Background
The cancer transition framework describes the shift from infection-related cancers, such as cervical cancer, toward cancers associated with aging and lifestyle, such as breast cancer, as societies develop. In Low- and Middle-Income Countries (LMICs), this transition often unfolds unevenly due to persistent social and health system inequalities. Brazil, characterized by profound regional disparities, provides a critical setting to examine how female cancer mortality reflects unequal progress in the cancer transition.
Objectives
To analyze long-term trends and regional patterns of breast and cervical cancer mortality among women in Brazil from 1980 to 2023, and to situate these trajectories within the global cancer transition using Sociodemographic Index (SDI) country groups, highlighting implications for equity-oriented cancer control in LMICs.
Methods
We conducted an ecological time-series study using age-standardized mortality rates for breast (C50) and cervical cancer (C53) derived from the Global Burden of Disease (GBD) 2023 study. Analyses were stratified by Brazil’s five macroregions and compared with five global SDI groups. Temporal trends were assessed using segmented log-linear Joinpoint regression, estimating Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals. Sensitivity analyses assessed the influence of the COVID-19 period.
Results
Marked regional inequalities were observed in both mortality levels and trends. Mean breast cancer mortality was highest in the Southeast (18.97 deaths/100,000) and South (18.20), and lowest in the North (11.08), whereas cervical cancer mortality showed the opposite gradient, peaking in the North (18.92) and reaching its lowest level in the Southeast (9.83).
Between 1980 and 2023, breast cancer mortality increased by 26.4% in the North, while high-SDI countries experienced a 35.7% reduction over the same period. Joinpoint analyses identified three national trend periods for breast cancer: an increase from 1980–1995 (APC +0.93%), a decline from 1995–2014 (APC −0.36%), and a renewed increase after 2014 (APC +0.42%). Regionally, sustained declines were observed in the South and Southeast from the mid-1990s onward, whereas the North and Northeast showed persistent increases in recent decades, aligning with low- and low-middle-SDI profiles.
Cervical cancer mortality declined nationwide, with a strong reduction from 1997–2023 (APC −1.95%). However, declines were substantially steeper in the South and Southeast (APCs up to −3.6%) compared with slower and more irregular reductions in the North and Northeast. By 2023, cervical cancer mortality in the North remained comparable to that observed in low-SDI countries globally, while the South and Southeast converged toward high-SDI patterns.
Conclusions / Implications
Female cancer mortality trends in Brazil reveal a highly unequal cancer transition. While wealthier regions display trajectories consistent with advanced transition stages, less developed regions face a dual burden of persistent cervical cancer mortality and rising breast cancer mortality. Equity-oriented strategies tailored to regional contexts are essential to accelerate cancer transition and reduce preventable female cancer mortality in LMIC settings.