over 65 years-old (APC -0.1%, 95%CI -0.4% to +0.2%, P 0.5). Conclusion: In contrast with data from other developing countries, a stable BC mortality has been demonstrated in southeastern Brazil over a 14-year period for the general population. However, a significant increase in BC mortality rates has been demonstrated among patients under 40 years-old. Citation Format: Guilherme Nader Marta, Laura Testa, Rodrigo Santa Cruz Guindalini, Gustavo Nader Marta, Maria Del Pilar Estevez Diz, Paulo M. Hoff. Trends in breast cancer mortality in Brazil - a 14-year registry-based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-27.

This study aimed to correct and describe cervical cancer mortality rates and trends by regions and age-groups in Brazil. It may help planning and implementing policies for cervical cancer control. Data from 2003 to 2012 were accessed through the centralized national mortality database. Correction of the age-specific mortality rates was done by proportional redistribution of ill-defined causes of death and deaths coded as 'uterine, part unspecified'. Annual percentage change (APC) was obtained by trend analysis (Joinpoint regression). In the 10-year period, cancer and ill-defined causes corresponded, respectively, to 18.9 and 10.8% of all deaths (except injuries). The proportion of ill-defined causes was reduced by more than a half in the period. The age-standardized cervical cancer mortality rate was 7.2 per 100,000 women-years after correction. The total increase in rates after corrections was 50.5%. A significant decreasing trend in rates was observed at the national level (APC=-0.17, p<0.001). North was the only region that did not show a decreasing significant trend (APC+0.07, p=0.28). Decreasing trends were restricted to age-groups over 40years. A consistent decreasing trend of cervical cancer mortality rates in Brazil from 2003 to 2012 was observed, although this was not consistent in all regions and restricted to older age-groups. Quality of data needs to be improved. Cancer control policies may consider the differences in access to care and the characteristics of regions to improve their efficiency.

Cancer is currently in the spotlight due to their heavy responsibility as main cause of death in both developed and developing countries. Analysis of the epidemiological situation is required as a support tool for the planning of public health measures for the most vulnerable groups. We analyzed cancer mortality trends in Brazil and geographic regions in the period 1996 to 2010 and calculate mortality predictions for the period 2011 to 2030.This is an epidemiological, demographic-based study that utilized information from the Mortality Information System on all deaths due to cancer in Brazil. Mortality trends were analyzed by the Joinpoint regression, and Nordpred was utilized for the calculation of predictions.Stability was verified for the female (annual percentage change [APC] = 0.4%) and male (APC = 0.5%) sexes. The North and Northeast regions present significant increasing trends for mortality in both sexes. Until 2030, female mortality trends will not present considerable variations, but there will be a decrease in mortality trends for the male sex. There will be increases in mortality rates until 2030 for the North and Northeast regions, whereas reductions will be verified for the remaining geographic regions. This variation will be explained by the demographic structure of regions until 2030.There are pronounced regional and sex differences in cancer mortality in Brazil, and these discrepancies will continue to increase until the year 2030, when the Northeast region will present the highest cancer mortality rates in Brazil.

Background: Social and regional inequalities in Brazil such as delayed diagnosis and the lack of an organized healthcare system, which hamper access to treatment, predominantly affect women from lower socioeconomic strata with breast cancer. Residents in urban centers are known to have a more favorable socioeconomic status and better access to medical care. Aim: To evaluate mortality trends in female breast cancer in urban centers and rural areas of the Brazilian states between 1980 and 2010. Methods: This was an ecological time series study, using the number of breast cancer deaths in Brazil was obtained from the Nationwide Mortality Database (SIM/WHO), and demographic database were obtained from the Brazilian Institute of Geography and Statistics (IBGE/WHO). A systematic analysis of temporal trends in the mortality rate was performed by joinpoint regression. To describe the trend in each period, the annual percent change (APC) was obtained, together with the relevant 95% confidence intervals. P-values &amp;lt; 0.05 were considered statistically significant. Results: In urban centers in southern Brazil, mortality rates were almost 20 times higher than those in the north of the country. A declining trend in breast cancer mortality was found in some urban centers: Porto Alegre (-1.6%; -2.4 to -0.7; p&amp;lt;0.01); Rio de Janeiro (-0.9%; -1.4 to -0.4; p&amp;lt;0.01); São Paulo (-1.7%; -2.6 to -0.9; p&amp;lt;0.01); Belo Horizonte (-1.2%; -2.0 to -0.4; p = 0.01) and Recife (-0.9%; -1.7 to -0.1; p = 0.03). However, increases were found in other urban centers: Fortaleza (0.5%; 0.1–0.9; p = 0.02), Belém (0.8%; 0.2–1.5; p = 0.01), João Pessoa (1.6%; 0.7–2.6; p&amp;lt;0.01), Teresina (4.6%; 1.2–8.2; p = 0.01) and Porto Velho (9.0%; 3.8–14.6; p&amp;lt;0.01). A reduction occurred in rural areas of the state of São Paulo (-2.8%; 95%CI: -4.4 to -1.3; p&amp;lt;0.01). However, increases were found in most other rural areas in all the different states of the country, the worst being in Maranhão (17.6%; 95%CI: 9.2–26.7; p&amp;lt;0.01), Paraíba (14.5%; 10.0–19.2; p&amp;lt;0.01), Piauí (10.0%; 8.1–13.7; p&amp;lt;0.01) and Alagoas (10.8%; 7.1–14.6; p&amp;lt;0.01). In the majority of rural areas of Brazil, mortality from female breast cancer continues to rise, with the exception of some areas in the southern part of the country. Conclusion: Considerable disparity was found in female breast cancer mortality rates between the urban centers and rural areas of Brazil. These findings are in line with the socioeconomic inequalities present in the country. Another possible reason for the disparity found in breast cancer mortality may be a consequence of the variations in women's exposure to risk factors and of diagnostic practices. In the majority of the Brazilian states, mortality rates are lower in rural regions, a finding that could be attributed to the low incidence of breast cancer in rural areas or to the presence of protective factors such as multiparity, breastfeeding and the young age of women at the birth of their first child, occurrences that are common in rural areas of Brazil. The results presented here on mortality rates of female breast cancer in the urban and rural areas of Brazil may be considered an indicator of breast cancer control. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-23.

Pancreatic cancer mortality is greater in countries with a high Human Development Index (HDI). This study analyzed pancreatic cancer mortality rates trends, and their correlation with HDI in Brazil over 40 years. Data on pancreatic cancer mortality in Brazil between 1979 and 2019 were obtained from the Mortality Information System (SIM). Age-standardized mortality rates (ASMR) and Annual Average Percent Change (AAPC) were calculated. Pearson's correlation test was applied to compare mortality rates and HDI for three periods: 1986-1995 was correlated with HDI of 1991, 1996-2005 with HDI of 2000, and 2006-2015 with HDI of 2010; and to the correlation of AAPC versus the percentage change in HDI from 1991 to 2010. A total of 209,425 deaths from pancreatic cancer were reported in Brazil, with an annual increase of 1.5% in men and 1.9% in women. There was an upward trend for mortality in most Brazilian states, with the highest trends observed in the North and Northeast states. A positive correlation between pancreatic mortality and HDI was observed over the three decades (r>0.80, P<0.05) and also between AAPC and HDI improvement by sex (r=0.75 for men and r=0.78 for women, P<0.05). There was an upward trend in pancreatic cancer mortality in Brazil for both sexes, but rates among women were higher. Mortality trends were higher in states with a higher percentage improvement in HDI, such as the North and Northeast states.

Objective: The objective of this observational study was to evaluate the relationship between the oral cancer mortality rate and socioeconomic indicators throughout the Brazilian territory, between 2010 and 2019. Method: The variables used in this study were oral cancer mortality rates from the Mortality Information System (SIM) and population data from the Brazilian Institute of Geography and Statistics (IBGE) to calculate oral cancer mortality rates, along with the Human Development Index (HDI) and Social Vulnerability Index (SVI). The analysis was performed in tertile stratifications (Microsoft Excel 16.0), while temporal trends were examined by segmented linear regression (JoinPoint 4.9.0). Results: High mortality rates were observed in more developed regions (South and Southeast), whereas temporal analysis showed significant increasing trends in the North (annual percentage changes [APC] = +3.9%; p < 0.05) and Northeast (APC = +2.4%; p < 0.05) regions. The greater HDI (APC = +1.7%; p < 0.05) and SVI (APC = +2.2%; p < 0.05) tertiles had the lowest annual percentage increase, showing an inverse relationship between the temporal trend of mortality and socioeconomic indicators. Conclusion: Despite the higher number of oral cancer deaths in regions with higher social indices, increasing temporal trends are more accentuated in regions with lower socioeconomic levels.

The objective was to describe time trends in cervical cancer mortality rates in Brazil as a whole and in the country's major geographic regions and States from 1980 to 2009. This was an ecological time series study using data recorded in the Mortality Information System (SIM) and census data collected by the Brazilian Institute of Geography and Statistics (IBGE). Analysis of mortality trends was performed using Poisson regression. Cervical cancer mortality rates in Brazil tended to stabilize. In the geographic regions, a downward trend was observed in the South (-4.1%), Southeast (-3.3%), and Central-West (-1%) and an upward trend in the Northeast (3.5%) and North (2.7%). The largest decreases were observed in the States of São Paulo (5.1%), Rio Grande do Sul, Espírito Santo, and Paraná (-4.0%). The largest increases in mortality trends occurred in Paraíba (12.4%), Maranhão (9.8%), and Tocantins (8.9%). Cervical cancer mortality rates stabilized in the country as a whole, but there was a downward trend in three geographic regions and 10 States, while two geographic regions and another 10 States showed increasing rates.

Introduction: Non-melanoma skin cancer (NMSC) is the most common among all malignancies. Objective: To describe trends in NMSC mortality rates in Brazil and its macroregions from 2001 to 2018. Method: Adjusted mortality rates stratified by sex were estimated and presented per 100,000 person-years. An autoregressive analysis was implemented to assess temporal trends, annual percent change (APC) and 95% Confidence Intervals (95% CI). Results: There were 27,550 NMSC deaths in Brazil with higher frequency in males (58.1%) and among individuals aged ≥70 years (64.3%). The overall rates were 2.25 (males) and 1.22 (females) per 100,000 person-years. The trends followed an upward direction in Brazil for males (APC: 2.91%; 95% CI: 1.96%; 3.86%) and females (APC: 3.51%; 95% CI: 2.68%; 4.34%). The same occurred in the North Region, in males (APC: 9.75%; 95% CI: 7.68%; 11.86%) and in females (APC: 10.38; 95% CI: 5.77%; 15.21%), as well as in Northeast Region, in males (APC: 9.98%; 95% CI: 5.59%; 14.57%) and in females (APC: 8.34%; 95% CI: 3.29%; 13.64%). Conclusion: NMSC deaths are not rare in Brazil. Upward mortality trends were observed for the whole country and in the North and Northeast regions, which are the closest to the Equator line and also the least developed socioeconomically. A synergism between different types of inequalities and environmental exposure in these macroregions may be promoting an increase in the number of NMSC deaths, a type of cancer which is considered completely preventable.

&lt;p&gt;Supplementary Figure S1. All sites cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized all-sites cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S2. All sites cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized all-sites cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S3. Lung cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized lung cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S4. Lung mortality trends by sex, select countries, 1950-2012 Observed age-standardized lung cancer mortality rates with a five-year moving average, select countries, all ages, by sex, 1950-2012 Supplementary Figure S5. Colorectal cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized colorectal cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S6. Colorectal cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized colorectal cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S7. Female breast cancer incidence and mortality rates, select registries, 2003-2007 Ranking of age-standardized female breast cancer incidence and mortality rates for select registries for all ages, for the period 2003-2007, color-coded by region Supplementary Figure S8. Female breast mortality trends, select countries, 1950-2012 Observed age-standardized female breast cancer mortality rates with a five-year moving average, select countries, all ages, 1950-2012 Supplementary Figure S9. Prostate cancer incidence and mortality rates, select registries, 2003-2007 Ranking of age-standardized prostate cancer incidence and mortality rates for select registries for all ages, for the period 2003-2007, color-coded by region Supplementary Figure S10. Prostate cancer mortality trends, select countries, 1950-2012 Observed age-standardized prostate cancer mortality rates with a five-year moving average, select countries, all ages, 1950-2012 Supplementary Figure S11. Stomach cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized stomach cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S12. Stomach cancer mortality trends, males, select countries, 1950-2012 Observed age-standardized stomach cancer mortality rates with a five-year moving average, select countries, males, all ages, 1950-2012 Supplementary Figure S13. Liver cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized liver cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S14. Liver cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized liver cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S15. Esophageal cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized esophageal cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S16. Esophageal cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized esophageal cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S17. Cervical cancer incidence and mortality rates, select registries, 2003-2007 Ranking of age-standardized cervical cancer incidence and mortality rates for select registries for all ages, for the period 2003-2007, color-coded by region&lt;/p&gt;

&lt;p&gt;Supplementary Figure S1. All sites cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized all-sites cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S2. All sites cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized all-sites cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S3. Lung cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized lung cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S4. Lung mortality trends by sex, select countries, 1950-2012 Observed age-standardized lung cancer mortality rates with a five-year moving average, select countries, all ages, by sex, 1950-2012 Supplementary Figure S5. Colorectal cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized colorectal cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S6. Colorectal cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized colorectal cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S7. Female breast cancer incidence and mortality rates, select registries, 2003-2007 Ranking of age-standardized female breast cancer incidence and mortality rates for select registries for all ages, for the period 2003-2007, color-coded by region Supplementary Figure S8. Female breast mortality trends, select countries, 1950-2012 Observed age-standardized female breast cancer mortality rates with a five-year moving average, select countries, all ages, 1950-2012 Supplementary Figure S9. Prostate cancer incidence and mortality rates, select registries, 2003-2007 Ranking of age-standardized prostate cancer incidence and mortality rates for select registries for all ages, for the period 2003-2007, color-coded by region Supplementary Figure S10. Prostate cancer mortality trends, select countries, 1950-2012 Observed age-standardized prostate cancer mortality rates with a five-year moving average, select countries, all ages, 1950-2012 Supplementary Figure S11. Stomach cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized stomach cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S12. Stomach cancer mortality trends, males, select countries, 1950-2012 Observed age-standardized stomach cancer mortality rates with a five-year moving average, select countries, males, all ages, 1950-2012 Supplementary Figure S13. Liver cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized liver cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S14. Liver cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized liver cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S15. Esophageal cancer incidence rates by sex, select registries, 2003-2007 Ranking of age-standardized esophageal cancer incidence rates for select registries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S16. Esophageal cancer mortality rates by sex, select countries, 2003-2007 Ranking of age-standardized esophageal cancer mortality rates for select countries for all ages, by sex, for the period 2003-2007, color-coded by region Supplementary Figure S17. Cervical cancer incidence and mortality rates, select registries, 2003-2007 Ranking of age-standardized cervical cancer incidence and mortality rates for select registries for all ages, for the period 2003-2007, color-coded by region&lt;/p&gt;

OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according tosocioeconomic 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 NationalMortality Database, population data from the Brazilian Institute ofGeography and Statistics database, and socioeconomic and welfare informationfrom the Institute of Applied Economic Research. Moving averages werecalculated, disaggregated by capital city and municipality. The annualpercent change in mortality rates was estimated by segmented linearregression using the joinpoint method. Pearson’s correlation coefficientswere conducted between average mortality rate at the end of the three-yearperiod and selected indicators in the state capital and each Brazilianstate.RESULTS There was a decline in cervical cancer mortality rates throughout the periodstudied, except in municipalities outside of the capitals in the North andNortheast. There was a decrease in breast cancer mortality in the capitalsfrom the end of the 1990s onwards. Favorable socioeconomic indicators wereinversely correlated with cervical cancer mortality. A strong directcorrelation was found with favorable indicators and an inverse correlationwith fertility rate and breast cancer mortality in inner cities.CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breastcancer and attenuation of mortality because of increased, albeit unequal,access to and provision of screening, diagnosis and treatment.