ABSTRACT:

Objective:

To describe the mortality trend from all cancers and the five main ones in the state of Mato Grosso, Brazil, from 2000 to 2015.

Methods:

This is a descriptive, ecological, time series study, with data referring to deaths of residents of Mato Grosso due to cancer (ICD-10 codes C00 to C97), from the Mortality Information System (SIM). Time trend analyses of the standardized mortality rate from all cancers and five specific cancers (lung, prostate, breast, colorectal and cervical) for the state and according to macroregion (South, West, North, East and Center-North) were performed using linear regression (p<0.05).

Results:

From 2000 to 2015, 28,525 deaths from all cancers in residents of the state of Mato Grosso were recorded. An increasing trend was observed for all cancers, in addition to lung, breast and colorectal cancers. The South and North macroregions showed an increasing trend for all cancers, breast and colorectal, and Center-North for breast and colorectal. East showed an increasing trend for all cancers, prostate and colorectal, and decreasing for cervical.

Conclusion:

In the state of Mato Grosso, there was an increasing trend in mortality for all cancers and from specific ones, with emphasis on breast and colorectal cancer in most macroregions.

Keywords:
Mortality; Cancer; Health information systems; Temporal distribution

INTRODUCTION

Cancer is one of the main causes of incidence and early mortality in the world, and it is increasing rapidly. According to recent worldwide estimates, 19.3 million new cases (18.1 million excluding non-melanoma skin cancer) and nearly 10.0 million cancer deaths (9.9 million excluding non-melanoma skin cancer) occurred in 2020. It is expected that by 2040, there will be an increase of almost 50% in the number of new cases¹1 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71(3): 209-49. https://doi.org/10.3322/caac.21660
https://doi.org/10.3322/caac.21660... .

In Brazil, it is estimated that, for each year of the triennium 2020-2022, there are 625,000 new cases of cancer. The most common types, except for non-melanoma skin cancer, will be breast and prostate cancer (66,000 each), followed by colorectal (41,000), lung (30,000) and stomach cancer (21,000). The distribution of incidence by geographic region shows that the Southeast region concentrates more than 60% of new cases, followed by the Northeast (27.8%) and South (23.4%). There is, therefore, great variation in the magnitude and types of cancer between the different regions of Brazil. In the South and Southeast, the pattern of incidence shows that prostate and female breast cancers, as well as lung and intestine cancers, predominate. In the Central-West, the prostate, breast, cervical and stomach types predominate²2 Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2020: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2019. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf
https://www.inca.gov.br/sites/ufu.sti.in... .

Analysis of the trend in mortality from all cancers in the period from 1996 to 2010, in the country, revealed a significant increasing trend in the North and Northeast regions, decreasing trend in the Southeast region and stability in the South and Central-West regions. However, estimates indicate an increase in rates for the North and Northeast and a decrease for the Central-West and other regions by 2030³3 Barbosa IR, Souza DLB, Bernal MM, Costa ICC. Cancer mortality in Brazil: temporal trends and predictions for the year 2030. Medicine (Baltimore) 2015; 94(16): e746. https://doi.org/10.1097/MD.0000000000000746
https://doi.org/10.1097/MD.0000000000000... . In the period from 1990 to 2015, there was stability in mortality from all cancers in the country. However, a substantial decline was observed in the mortality rates for stomach cancer in women (-38.9%) and men (-37.3%), followed by a reduction for cervical cancer in women (-33.9%) and increase in colorectal cancer in men (+29.5%). In Mato Grosso, stomach cancer also showed a significant drop in women (-32.3%) and men (-42.6%), followed by cervical cancer (-32.1%) and an increase in colorectal cancer among men (+33.0%)⁴4 Guerra MR, Bustamante-Teixeira MT, Corrêa CSL, Abreu DMX, Curado MP, Mooney M, et al. Magnitude e variação da carga da mortalidade por câncer no Brasil e Unidades da Federação, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Suppl) 1: 102-15. https://doi.org/10.1590/1980-5497201700050009
https://doi.org/10.1590/1980-54972017000... .

Accordingly, the objective of this study was to analyze the temporal trend of standardized mortality rates for all cancers and for five specific cancers (lung, prostate, breast, colorectal and cervical) for the different macroregions of Mato Grosso, in the period from 2000 to 2015.

METHODS

We conducted a descriptive, ecological, time series study, in which the trend of standardized mortality rates for all cancers and the five most common cancers (lung, prostate, female breast, colorectal and cervical) was analyzed in the state of Mato Grosso, from 2000 to 2015.

Located in the Central-West region of Brazil, Mato Grosso has an estimated population of 3,526,220 inhabitants and an area of 903,207,050 km² (year 2020), with a population density of 3.36 inhabitants per km² (2010)⁵5 Brasil. Instituto Brasileiro de Geografia e Estatística. Cidades e Estados [Internet]. 2021 [accessed on Aug. 30, 2021]. Available at: https://www.ibge.gov.br/cidades-e-estados.html?view=municipio
https://www.ibge.gov.br/cidades-e-estado... . The state is divided into five macroregions (Center-North, East, North, West and South) and 141 municipalities (Figure 1).

Data on deaths of residents of Mato Grosso, registered between 2000 and 2015, were obtained through the Mortality Information System (SIM), as part of the Extension Project "VIGICAN: Cancer Surveillance and Associated Factors: Update of Population-Based and Hospital-Based Cancer Registries". Carried out in partnership with and with funding from the Mato Grosso State Health Department (SES-MT), the project ran from April 2016 to March 2021. To carry out the analyses and publish the results, SES-MT authorized the use of the data and the research project titled "Cancer and its associated factors: analysis of population-based and hospital-based registries".

To identify the underlying cause of death from cancers, the 10th edition of the International Classification of Diseases (ICD-10) was used, and the following codes were considered: C53 (cervical), C18 to C21 (colorectal), C50 (breast), C61 (prostate) and C34 (bronchi and lungs). Population data were obtained from the 2000 and 2010 Demographic Census, and for the intercensal periods, population estimates prepared by the Ministry of Health and made available through the Information Technology Department of the Unified Health System (DATASUS) were used⁶6 DATASUS. População residente – estudo de estimativas populacionais para os municípios, idade e sexo 2000-2021 – Brasil. Available at: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?popsvs/cnv/popbr.def
http://tabnet.datasus.gov.br/cgi/deftoht... . The number of cancer deaths was divided by the population over the period, multiplied by 100,000 inhabitants. Crude rates were calculated and then standardized by the direct method, considering the standard world population proposed by Segi⁷7 Segi M. Cancer mortality for selected sites in 24 countries (1950-1957). Sendai: Department of Public Health, Tohoku University, School of Medicine; 1960. and modified by Doll et al.⁸8 Doll R, Payne P, Waterhouse JAH. Cancer incidence in five continents vol. I. Berlin: Springer-Verlag; 1966..

A simple linear regression model was fitted that explored the relationship between two variables; in this case, the response variable was the standardized rate, and the explanatory variable was the year. The model has the following form:

Where: Y is the response variable (dependent); α is the intercept; β is the slope in relation to the explanatory variable (independent variable); and ε_i is the random component, which represents residual factors and possible measurement errors.

To visualize the trend in mortality rates by means of a percentage, the annual percent change (APC) was used. Its calculation was performed through the ratio between the regression coefficient and the mortality rate at the beginning of the analyzed period, in this case the rate referring to the year 2000, followed by multiplication by 100. The trend of the rates was interpreted as increasing (positive APC and p<0.05), decreasing (negative APC and p<0.05) or stable (p≥0.05). Data analysis was performed using Excel for Windows, Stata version 12.0 and R version 3.6.2 for Windows.

This study was approved by the Ethics Committee of Hospital Universitário Júlio Muller (CEP-HUJM), under approval No. 3.048.183, of November 20, 2018, and by the Research Ethics Committee of the Mato Grosso State Health Department (SES-MT), under approval No. 3.263.744, of April 12, 2019.

RESULTS

In the period from 2000 to 2015, there were 28,525 cancer deaths among residents of the state of Mato Grosso. Among the five cancers selected, the most frequent was lung cancer (12.0%), followed by prostate (8.7%), female breast (5.7%), colorectal (5.5%) and cervical (3.9%) cancer.

Regarding the temporal trend of standardized mortality rates in Mato Grosso, an increasing trend was observed for all cancers and lung, breast and colorectal cancer. For prostate and cervical, the trend was stable (Table 1).

When considering all cancers, the South, North and East macroregions showed an increasing trend and the West and Center-North macroregions, a stable trend. The lung cancer trend was stable for all macroregions. In the case of prostate cancer, there was a growing trend in the East microregion, and in all the others, the trend was stable. Breast cancer showed an increasing trend in the South, North and Center-North macroregions and a stable trend in the West and East. Colorectal cancer showed a stable trend in the West macroregion and an increasing trend in all others. Cervical cancer had a stable trend in all macroregions, with the exception of the East, where it showed a decreasing trend. (Table 2).

DISCUSSION

In Mato Grosso, from 2000 to 2015, there was an increasing trend in mortality from all cancers. Among the specific cancers, lung, female breast and colorectal also showed an increasing mortality trend in the state. For breast and colorectal cancer, the trend was increasing in most macroregions.

Chronic non-communicable diseases (NCDs) were responsible for 54.7% of deaths in Brazil in 2018. In part, these statistics are due to the demographic transition that the country has been going through, which go hand in hand with the aging of the population and the improvement in the quality of life and access to health services. In 2020, there were 717,939 deaths from NCDs in Brazil, of which 30.5% were due to cancer (ICD C00-C97). In Mato Grosso, 8,898 deaths from NCDs were recorded in the same year, with cancer being responsible for 29.93% of deaths; that is, the state follows the national trend of proportionality of deaths from cancer in relation to those from NCDs⁹9 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis. Plano de ações estratégicas para o enfrentamento das doenças crônicas e agravos não transmissíveis no Brasil 2021-2030. Brasília: Ministério da Saúde; 2021. Available at: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/doencas-cronicas-nao-transmissiveis-dcnt/09-plano-de-dant-2022_2030.pdf/#:~:text=O%20plano%20de%20A%C3%A7%C3%B5es%20Estrat%C3%A9gicas,a%20dirimir%20desigualdades%20em%20sa%C3%BAde
https://www.gov.br/saude/pt-br/centrais-... .

A study that evaluated mortality from chronic diseases in Brazil and its regions, between 2000 and 2011, showed that there was an average decline of 2.5% per year in the age group 30 to 69 years, in the set of the four main NCDs — which is in accordance with the Action Plan to Confront NCDs in Brazil, 2011–2022. However, cancer was the cause that showed the smallest decline (annual drop of 0.9%), falling behind cardiovascular causes, chronic respiratory diseases and diabetes and, therefore, not reaching the goals of the plan, which aims for annual reduction of 2%¹⁰10 Malta DC, Moura L, Prado RR, Escalante JC, Schimidt MI, Duncan BB. Mortalidade por doenças crônicas não transmissíveis no Brasil e suas regiões, 2000 a 2011. Epidemiol Serv Saúde 2014; 23(4): 599-608. https://doi.org/10.5123/S1679-49742014000400002
https://doi.org/10.5123/S1679-4974201400... .

Corroborating these findings, another study evaluated all states between 2000 and 2011 and classified them as lacking with regard to cancer; that is, none of them achieved a 2% reduction in mortality for NCDs in the age group 30 to 69 years old, as recommended by the National Plan¹¹11 Alves CG, Morais Neto OL. Tendência da mortalidade prematura por doenças crônicas não transmissíveis nas unidades federadas brasileiras. Ciênc Saúde Coletiva 2015; 20(3): 641-54. https://doi.org/10.1590/1413-81232015203.15342014
https://doi.org/10.1590/1413-81232015203... . In the present study, an unfavorable scenario was also observed, with an increasing trend in mortality from all cancers.

Regarding the five specific cancers, the Brazilian mortality scenario in 2019 was: among men, cancer of trachea, bronchi and lungs occupied first place with 13.8%, followed by prostate (13.1%) and colorectal (8.4%); among women, breast cancer was first with 16.4%, followed by trachea, bronchi and lungs (11.4%), colorectal (9.4%) and cervical (6%). In Mato Grosso, between 2000 and 2015, the five most common cancers, in descending order, were lung, prostate, breast, colorectal and cervical¹²12 Brasil. Ministério da Saúde. Instituto Nacional de Câncer. Causas e prevenção. Estatísticas de câncer [Internet]. 2021 [accessed on Aug. 19, 2021]. Available at: https://www.inca.gov.br/numeros-de-cancer
https://www.inca.gov.br/numeros-de-cance... .

In this state, an increasing trend in the standardized mortality rate for all cancers was found, with an increase in the East macroregion, which showed the highest APC, in contrast to the Center-North macroregion, with a small non-significant change, indicating stability. This fact follows the scenario of developing countries, in which mortality trends have also been increasing in recent decades, and differs from developed countries, such as Canada and the United States, in which, despite the high incidence rates for all cancers, the mortality trend is in decline¹³13 Hulvat MC. Cancer incidence and trends. Surg Clin North Am 2020; 100(3): 469-81. https://doi.org/10.1016/j.suc.2020.01.002
https://doi.org/10.1016/j.suc.2020.01.00... . This is thanks to extensive cancer screening, which favors early detection and effective treatment¹1 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71(3): 209-49. https://doi.org/10.3322/caac.21660
https://doi.org/10.3322/caac.21660... ,¹⁴14 Bray F, Piñeros M. Cancer patterns, trends and projections in Latin America and the Caribbean: a global context. Salud Publica Mex 2016; 58(2): 104-17. https://doi.org/10.21149/spm.v58i2.7779
https://doi.org/10.21149/spm.v58i2.7779... .

In the Brazilian context, in a study that analyzed cancer mortality trends in Brazilian capitals, from 1980 to 2004¹⁵15 Tallon B, Monteiro D, Soares L, Rodrigues N, Morgado F. Tendências da mortalidade por câncer de colo no Brasil em 5 anos (2012-2016). Saúde Debate 2020; 44(125): 362-71. https://doi.org/10.1590/0103-1104202012506
https://doi.org/10.1590/0103-11042020125... , a decreasing or stable trend was found for the most frequent cancers. It was also observed that the Southeast and South regions had a decrease in mortality rates when compared to the Northeast and North, which showed an increase, and with the Central-West, which showed an increase followed by stability — rates associated with patterns related to poverty and sedentary lifestyle¹⁶16 Azevedo e Silva G, Jardim BC, Ferreira VM, Junger WL, Girianelli VR. Mortalidade por câncer nas capitais e no interior do Brasil: uma análise de quatro décadas. Rev Saúde Pública 2020; 54: 126. https://doi.org/10.11606/s1518-8787.2020054002255
https://doi.org/10.11606/s1518-8787.2020... .

The literature is conflicting regarding these findings, but there seems to be a higher incidence trend in developed areas, while those in development account for the higher mortality, probably due to unfavorable socioeconomic factors, delay in diagnosis and insufficient access to adequate therapy. This trend seems to follow the course of Latin America, where there was an increase in cancer mortality between 1979 and 2010, which demonstrates the influence of socioeconomic factors on the epidemiology of the disease¹⁷17 Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14(5): 391-436. https://doi.org/10.1016/S1470-2045(13)70048-2
https://doi.org/10.1016/S1470-2045(13)70... . In Brazil, studies indicate regional variations in cancer mortality indicators. In a study that evaluated the trend in cancer mortality in Brazil between 1980 and 2006, higher mortality was identified in the countryside compared to capitals, and the general trends in mortality in the country did not indicate a reduction in that period¹⁸18 Azevedo e Silva G, Gamarra CJ, Girianelli VR, Valente JG. Tendência da mortalidade por câncer nas capitais e interior do Brasil entre 1980 e 2006. Rev Saúde Pública 2011; 45 (6): 1009-18. https://doi.org/10.1590/S0034-89102011005000076
https://doi.org/10.1590/S0034-8910201100... .

Variations in mortality rates for different types of cancer have been observed in national studies, such as increasing trends for cervical cancer between 2012 and 2016, with a greater number of deaths in the range between 50 and 54 years¹⁵15 Tallon B, Monteiro D, Soares L, Rodrigues N, Morgado F. Tendências da mortalidade por câncer de colo no Brasil em 5 anos (2012-2016). Saúde Debate 2020; 44(125): 362-71. https://doi.org/10.1590/0103-1104202012506
https://doi.org/10.1590/0103-11042020125... . However, in the present investigation, this type was the only one to show a decreasing trend in the East macroregion, when compared to the other types and macroregions of the state.

In the Central-West region, lung cancer in a more recent period (1995-2017) showed a decrease in the capitals and an increase in the countryside, tending to decrease in intensity throughout the period, among men. In women, there was an increase in both areas, also with a decrease in intensity¹⁶16 Azevedo e Silva G, Jardim BC, Ferreira VM, Junger WL, Girianelli VR. Mortalidade por câncer nas capitais e no interior do Brasil: uma análise de quatro décadas. Rev Saúde Pública 2020; 54: 126. https://doi.org/10.11606/s1518-8787.2020054002255
https://doi.org/10.11606/s1518-8787.2020... . In the period 1990–2015, there was an increase of 20.7% in females and a reduction of 12% in males⁴4 Guerra MR, Bustamante-Teixeira MT, Corrêa CSL, Abreu DMX, Curado MP, Mooney M, et al. Magnitude e variação da carga da mortalidade por câncer no Brasil e Unidades da Federação, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Suppl) 1: 102-15. https://doi.org/10.1590/1980-5497201700050009
https://doi.org/10.1590/1980-54972017000... . Similar results were found by Malta et al.¹⁹19 Malta DC, Abreu DMX, Moura L, Lana GC, Azevedo G, França E. Trends in corrected lung cancer mortality rates in Brazil and regions. Rev Saúde Pública 2016; 50: 33. https://doi.org/10.1590/S1518-8787.2016050006209
https://doi.org/10.1590/S1518-8787.20160... between 1996 and 2011, despite the fact that absolute mortality was higher in men. In the present study, although a non-significant increase between 1 and 2% was observed in almost all macroregions, classifying trends as stable, a small significant increase was observed in the state. It is worth mentioning that, despite the reduction in the prevalence of current smokers having been verified in Brazil and regions thanks to the success of the programs and the continuous monitoring of this risk factor, no significant reduction was observed among women in Mato Grosso²⁰20 Malta DC, Vieira ML, Szwarcwald CL, Caixeta R, Brito SMF, Reis AAC. Tendência de fumantes na população Brasileira segundo a Pesquisa Nacional de Amostra de Domicílios 2008 e a Pesquisa Nacional de Saúde 2013. Rev Bras Epidemiol 2015; 18 Suppl 2: 45-56. https://doi.org/10.1590/1980-5497201500060005
https://doi.org/10.1590/1980-54972015000... .

For breast cancer, stable⁴4 Guerra MR, Bustamante-Teixeira MT, Corrêa CSL, Abreu DMX, Curado MP, Mooney M, et al. Magnitude e variação da carga da mortalidade por câncer no Brasil e Unidades da Federação, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Suppl) 1: 102-15. https://doi.org/10.1590/1980-5497201700050009
https://doi.org/10.1590/1980-54972017000... ,²¹21 Gonzaga CMR, Freitas-Junior R, Curado MP, Sousa ALL, Souza-Neto JA, Souza MR. Temporal trends in female breast cancer mortality in Brazil and correlations with social inequalities: ecological time-series study. BMC Public Health 2015; 15: 96. https://doi.org/10.1186/s12889-015-1445-7
https://doi.org/10.1186/s12889-015-1445-... and increasing trends were observed in the country²²22 Kluthcovsky ACGC, Faria TN, Carneiro FH, Strona R. Female breast cancer mortality in Brazil and its regions. Rev Assoc Med Bras 2014; 60(4): 387-93. https://doi.org/10.1590/1806-9282.60.04.019
https://doi.org/10.1590/1806-9282.60.04.... . In the present study, an increasing trend was also observed in the state, as well as an increase in three of the five macroregions (South, Center-North and North) and stability for the others. The difficulty in accessing early diagnosis services, delay in diagnosis and time interval between diagnostic tests and adequate treatment of breast cancer can promote disease progression²²22 Kluthcovsky ACGC, Faria TN, Carneiro FH, Strona R. Female breast cancer mortality in Brazil and its regions. Rev Assoc Med Bras 2014; 60(4): 387-93. https://doi.org/10.1590/1806-9282.60.04.019
https://doi.org/10.1590/1806-9282.60.04.... .

It is noteworthy that there are barriers to screening and early detection of different types of cancer. With regard to breast cancer, despite the recommendation of a routine mammogram for women between 50 and 69 years old once every two years, the lack of resources to acquire state-of-the-art equipment and hire specialists trained to handle the instrumentation and read the imaging results can compromise the mammogram coverage²³23 Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil. Rio de Janeiro: INCA; 2015 [accessed on Aug. 3, 2021]. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//diretrizes_deteccao_precoce_cancer_mama_brasil.pdf
https://www.inca.gov.br/sites/ufu.sti.in... ,²⁴24 Migowski A, Azevedo e Silva GA, Dias MBK, Diz MDPE, Sant’Ana DR, Nadanovsky P. Diretrizes para detecção precoce do câncer de mama no Brasil: II – Novas recomendações nacionais, principais evidências e controvérsias. Cad Saúde Pública 2018; 34(6): e00074817. https://doi.org/10.1590/0102-311X00074817
https://doi.org/10.1590/0102-311X0007481... .

For cervical cancer, the existing national screening policy recommends a Pap smear test for women between 25 and 64 years old, who have been or are sexually active. The application of this method by health professionals has proven to be effective; however, there is the possibility of false-negative and false-positive results in the tests performed; and due to the manifestation of symptoms only in advanced stages, cervical cancer may have its screening impaired²⁵25 Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. Divisão de Detecção Precoce e Apoio à Organização de Rede. Diretrizes brasileiras para o rastreamento do câncer do colo do útero. 2ᵃ ed. rev. atual. Rio de Janeiro: INCA; 2016. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//diretrizesparaorastreamentodocancerdocolodoutero_2016_corrigido.pdf
https://www.inca.gov.br/sites/ufu.sti.in... ,²⁶26 Organização Pan-Americana da Saúde. Controle integral do câncer do colo do útero. Guia de práticas essenciais. Washington: OPAS; 2016. Available at: https://iris.paho.org/bitstream/handle/10665.2/31403/9789275718797-por.pdf?sequence=1&isAllowed=y
https://iris.paho.org/bitstream/handle/1... . Despite showing a stable trend in Mato Grosso and in most macroregions, it was the only type that showed a reduction in mortality trend. One of the goals of the National Plan is to increase the coverage of this preventive examination. According to data from VIGITEL 2016, in 27 cities examined, 81% of women between 25 and 64 had a Pap smear in the last three years. Cuiabá reached 78%, ranking 15th²⁷27 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2016. Brasília: Ministério da Saúde; 2017. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2016_fatores_risco.pdf
https://bvsms.saude.gov.br/bvs/publicaco... .

Colorectal cancer is the third most common type in the world and the second in terms of mortality¹1 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71(3): 209-49. https://doi.org/10.3322/caac.21660
https://doi.org/10.3322/caac.21660... . In Brazil, it is the second in incidence and third in mortality²2 Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2020: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2019. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf
https://www.inca.gov.br/sites/ufu.sti.in... . In developed countries, there are screening programs, accompanied by early diagnosis and effective treatment, which contribute to reducing mortality trends of this cancer²⁸28 Bishehsari F, Mahdavinia M, Vacca M, Malekzadeh R, Mariani-Costantini R. Epidemiological transition of colorectal cancer in developing countries: environmental factors, molecular pathways, and opportunities for prevention. World J Gastroenterol 2014; 20(20): 6055-72. https://doi.org/10.3748/wjg.v20.i20.6055
https://doi.org/10.3748/wjg.v20.i20.6055... . Such programs are not fully implemented in Brazil or Mato Grosso. The disease has a much better prognosis when its lesions are detected at an early stage, and the main screening tests are fecal occult blood tests and endoscopic examinations (colonoscopy or rectosigmoidoscopy). The World Health Organization (WHO) advises that all people over 50 years of age undergo a fecal occult blood test, if the country has conditions for diagnostic confirmation, referral and adequate treatment²⁹29 World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Genebra: World Health Organization; 2013. Available at: https://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng.pdf?sequence=1&isAllowed=y
https://apps.who.int/iris/bitstream/hand... .

Colorectal cancer screening is justified for several reasons: the incidence of the disease is high and its preclinical stage is long³⁰30 Kuipers EJ, Rösch T, Bretthauer M. Colorectal cancer screening--optimizing current strategies and new directions. Nat Rev Clin Oncol 2013; 10(3): 130-42. https://doi.org/10.1038/nrclinonc.2013.12
https://doi.org/10.1038/nrclinonc.2013.1... . Furthermore, it can start as an easily treatable adenoma, whose progression to a malignant lesion takes between five and ten years³¹31 Brenner H, Altenhofen L, Stock C, Hoffmeister M. Natural history of colorectal adenomas: birth cohort analysis among 3.6 million participants of screening colonoscopy. Cancer Epidemiol Biomarkers Prev 2013; 22(6): 1043-51. https://doi.org/10.1158/1055-9965.EPI-13-0162
https://doi.org/10.1158/1055-9965.EPI-13... . It is also worth mentioning that the five-year survival rates for patients whose lesion is detected at an early stage are approximately 90%, while, if the cancer is detected at an advanced stage, they are around 10%³²32 Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJY, Young GP, et al. Colorectal cancer screening: a global overview of existing programmes. Gut 2015; 64(10): 1637-49. https://doi.org/10.1136/gutjnl-2014-309086
https://doi.org/10.1136/gutjnl-2014-3090... . Finally, as the follow-up of the disease and its treatment are very expensive, screening can save public resources³³33 Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG, Habbema JDF, Kuipers EJ. Effect of rising chemotherapy costs on the cost savings of colorectal cancer screening. J Natl Cancer Inst 2009; 101(20): 1412-22. https://doi.org/10.1093/jnci/djp319
https://doi.org/10.1093/jnci/djp319... . However, this is not the reality in Brazil. The Ministry of Health prioritizes early diagnosis actions for patients with clinical suspicion of colorectal cancer; and screening for high-risk patients with a family history of colorectal cancer or suspected Lynch syndrome or familial adenomatous polyposis³⁴34 Brasil. Ministério da Saúde. Proctologia. Protocolos de encaminhamento da atenção básica para a atenção especializada; vol. 7. Brasília: Ministério da Saúde; 2016. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/protocolos_atencao_basica_especializada_proctologia_v_VII.pdf
https://bvsms.saude.gov.br/bvs/publicaco... .

In Mato Grosso, the highest annual percent increase was found for colorectal cancer. The disease affects both sexes, but especially among men (variations of 29.5% in males and 12.5% in females) and for all age groups, except women over 70 years of age because of the lack of public tracking policies³⁵35 Oliveira MM, Latorre MRDO, Tanaka LF, Rossi BM, Curado MP. Disparidades na mortalidade de câncer colorretal nos estados brasileiros. Rev Bras Epidemil 2018; 21: E180012. https://doi.org/10.1590/1980-549720180012
https://doi.org/10.1590/1980-54972018001... .

In the present study, the types of cancer that stood out showed an increasing mortality trend in the South, North and Center-North macroregions. These are marked by having high mortality rates, expressed through the socioeconomic indicators of the municipalities that integrate them, as well as inequalities in established capacity and in public and private investments, such as lower availability of primary care services, low health expenditures, low availability of specialized care establishments and low outpatient care, per inhabitant, of medium and high complexity³⁶36 Scatena JHG, Oliveira LR, Galvão ND, Neves MAB. Caracterização das regiões de saúde de Mato Grosso. In: Scatena JHG, Kehrig RT, Spinelli MAS, ed. Regiões de saúde: diversidade e processo de regionalização em Mato Grosso. São Paulo: Hucitec; 2014. p. 135-67.–³⁸38 Alves MR, Galvão ND, Souza RAG, Andrade ACD, Oliveira JCS, Souza DSN, et al. Distribuição espacial e temporal da mortalidade por câncer em um estado da Amazônia Legal Brasileira entre 2000 e 2015. Rev Bras Epidemiol 2021; 24 (suppl 1): E210009. https://doi.org/10.1590/1980-549720210009.supl.1
https://doi.org/10.1590/1980-54972021000... . Another characteristic of the state is that agriculture is the economic base of practically all municipalities. Therefore, there is intensive use of chemical fertilizers and pesticides and biotechnology. It should be noted that the macroregions mentioned include municipalities close to BR-163, a federal highway used to transport agricultural production to other countries, so the regional population, in turn, is exposed to pesticides through the environment, food and water contamination³⁸38 Alves MR, Galvão ND, Souza RAG, Andrade ACD, Oliveira JCS, Souza DSN, et al. Distribuição espacial e temporal da mortalidade por câncer em um estado da Amazônia Legal Brasileira entre 2000 e 2015. Rev Bras Epidemiol 2021; 24 (suppl 1): E210009. https://doi.org/10.1590/1980-549720210009.supl.1
https://doi.org/10.1590/1980-54972021000... .

As this was an ecological study, possible limitations due to the occurrence of bias or confounders cannot be ruled out. The underreporting of deaths stands out as a potential bias, observed in studies that used secondary data³⁹39 Silva GDM, Duarte EC, Cruz OG, Garcia LP. Identificação de microrregiões com subnotificação de casos de tuberculose no Brasil, 2012 a 2014. Epidemiol Serv Saude 2020; 29(1): e2018485. https://doi.org/10.5123/S1679-49742020000100025
https://doi.org/10.5123/S1679-4974202000... –⁴¹41 Tiago ZS, Picoli RP, Graeff SVB, Cunha RV, Arantes R. Subnotificação de sífilis em gestantes, congênita e adquirida entre povos indígenas em Mato Grosso do Sul, 2011-2014. Epidemiol Serv Saúde 2017; 26(3): 503-12. https://doi.org/10.5123/S1679-49742017000300008
https://doi.org/10.5123/S1679-4974201700... .

Analyzing cancer mortality can contribute to future epidemiological research on the issue, not only for Mato Grosso but also on the country level. Although there are studies on the subject, they are still scarce, and there is a need to expand our knowledge to identify priority areas (aimed at reducing mortality).

ETHICAL APPROVAL

The study was assessed and approved by the Ethics Committee of Hospital Universitário Júlio Muller (CEP-HUJM) under CAAE No. 98150718.1.0000.8124, approval No. 3.048.183, of November 20, 2018, and by the Research Ethics Committee of the Mato Grosso State Health Department (SES-MT), CAAE No. 98150718.1.3003.5164, approval No. 3.263.744, of April 12, 2019.

ACKNOWLEDGMENTS

To the Mato Grosso State Health Department and to the Ministry of Labor (23rd Region) for funding.

REFERENCES

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