Background: Cervical cancer remains one of the leading cause of cancer-related mortality among women in Brazil. Despite the availability of screening and treatment, late diagnosis across the country has an impact on prognosis.
Objectives: To evaluate survival among women aged ≥25 years diagnosed with cervical cancer and to identify prognostic factors associated with early- and advanced-stage disease.
Methods: Data were obtained from the Hospital-Based Cancer Registry of the State of São Paulo (HBCR/SP). Women aged ≥25 years, residing in the State of São Paulo, and diagnosed with cervical cancer between January 1, 2010, and December 31, 2017 were included (n = 10,180) and followed until December 31, 2022. Variables analyzed according to clinical stage at diagnosis (TNM system: stages I–II as early-stage and III–IV as advanced-stage) included demographic characteristics (age strata and educational level), treatment (no treatment, defined as absence of oncologic therapy; surgical treatment; and non-surgical treatment), follow-up status (alive or death), and socioeconomic status (GEOSES and the Brazilian Deprivation Index – IBP). Sensitivity analyses assessed the impact of missing data, showing no significant differences. Overall survival (OS) was chosen to minimize bias due to misclassification of cause of death, as deaths related to cancer may be recorded under other causes. OS stratified by disease stage (early vs. advanced) was estimated using the Kaplan–Meier method, and prognostic factors were assessed with uni and multivariable Cox proportional hazards regression models. All statistical tests were two-sided, with a significance level of 0.05 and 95% confidence intervals. This project receives support from the São Paulo Research Foundation (FAPESP) and the State Health Secretariat.
Results: Squamous cell carcinoma and adenocarcinoma were frequently diagnosed at early than at advanced stages (51.7% and 64.0%, respectively; p<0.001). Advanced stage at diagnosis was the strongest predictor of survival. Early-stage disease was common among women aged 25-39 years (64.3%) and with higher education attainment (66.4%), whereas advanced-stage disease predominated in women aged ≥65 years (56.4%). Treatment patterns differed markedly by stage: 77.3% of surgically treated women had early-stage disease, while 81.2% of untreated women presented with advanced-stage disease. Socioeconomic indicators showed no significant associations with the outcomes analyzed. Five-year OS was 82% among surgically treated patients with early-stage disease, compared to 38% among those with advanced-stage disease. Among untreated patients with advanced-stage disease, one-year survival was 3%. In advanced-stage disease, women aged ≥65 years had a higher risk of death compared to those aged 25–39 years (HR=1.21; 95% CI: 1.21–1.34). In early-stage disease, lower educational attainment was associated with a graded increase in mortality risk, a pattern not observed in advanced-stage disease. Surgical treatment was independently associated with improved survival in both stage groups.
Conclusions/Implications: Disease stage at diagnosis remains the primary determinant of survival in cervical cancer. Inequalities in stage distribution by age and education, with the survival benefit associated with surgical treatment, underscore the impact of structural and socioeconomic factors on outcomes. These findings reinforce the need for public health strategies prioritizing equitable screening, early diagnosis, and access to treatment in Brazil.