Abstract

The scope was to analyze the time-series trend in the incidence of cancer in the health macro-regions of the State of Mato Grosso from 2001 to 2016. It involved an ecological time-series study with data from the Mato Grosso Population-Based Cancer Registry. Age-standardized incidence rates, disaggregated by year, sex, macro-region and type of cancer, were calculated. For men, the trend was increasing for prostate cancer in the state and the Central-Northwest, East, West, and South macro-regions, and for colorectal cancer in the North; and decreasing for stomach cancer in the state and the Central-Northwest and North, for lung cancer in the East, and for esophageal cancer in the Central-Northwest. For women, the trend was increasing for breast cancer in the state from 2009 to 2016, for lung cancer in the state (2008 to 2016) and in the Central-North (2001 to 2016) and South (2007 to 2016) macro-regions; and decreasing for cervical cancer in the state and for all macro-regions, and for stomach cancer in the state and in the Central-Northwest. Colorectal cancer revealed a stable trend for the state and all macro-regions. Cancer surveillance, prevention and control actions should consider regional differences and variations in magnitude of the occurrence of the disease.

Key words:
Neoplasms; Incidence; Time-series studies; Information systems

Introduction

Cancer is an important worldwide public health problem, due to high morbidity and mortality and high cost of treatment, and has shown an increasing trend in incidence rates in recent decades. This growth can be explained in part by aging, population growth, and also by the change in the distribution of cancer risk factors, especially modifiable factors, such as tobacco and alcohol consumption, physical inactivity, overweight and obesity, inadequate diet, in addition to social, environmental, political and economic conditions¹1 World Health Organization (WHO). Global Action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: WHO; 2018.^,22 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6):394-424..

In the world, in men, the most common cancer in developing countries was prostate cancer (11.3 per 100 thousand/men), followed by lung cancer (10.3 per 100 thousand/men), and for women it was breast cancer (55.9 per 100 thousand/women), followed by colorectal cancer (20.0 per 100 thousand/women)³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249.. In Brazil (2023-2025), prostate cancer (55.49 per 100 thousand/men), lung cancer (12.43 per 100 thousand/men) and colorectal cancer (12.43 per 100 thousand/men) were the most common among men, and for women breast cancer (41.89 per 100 thousand/women), cervical cancer (13.25 per 100 thousand/women) and colorectal (11.06 per 100 thousand/women), excluding non-melanoma skin cancers. In Mato Grosso, among men, the most common types of cancer were prostate, colorectal and lung cancer, and for women, breast, colorectal and cervical cancer⁴4 Instituto Nacional de Câncer (INCA). Estimativa 2023: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2022.. However, there is no information on the incidence of various types of cancer in the state, broken down by geographic region.

Analyzes disaggregated into smaller geographic units allow us to better investigate the relationships and interactions between the incidence of cancer and changes in socioeconomic and demographic dimensions and the availability of health services. In addition to contributing to the identification of priorities in disease control, with support for the planning and management of health services⁵5 Oliveira JFP, Lima FCS, Galvão ND, Souza PCF. Cancer incidence in Mato Grosso state, Brazil: analysis of population-based registries (2007 a 2011). Rev Bras Epidemiol 2022; 25(Supl. 1):e220010..

To understand the magnitude of cancer, Population-Based Cancer Registries (RCBP) have been an important source of secondary data on all new cancer diagnoses occurring in populations within a defined geographic area⁶6 Bray F, Znaor A, Cueva P, Korir A, Swaminathan R, Ullrich A, Wang SA, Parkin DM. Planning and Developing Population-based Cancer Registration in Low- and Middle-income Settings. Lyon: International Agency for Research on Cancer; 2014.. In the State of Mato Grosso, the RCBP Cuiabá and Interior, despite their operational complexity, make it possible to determine, annually, the incidence and distribution of cancer in the State, and in smaller geographic units, such as health macro-regions, health regions and municipalities⁷7 Ribeiro AG, Ferlay J, Piñeros M, Latorre MDRDO, Fregnani JHTG, Bray F. Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001-17. Cancer Epidemiol 2023; 85:102403..

The state of Mato Grosso is characterized by heterogeneous geographic areas and regional inequalities⁸8 Scatena JHG, Oliveira LR, Galvão ND, Neves MAB. O uso de indicadores compostos para classificação das regiões de saúde de Mato Grosso. In: Scatena JHG, Kehrig RT, Spinelli MAS, organizadores. Regiões de saúde: diversidade e processo de regionalização em Mato Grosso. São Paulo: Hucitec; 2014. p. 169-192., in addition to socioeconomic and environmental transformations, which can interfere with carcinogenesis processes, by combining different risk factors. The state’s economy is based on the production of agricultural commodities (soy, cotton, sugar cane and corn) through the agribusiness production model⁹9 Instituto Mato-Grossense de Economia Agropecuária. Mapa das macrorregiões do IMEA [Internet]. 2017. [acessado 2023 set 20]. Disponível em: https://www.imea.com.br/imea-site/view/uploads/metodologia/justificativamapa.pdf
https://www.imea.com.br/imea-site/view/u... , which makes it the largest consumer of pesticides in Brazil in recent years¹⁰10 Pignati WA, Lima FANSE, Lara SS, Correa MLM, Barbosa JR, Leão LHDC, Pignatti MG. Spatial distribution of pesticide use in Brazil: a strategy for Health Surveillance. Cien Saude Colet 2017; 22(10):3281-3293.. In this sense, the objective of the study was to analyze the temporal trend in the incidence of cancer in the health macro-regions of the state of Mato Grosso from 2001 to 2016.

Methods

This is an ecological time series study of the five most common types of cancer by sex, excluding non-melanoma skin cancer, in the health macro-regions of the state of Mato Grosso, from 2001 to 2016.

The state of Mato Grosso is located in the Central-West Region of Brazil and is made up of 141 municipalities grouped into six health macro-regions (Center North, Center Northwest, East, North, West and South)¹¹11 Governo do Estado de Mato Grosso. Secretaria Estadual de Saúde. Resolução CIB/MT nº 57 de 26 de julho de 2018. Dispõe sobre as diretrizes do Planejamento Regional Integrado (PRI) estabelece a conformação das 16 (dezesseis) regiões de saúde no Estado de Mato Grosso em 06 (seis) macrorregiões [Internet]. 2018. [acessado 2023 abr 16]. Disponível em: http://www.saude.mt.gov.br/upload/noticia/2/arquivo/240820160127-SES-MT-A-mapa-de-saude-mt-2020.pdf
http://www.saude.mt.gov.br/upload/notici... . The state capital, Cuiabá, belongs to the Center North macroregion, as does Várzea Grande, which is the second municipality with the largest population¹²12 Brasil. Ministério da Saúde (MS). Demográficas e socioeconômicas - população residente [Internet]. [acessado 2023 set 17]. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/
https://datasus.saude.gov.br/informacoes... .

Health macro-regions are marked by demographic, socioeconomic and health differences, which reflect the profile of the health regions that comprise them⁸8 Scatena JHG, Oliveira LR, Galvão ND, Neves MAB. O uso de indicadores compostos para classificação das regiões de saúde de Mato Grosso. In: Scatena JHG, Kehrig RT, Spinelli MAS, organizadores. Regiões de saúde: diversidade e processo de regionalização em Mato Grosso. São Paulo: Hucitec; 2014. p. 169-192.^,1313 Martinelli NL, Scatena JHG, Castro ML, Soares NRF, Charbel SC, Souza NFDS, Medeiros ARS, Souza DPO. Análise da estruturação da Rede de Atenção à Saúde no estado de Mato Grosso, Brasil, no contexto da Regionalização. Cien Saude Colet 2023; 28(2):585-598.. Specialized oncology care services are distributed across five healthcare macro-regions, and their provision is concentrated in the capital¹⁴14 Governo de Mato Grosso. Secretaria de Estado de Saúde. Resolução CIB/MT Ad referendum n° 001 de 20 de fevereiro de 2017. Dispõe sobre a Aprovação do Plano de Ação da Atenção Oncológica no Estado de Mato Grosso de 2017 a 2019 [Internet]. 2017. [acessado 2023 set 20]. Disponível em: www.saude.mt.gov.br/arquivo/7317
www.saude.mt.gov.br/arquivo/7317... . Table 1 presents the characteristics of the health macro-regions: a) resident population aged 60 or over (2021); b) average household income per capita (IBGE, 2010); c) illiteracy rate (IBGE, 2010); d) percentage of the population with completed 2nd primary education or more (IBGE, 2010); e) gross domestic product per capita (GDP per capita) (IBGE, 2010); f) coverage of primary care teams (2015); g) medium and high complexity outpatient procedures per 100 inhabitants (2015). The information was obtained from the Information Technology Department of the Unified Health System (DATASUS)¹²12 Brasil. Ministério da Saúde (MS). Demográficas e socioeconômicas - população residente [Internet]. [acessado 2023 set 17]. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/
https://datasus.saude.gov.br/informacoes... ^,1515 Brasil. Ministério da Saúde (MS). Indicadores de saúde e pactuações - rol de diretrizes, objetivos, metas e indicadores 2013-2015 - edição 2015 [Internet]. 2013. [acessado 2023 set 20]. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/
https://datasus.saude.gov.br/informacoes... .

Data on new cancer cases were obtained through RCBP-Interior and RCBP-Cuiabá. The period chosen for the study was defined based on updated information from the Extension Project “Cancer Surveillance and its associated factors: updating population-based and hospital records”. The 2010 census population and the intercensal population estimates used as denominators for calculating incidence rates were extracted from the Tabnet - DATASUS¹²12 Brasil. Ministério da Saúde (MS). Demográficas e socioeconômicas - população residente [Internet]. [acessado 2023 set 17]. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/
https://datasus.saude.gov.br/informacoes... .

The five most common types of cancer were selected, according to the distribution of data in the State, excluding non-melanoma skin cancer, according to sex and considering the International Statistical Classification of Diseases and Related Health Problems (ICD-10): (C61) prostate; (C33-C34) lung; (C18-C19-C20-C21) colorectal; (C16) stomach; and (C15) esophagus, for males and (C53) cervix; (50) breast; (C18-C19-C20-C21) colorectal; (C33-C34) lung; and (C16) stomach, for females. All cases of benign neoplasia, with uncertain or unknown behavior were excluded (D00-D48).

Age-standardized incidence rates per 100,000 inhabitants were calculated based on the global standard population proposed by Segi¹⁶16 Segi M. Cancer mortality for selected sites in 24 countries (1950-57). Sendai: Tohoku University School of Medicine; 1960.. The direct method was used and estimates were made based on age-specific rates at 10-year intervals, disaggregated by year, sex, macro-region and cancer.

For incidence trend analysis, Joinpoint regression was used using the calendar year as a regressor variable. Joinpoint regression describes the relationship between two variables through piecewise linear regression, where pattern changes are connected by inflection points¹⁷17 Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000; 15;19(3):335-351.. Serial autocorrelation was verified using the Durbin-Watson test. The assumption of normality was verified using the Shapiro-Wilk test and homoscedasticity using the Breusch-Pagan test. The choice of the analysis model was made based on checking the model’s assumptions. The annual percentage change (APC) and Average Annual Percent Change (AAPC) were calculated - weighted geometric average of the different APC with weight equal to the size of the segment for each time interval¹⁷17 Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000; 15;19(3):335-351.. Positive APC means increasing trend, negative APC means decreasing trend, and p-value>0.05 means stable trend. The Joinpoint Regression Program software, version 8.3.6.1 (Statistical Research and Applications Branch, National Cancer Institute, Bethesda, United States) was used for trend analysis and the STATA software, version 16.0 for descriptive analysis and graphs.

This project is part of a larger project entitled “Cancer and Its Associated Factors: Population and Hospital Base Registry Analyzes of Mato Grosso”, sent to the UFMT Ethics and Health Research Committee with approval opinion number 4,858,521, of 07/20/2021. The project has a partnership and financing from the Public Ministry of Labor, 23rd Region, effective from July 2019 to July 2023.

Results

In the period from 2001 to 2016, the state of Mato Grosso reported 74,756 new cases of cancer (including non-melanoma skin cancer), 53.0% in males. The most frequent for men were prostate (22.8%), lung (6.7%), stomach (5.5%), colorectal (5.0%) and esophagus (3.2%). In women, they were breast (19.6%), cervix (13.2%), colorectal (5.6%), lung (4.0%) and stomach (3.0%).

The incidence rate among men increased for prostate (37.8 in 2001 to 44.9/100 thousand men in 2016) and colorectal (9.4 to 10.5/100 thousand men) and reduced for lung (14.8 for 11.1/100 thousand men), stomach (14.0 to 8.9/100 thousand men) and esophagus (6.9 to 5.3/100 thousand men) (Figure 1). In women, the rate increased for breast (31.1 to 39.4/100 thousand women) and colorectal (9.6 to 10.9/100 thousand women) and a small reduction for the cervix (33.5 to 17.7/100 thousand women), lung (7.9 to 7.8/100 thousand women) and stomach (6.3 to 5.1/100 thousand women) (Figure 2).

Table 2 presents the annual percentage changes in incidence rates for men. For prostate cancer, an increase of 7.1% was observed in the period from 2001 to 2016 in the East macro-region, 5.9% in the West, 4.7% in the South, 4.5% in the Central Northwest and in the state, 1.7%. For lung cancer, there was a 3.5% reduction in the incidence rate in the East macro-region from 2001 to 2016 and 4.1% in the state for the same period. For colorectal cancer, there was a 4.3% increase in the incidence rate in the North macro-region. For stomach cancer in the period from 2001 to 2016, a reduction of 2.7% was observed in the Central Northwest macro-region, 4.5% in the North and 3.3% in the state, while for the East macro-region the reduction was observed in the period from 2001 to 2009 (APC = -13.1%) and for the West in the periods from 2001 to 2008 (APC = -9.6%) and 2011 to 2016 (APC = -8.7%). For esophageal cancer, the reduction was only observed for the Central Northwest macroregion (AAPC = -4.5%).

Table 3 presents the annual percentage changes in incidence rates for women. For breast cancer, a reduction of 3.0% was observed in the period from 2001 to 2009 in the Central North macroregion and an increase of 6.8% in the period from 2009 to 2016 for the state. For cervical cancer, from 2012 to 2016, the trend was decreasing for the state (AAPC = -6.0%) and in almost all macro-regions, Central Northwest (AAPC = -5.7%), East (AAPC = -7.6), North (AAPC = -7.0%), West (AAPC = -5.2%), South (AAPC = -4.9%). The Central North macro-region showed a decreasing trend only in the period from 2003 to 2010 (APC = -11.2). For lung cancer, the Central North macro-region showed an increasing trend (AAPC = 2.6%) and the South showed a break in the series, with a decreasing trend in the period from 2001 to 2007 (APC = -8.4%) and an increasing trend in the period from 2007 to 2016 (APC = 7.9%), and for the state the trend was decreasing from 2001 to 2008 (APC = -2.9%), and increasing from 2008 to 2016 (APC = 4.8%). For colorectal cancer, stable trends were observed for all macro-regions and the state. Stomach cancer showed a reduction in the incidence trend in the Central Northwest macro-region (AAPC = -5.9%) and in the state (AAPC = -2.5%) in the period from 2001 to 2016.

Discussion

In the present study, trends in standardized incidence rates of the five most common types of cancer were presented, for both sexes, in the state of Mato Grosso, and according to health macro-regions, in the period from 2001 to 2016. Similar to the global cancer profile³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249., and also in South America and the Caribbean¹⁸18 Piñeros M, Laversanne M, Barrios E, Cancela CM, Vries E, Pardo C, Bray F. An updated profile of the cancer burden, patterns and trends in Latin America and the Caribbean. Lancet Reg Heal Am 2022; 13. DOI: 10.1016/j.lana.2022.100294
https://doi.org/10.1016/j.lana.2022.1002... , the most common cancers in the state were prostate, breast, colorectal, lung and stomach. The state’s cancer burden reflects the epidemiological transition, with cancer types associated with infections and attributed to socioeconomic development, as well as unhealthy lifestyle habits³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249.^,66 Bray F, Znaor A, Cueva P, Korir A, Swaminathan R, Ullrich A, Wang SA, Parkin DM. Planning and Developing Population-based Cancer Registration in Low- and Middle-income Settings. Lyon: International Agency for Research on Cancer; 2014.^,77 Ribeiro AG, Ferlay J, Piñeros M, Latorre MDRDO, Fregnani JHTG, Bray F. Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001-17. Cancer Epidemiol 2023; 85:102403..

For men, prostate cancer showed an increasing trend for the state and for four of the six macro-regions studied (Central Northwest, East, West and South). Study on the incidence and mortality of prostate cancer in 89 countries from 2000 to 2019, observed that the incidence increased in 65 countries, remained stable in 15 and decreased in 9, and countries with a very high Human Development Index (HDI) had an incidence rate twice as high as those in countries with a low HDI. In Brazil, the trend was increasing in the period (AAPC: 0.47), however in the periods from 2004 to 2007 and 2007 to 2017 it showed a stable and decreasing trend, respectively19. A study carried out in the municipalities of Cuiabá and Várzea Grande, from 2000 to 2016, observed a stable trend and a drop in 2006, with a decreasing trend at the end of the series²⁰20 Souza BSN, Melanda FN, Lima FCS, Silva PFO, Aguilar LB. Incidence trend of five main causes of cancer, in greater Cuiabá, Mato Grosso, Brazil, 2000 to 2016. Rev Bras Epidemiol 2022; 25(Supl.1):e220012..

The decreasing or stable incidence rate for prostate cancer is related to recent changes in the use of prostate-specific antigen (PSA) testing for screening. Most government regulatory agencies in countries such as Brazil, Argentina and Colombia currently oppose PSA screening²¹21 Culp MBB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol 2020; 77(1):38-52.. The increase in the incidence of prostate cancer may be related to the occurrence of the main modifiable risk factors, which are generally related to lifestyle, such as diet and physical activity, and non-modifiable factors such as age, hormonal and genetic aspects³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249. and provision of health care services²²22 Klein J, von dem Knesebeck O. Socioeconomic inequalities in prostate cancer survival: a review of the evidence and explanatory factors. Soc Sci Med 2015; 142:9-18.^,2323 Sacramento RS, Simão LJ, Viana KCG, Andrade MAC, Amorim MHC, Zandonade E. Associação de variáveis sociodemográficas e clínicas com os tempos para início do tratamento do câncer de próstata. Cien Saude Colet 2019; 24(9):3265-3274..

For women, breast cancer showed an increasing trend in the period from 2009 to 2016 for the state, and a decreasing trend in the Central North macro-region in the period from 2001 to 2009, a result similar to that observed in the municipalities of Cuiabá and Várzea Grande, which showed an increase in incidence rates in the period from 2000 to 2016²⁰20 Souza BSN, Melanda FN, Lima FCS, Silva PFO, Aguilar LB. Incidence trend of five main causes of cancer, in greater Cuiabá, Mato Grosso, Brazil, 2000 to 2016. Rev Bras Epidemiol 2022; 25(Supl.1):e220012., and in developing countries, since the 2000s, both incidence and mortality have shown an increasing trend³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249..

The increase in breast cancer incidence rates may reflect the occurrence of reproductive risk factors, such as delayed pregnancy, fewer children and shorter periods of exclusive breastfeeding, and lifestyle, such as alcohol intake, excess body weight, sedentary lifestyle, in addition to offering health resources and improving breast cancer screening³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249.. According to the Guidelines for the Early Detection of Breast Cancer in Brazil, mammographic screening should be performed in women aged 50 to 69 once every two years²⁴24 Instituto Nacional de Câncer (INCA). Diretrizes para a detecção precoce do câncer de mama no Brasil. Rio de Janeiro: INCA; 2015.. However, it is necessary to consider that increased screening may indicate some degree of overdiagnosis, and that there are inequalities in the distribution of supply and use of early detection procedures for breast cancer in Brazilian regions²⁵25 Tomazelli JG, Silva GA. Rastreamento do câncer de mama no Brasil: uma avaliação da oferta e utilização da rede assistencial do Sistema Único de Saúde no período 2010-2012. Epidemiol Serv Saude 2017; 26(4):713-724.. Regions with greater inequality, measured by the Gini index, have less access to mammography exams²⁶26 Bezerra HS, Melo TFV, Barbosa JV, Feitosa EELC, Souza LCM. Avaliação do acesso em mamografias no Brasil e indicadores socioeconômicos: um estudo espacial. Rev Gaucha Enferm 2018; 39:e20180014., and those with higher HDI have a higher proportion of mammograms performed in the last two years²⁷27 Sadovsky ADI, Poton WL, Reis-Santos B, Barcelos MRB, Silva ICMS. Índice de desenvolvimento humano e prevenção secundária de câncer de mama e colo do útero: um estudo ecológico. Cad Saude Publica 2015; 31(7):1539-1550..

Cervical cancer showed a decreasing trend for the state and almost all macro-regions in the period from 2001 to 2016, except for the Central North macro-region in which there was a stable trend from 2000 to 2003 and 2010 to 2016, and a reduction from 2003 to 2010. In the world, in recent decades, a decline in the incidence rate of cervical cancer has been observed, being higher in Latin America and Asia²⁸28 Zhang X, Zeng Q, Cai W, Ruan W. Trends of cervical cancer at global, regional, and national level: data from the Global Burden of Disease study 2019. BMC Public Health 2021; 21(1):894.. The trend in the incidence of cervical cancer in ten Brazilian capitals, with data from the RCBP from 1996 to 2011, showed a decrease in most of the capitals analyzed, highlighting Curitiba, São Paulo and Goiânia²⁹29 Instituto Nacional de Câncer (INCA). Magnitude da ocorrência do câncer do colo do útero no Brasil. Inform Vigil Cancer 2013; 4:1-16.. In a study carried out in Campinas, a reduction in the standardized incidence rate of cervical cancer was also observed, which went from 16.08 cases/100,000 women in 1991 to 1995 to 6.94 cases/100 thousand women in 2010 to 2014³⁰30 Ferreira MDC, Vale DB, Barros MBA. Incidence and mortality from breast and cervical cancer in a Brazilian town. Rev Saude Publica 2021; 55:67..

Improving access to health services, increasing the level of education or educational campaigns for vulnerable population groups, reducing the risk of HPV (Human Papillomavirus) infection and prevention campaigns are strategies which may contribute to reducing the incidence of cervical cancer³3 Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021: 71: 209- 249.^,3030 Ferreira MDC, Vale DB, Barros MBA. Incidence and mortality from breast and cervical cancer in a Brazilian town. Rev Saude Publica 2021; 55:67.. In Brazil, the offer of cervical cytopathological exams for women aged 25 to 64 has been increasing since 2015³¹31 Instituto Nacional de Câncer (INCA). Detecção precoce do câncer. Rio de Janeiro: INCA; 2021., and this age group is recommended for screening, every three years, according to current guidelines³²32 Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Diretrizes brasileiras para o rastreamento do câncer do colo do útero. Rio de Janeiro: INCA; 2016.. According to data from the National Health Survey, in Mato Grosso, in 2019, the percentage of women aged 25 to 64 who underwent the last preventive exam for cervical cancer less than 3 years ago was 79.7%³³33 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde [Internet]. [acessado 2023 set 17]. Disponível em: https://www.ibge.gov.br/estatisticas/sociais/saude/9160-pesquisa-nacional-de-saude.html
https://www.ibge.gov.br/estatisticas/soc... . Carrying out cytological tests for early diagnosis of cervical cancer produces positive impacts on morbidity and mortality rates³⁴34 Wright JD, Chen L, Tergas AI, Burke WM, Hou JY, Neugut AI, Ananth CV, Hershman DL. Population-level trends in relative survival for cervical cancer. Am J Obstet Gynecol 2015; 213(5):670.e1-7..

Lung cancer showed a stable trend in both sexes in the state and in almost all health macro-regions, except the East for men, which was decreasing, and for women, the Central North from 2001 to 2016, which was increasing, and South, which decreased from 2001 to 2007 and increased from 2007 to 2016. In relation to the state, for women there was a reduction from 2001 to 2008 and an increase from 2008 to 2016. Unlike the study that analyzed incidence trends in Cuiabá and Várzea Grande, it showed that for women there was stability in the period from 2000 to 2016 and an increase only for the age group from 50 to 79 years old, while for men it was decreasing for all the age groups³⁵35 Cabral JF, Caló RS, Evangelista FM, Reis JB, Oliveira JFP, Lima FCS, Galvão ND, Silva AMC. Trend analysis of lung cancer incidence and mortality in Grande Cuiabá, Mato Grosso, Brazil, 2000 to 2016. Rev Bras Epidemiol 2022; 25(Supl. 1):e220014..

At a global level, over ten years, decreasing incidence trends were identified in lung cancer among men and increasing incidence among women, which may be a reflection of patterns of adherence and cessation of smoking. For men, the countries with the most significant drop were Bahrain (AAPC: -6.53), Colombia (AAPC: -5.69) and Brazil (AAPC: -4.61). For women, there was a more dramatic increase in India (AAPC: 4.34), Brazil (AAPC: 2.43) and South Korea (AAPC: 2.35)³⁶36 Zhou B, Zang R, Zhang M, Song P, Liu L, Bie F, Peng Y, Bai G, Gao S. Worldwide burden and epidemiological trends of tracheal, bronchus, and lung cancer: a population-based study. EBioMedicine 2022; 78:103951..

The estimate for 2050 is that there will be around 3.8 million annual cases of lung cancer worldwide, even with current risk levels and age-specific rates³⁷37 Sharma R. Mapping of global, regional and national incidence, mortality and mortality-to-incidence ratio of lung cancer in 2020 and 2050. Int J Clin Oncol 2022; 27(4):665-675., and greater preventive interventions are recommended for specific populations³⁸38 Instituto Nacional de Câncer (INCA). Pesquisa especial de tabagismo. Rio de Janeiro: INCA; 2011.. Over the last 20 years, the tobacco control policy in Brazil has resulted in a sharp drop in the prevalence of smokers, due to legislative, social and political changes that have stimulated this change in behavior in society, achieving smoking cessation rates of up to 50%³⁹39 Sá VK, Coelho JC, Capelozzi VL, Azevedo SJ. Lung cancer in Brazil: epidemiology and treatment challenges. Lung Cancer (Auckl) 2016; 7:141-148..

Smoking is, by far, the most significant risk factor for lung cancer, not only in Brazil but also around the world³⁹39 Sá VK, Coelho JC, Capelozzi VL, Azevedo SJ. Lung cancer in Brazil: epidemiology and treatment challenges. Lung Cancer (Auckl) 2016; 7:141-148.^,4040 Siegel RL, Miller K, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1):7-30.. Despite the decrease in tobacco consumption, the country spends more than three times what it earns on tobacco use, with R$17.5 billion on indirect costs per year and R$39.4 billion on medical costs per year⁴¹41 Salem Szklo A, Lacerda Mendes F, Cavalcante TM, Viegas JR. Interferência da indústria do tabaco no Brasil: a necessidade do ajuste de contas. Rev Bras Cancerol 2020; 66(2):e-11878.. Since 2014, electronic cigarettes (a mixture of flavorings, solvents, and liquid nicotine) have gained ground in the consumer market around the world⁴²42 Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl Lung Cancer Res 2018; 7(3):220-233.. The current electronic cigarette market presents significant challenges for the formulation of regulatory policies, considering that electronic cigarettes are not regulated and with high levels of commercialization via the internet, facilitating substantial access to the product³⁶36 Zhou B, Zang R, Zhang M, Song P, Liu L, Bie F, Peng Y, Bai G, Gao S. Worldwide burden and epidemiological trends of tracheal, bronchus, and lung cancer: a population-based study. EBioMedicine 2022; 78:103951.. However, the components present in the particles in e-cigarette vapor can cause inflammatory damage to the airways and lungs, and long-term damage⁴³43 Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control 2014; 23(Suppl. 2):ii36-40..

For colorectal cancer, in both sexes, the state and macro-regions showed a stable trend, except in the North for males, where the trend was increasing. A different result from that observed in São Paulo, which showed an increase in the incidence of colorectal cancer among women, up to the age of 60 and among men, the trend in the incidence rate was increasing up to 29 years and in age groups from 40 years was stable for the total⁴⁴44 Oliveira MM. Desigualdades na incidência e mortalidade do câncer colorretal no Município de São Paulo e Brasil [Tese]. São Paulo: Faculdade de Saúde Pública da Universidade de São Paulo; 2018.. In low- and middle-income countries the incidence of colorectal cancer has increased, and in high-income countries it has decreased or stabilized⁴⁰40 Siegel RL, Miller K, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1):7-30..

Colorectal cancer is considered a marker of socioeconomic development in low- and middle-income countries⁴⁵45 Fidler MM, Soerjomataram I, Bray F. A global view on cancer incidence and national levels of the human development index. Int J Cancer 2016; 139(11):2436-2446.. However, in high-income countries, incidence rates show different behavior, especially for individuals over the age of 50, with stability and/or reduction⁴⁰40 Siegel RL, Miller K, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1):7-30.^,4646 Bailey CE, Hu C, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, Cantor SB, Chang GJ. Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers in the United States, 1975-2010. JAMA Surg 2015; 150(1):17-22.. The recommendations to be adopted to control colorectal cancer imply specialized care, combined with the implementation of measures and continuous efforts to monitor trends in the incidence of the disease⁴⁰40 Siegel RL, Miller K, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1):7-30..

Stomach cancer in the state of Mato Grosso showed a decreasing trend in both sexes and also in the Central Northwest and North macroregions for males and Central Northwest for females. Worldwide, the decline in stomach cancer incidence rates began in the mid-20th century, starting in North America and Europe, and in many other countries, including those in Asia and Latin America⁴⁷47 Torre LA, Siegel RL, Ward EM, Jemal A; Global Cancer Incidence and Mortality Rates and Trends. An Update. Cancer Epidemiol Biomarkers Prev 2016; 25(1):16-27.. In the municipalities of Cuiabá and Várzea Grande, from 2000 to 2016, a decreasing trend in the incidence rate was observed for men and stability for women²⁰20 Souza BSN, Melanda FN, Lima FCS, Silva PFO, Aguilar LB. Incidence trend of five main causes of cancer, in greater Cuiabá, Mato Grosso, Brazil, 2000 to 2016. Rev Bras Epidemiol 2022; 25(Supl.1):e220012.. In Fortaleza, between 1990 and 2002, stomach cancer showed a decreasing trend for men (APC = -1.9%) and an increase for women (APC = 8.5%)⁴⁸48 Oliveira JFP, Koifman RJ, Monteiro GTR. Câncer de estômago: tendência da incidência e da mortalidade no município de Fortaleza, Ceará. Cad Saude Colet 2012; 20(3):359-366..

Esophageal cancer showed a stable trend in the state in almost all health macro-regions, except for the Central Northwest macro-region, which saw a downward trend. In Brazil, the majority of cases are found in men, and increased from 69% in 2005 to 78% in 2015, with an increase in incidence from 12.8 to 19.1/100,000 men in the same period, while rates for women remained stable during the period. It is noteworthy that new cases presented higher concentrations in the southern regions of Brazil⁴⁹49 Amorim CA, Souza LP, Moreira JP, Luiz RR, Carneiro AJV, Souza HSP. Geographic distribution and time trends of esophageal cancer in Brazil from 2005 to 2015. Mol Clin Oncol 2019; 10(6):631-638..

Despite the presence of risk factors such as smoking, physical inactivity, inadequate food consumption and excess weight, on the other hand, there was also a reduction in tobacco consumption and H. Pylori infection, access to better foods (raw vegetables, citrus fruits), being a protective factor for stomach and esophageal cancer⁵⁰50 Plummer M, Franceschi S, Vignat J, Forman D, de Martel C. Global burden of gastric cancer attributable to pylori. Int J Cancer 2015; 136:487-490.

51 Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F; Gastric Cancer: Descriptive Epidemiology, Risk Factors, Screening, and Prevention. Cancer Epidemiol Biomarkers Prev 2014; 23(5):700-713.^-5252 Ilic M, Ilic I. Epidemiology of stomach cancer. World J Gastroenterol 2022; 28(12):1187-1203.. With the rise of new therapeutic technologies and early diagnosis, additional clarification on risk factors helps identify multiple prevention opportunities and reduce the impact of gastrointestinal cancers⁵²52 Ilic M, Ilic I. Epidemiology of stomach cancer. World J Gastroenterol 2022; 28(12):1187-1203.

53 Oliveira MM, Silva IPB, Teixeira R, Malta DC, Iser BPM. Esophageal cancer mortality in Brazil: a time-series analysis from the global burden of disease study. Arq Gastroenterol 2021; 58(1):100-106.^-5454 Cruz AIBM, Pinto LFR, Thuler LCS, Bergmann A. Perfil dos Pacientes com Câncer de Esôfago Diagnosticados entre 2001 e 2010 no Brasil. Rev Bras Cancerol 2018; 64(4):471-477..

This study provided information on the temporal trend of the five main types of cancer in Mato Grosso, disaggregated by health macro-regions, demonstrating the importance of RCBP for cancer surveillance in the state. The analysis of time series of cancer incidence is important to assist in the planning and evaluation of public policies for the prevention and control of the disease. This study advanced by analyzing an updated historical series with good representation of cancer in the state of Mato Grosso. Regarding the quality of RCBP data, for the period from 2001 to 2016, it was observed for RCBP Cuiabá, a percentage of cases registered only by death certificate (%SDO) lower than 20% (10.5% for males and 8.7% for females), while for RCBP Interior it was 25.8% for males and 19.4% for females. The percentage of microscopic verification was greater than 70% for registration in the capital and interior⁵⁵55 International Agency for Research on Cancer (IARC). Cancer incidence in five continents. Lyon: IARC; 2007.. As it is secondary data, it may present problems of underreporting, filling and coding errors, which were minimized by improving the quality of information over time⁶6 Bray F, Znaor A, Cueva P, Korir A, Swaminathan R, Ullrich A, Wang SA, Parkin DM. Planning and Developing Population-based Cancer Registration in Low- and Middle-income Settings. Lyon: International Agency for Research on Cancer; 2014..

The most common cancer among men was prostate cancer and showed an increasing trend for the state and four macro-regions, Central Northwest, East, West and South, and for women it was breast cancer with an increasing trend for the state and the Central North macro-region. Also noteworthy is the growing trend of lung cancer for the state in the period from 2008 to 2016 and the Central North and South macro-regions among women and colorectal cancer in the North macro-region among men. For cervical cancer, stomach cancer for both sexes and esophageal cancer for men, there was a reduction in incidence rates during the study period.

Differences in the incidence trends of the five types of cancer between the state’s macro-regions may reflect different stages of the demographic and epidemiological transition⁸8 Scatena JHG, Oliveira LR, Galvão ND, Neves MAB. O uso de indicadores compostos para classificação das regiões de saúde de Mato Grosso. In: Scatena JHG, Kehrig RT, Spinelli MAS, organizadores. Regiões de saúde: diversidade e processo de regionalização em Mato Grosso. São Paulo: Hucitec; 2014. p. 169-192., as well as the socioeconomic profile and the supply of health resources⁹9 Instituto Mato-Grossense de Economia Agropecuária. Mapa das macrorregiões do IMEA [Internet]. 2017. [acessado 2023 set 20]. Disponível em: https://www.imea.com.br/imea-site/view/uploads/metodologia/justificativamapa.pdf
https://www.imea.com.br/imea-site/view/u... ^,1111 Governo do Estado de Mato Grosso. Secretaria Estadual de Saúde. Resolução CIB/MT nº 57 de 26 de julho de 2018. Dispõe sobre as diretrizes do Planejamento Regional Integrado (PRI) estabelece a conformação das 16 (dezesseis) regiões de saúde no Estado de Mato Grosso em 06 (seis) macrorregiões [Internet]. 2018. [acessado 2023 abr 16]. Disponível em: http://www.saude.mt.gov.br/upload/noticia/2/arquivo/240820160127-SES-MT-A-mapa-de-saude-mt-2020.pdf
http://www.saude.mt.gov.br/upload/notici... . The results reinforce the need for specific cancer surveillance, prevention, control and assistance actions throughout the state, to guarantee the line of care and access to diagnosis and cancer care by strengthening and expanding the cancer treatment network in the Unified Health System. It is relevant to highlight the importance of actions to increase access to primary prevention, early diagnosis, treatment and rehabilitation, taking into account the social disparities that exist in the health macro-regions in the state of Mato Grosso.

Acknowledgments

To the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior for the master’s scholarship; the Mato Grosso State Health Department (SES-MT) and the Labor Public Ministry of the 23rd Region for the financial support for the project; and the Instituto Nacional do Cân cer (INCA) for the contribution to the training of cancer registrars.

References

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History