Abstract
Background:Cervical cancer represents an important preventable cause of morbidity and mortality in developing countries such as Brazil. Investigating temporal evolution of a disease burden in the different realities of the country is essential for improving public policies.Objective:To describe the national and subnational burden of cervical cancer, based on the estimates of the 2017 Global Burden of Disease study.Methods:Descriptive study of premature mortality (years of life lost [YLL]) and burden of disease (disability-adjusted life years [DALYs]) associated with cervical cancer among Brazilian women aged 25–64 years, between 2000 and 2017.Findings:During the study period, age-standardized incidence decreased from 23.53 (22.79–24.26) to 18.39 (17.63–19.17) per 100,000 women, while mortality rates decreased from 11.3 (11.05–11.56) to 7.74 (7.49–8.02) per 100,000 women. These rates were about two to three times greater than equivalent rates in a developed country, such as England: 11.98 (11.45–12.55) to 10.37 (9.85–10.9), and 3.75 (3.68–3.84) to 2.82 (2.75–2.9) per 100,000 women, respectively. Poorer regions of Brazil had greater rates of the disease; for instance, Amapá State in the Northern Region had rates twice as high as the national rates during the same period. Cervical cancer was the leading cause of premature cancer-related mortality (YLL = 100.69, 91.48–110.61 per 100,000 women) among young women (25–29 years) in Brazil and eight federation units of all country regions except the Southeast in 2017. There was a decrease in the burden of cervical cancer in Brazil from 339.59 (330.82–348.83) DALYs per 100,000 women in 2000 to 238.99 (230.45–247.99) DALYs per 100,000 women in 2017.Conclusion:Although there has been a reduction in the burden of cervical cancer in Brazil, the rates remain high, mainly among young women. The persistence of inequalities between regions of Brazil suggests the importance of socioeconomic determinants in the burden for this cancer.
Highlights
Cervical cancer is considered a preventable disease, it remains a major cause of morbidity and mortality worldwide, especially in developing countries
Brazil had cervical cancer incidence rate that was double the rate reported for the high sociodemographic index (SDI) countries, smaller than the medium-high SDI countries, and similar to the medium SDI country
At the beginning of the new century, despite a general downward trend on the rates evaluated, this study shows that cervical cancer remains an important cause of morbidity and mortality among Brazilian women, including the ones in the reproductive age
Summary
Cervical cancer is considered a preventable disease, it remains a major cause of morbidity and mortality worldwide, especially in developing countries. In 2018, 569,847 new cases of cervical cancer were estimated globally, with an age-standardized incidence rate of 13.1/100,000 women [1]. Between 1990 and 2015, cervical cancer was a leading cause of death among women, despite a marked decrease of mortality rates by the disease over the period [2]. In the North, cervical cancer was the leading cause of cancer death, with the mortality rate of 11.07/100,000 women, roughly double that of cervical cancer-specific global mortality rate in 2016 [3, 4] These inequalities are longstanding, with temporal analysis revealing high mortality rates by this cancer, in the less developed regions of Brazil, northern and northeastern, since 1980 [5, 6]. The persistence of inequalities between regions of Brazil suggests the importance of socioeconomic determinants in the burden for this cancer
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