Background: Cervical cancer (CC) remains a major public health problem in Brazil, with approximately 17,000 new cases annually (incidence ~15/100,000).
Objectives: To analyze national hospital cancer registry data (2010-2020) to estimate the prevalence of advanced-stage diagnosis, delays in treatment initiation (>60 days), and lack of surgery as the initial treatment among women with CC. We also aimed to identify sociodemographic and regional factors associated with these outcomes, assess temporal trends, and highlight regional inequalities.
Methods: We conducted a hospital-based cross-sectional study including 56,217 women aged ≥18 years diagnosed with CC between 2010 and 2020. Data were obtained from the RHC-INCA (Hospital Cancer Registries - National Cancer Institute) Integrator and the São Paulo state Cancer Registry (Oncocentro Foundation of São Paulo, FOSP). Outcomes included advanced stage disease (III–IV), treatment delay (>60 days from diagnosis to treatment initiation), and absence of surgery as the first treatment modality. Descriptive analysis and multivariate Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals.
Results: Overall, 52.4% of women were diagnosed at an advanced stage (III–IV). The median time from diagnosis to treatment initiation was 65 days (mean: 80 days), and 57% of patients started treatment  after 60 days. Only 28% underwent surgery as the initial treatment, and approximately 59% did not receive surgery at any point during treatment. Marked regional disparities were observed, with worse outcomes in the North and Northeast regions compared to the South and Southeast. For example, nearly 70% of women in the North started treatment after 60 days, compare with 50% in the South. In multivariable analyses, advanced-stage diagnosis was more prevalent among Black (PR = 1.07; 95% CI 1.02–1.12), Mixed-race (PR = 1.04; 95% CI 1.01–1.07), or Indigenous women (PR = 1.10; 95% CI 1.01–1.20) compared to White women. Older age was positively associated with late diagnosis (≥60 years vs. <45 years; PR ≈ 1.30), and lower education attainment (incomplete primary education vs. higher education; PR ≈ 1.28). Treatment delays were more frequent among Black and Mixed-race (PR ≈ 1.05) and those with lower education levels (PR ≈ 1.10–1.20).
Conclusions: Striking inequalities persist in cervical cancer control in Brazil. Approximately half of women are diagnosed at an advanced stage, and a large proportion experience delays treatment initiation, particularly among socially vulnerable groups including non-White women, those with lower education, and residents of the North and Northeast regions  (those with the least social development). These findings underscore the need for targeted policies and interventions to reduce inequities and support Brazil’s progress towards achieving the World Health Organization 2030 targets, contributing to the elimination of cervical cancer as a public health problem.