Background: Lung cancer (LC) is the leading cause of cancer-related mortality in Brazil as well as worldwide. Despite the universal health care in Brazil, access to diagnosis and oncological care, such as radiotherapy (RTX) and chemotherapy (CT), remains unequal. Additionally, limitations in health information systems contribute to underreporting of LC cases, mainly in socioeconomically disadvantaged regions. These challenges can impact the accurate estimation of the disease burden and compromise the planning and evaluation of public health policies. Therefore, identifying regional mortality patterns, the magnitude of underreporting, and disparities in access to treatment is essential for strengthening LC care within the Brazilian Unified Health System (Sistema Único de Saúde – SUS).
Objectives: To analyze LC mortality according to place of residence, estimating the extent of LC underreporting cases, and to evaluate access to radiotherapy (RTX) and chemotherapy (CT) in SUS, considering interstate patient mobility (travel) and sociodemographic profile by federative unit (FU).
Methods: A retrospective study was conducted using data from three national health information systems: the Mortality Information System (SIM), the Hospital Cancer Registry (RHC), and the Outpatient Information System of the SUS (SIA-SUS), specifically the Authorization for High-Complexity Procedures (APAC) records for radiotherapy and chemotherapy. The study period covered 2013 to 2019. Data correction and adjustment procedures were applied to improve completeness and consistency across databases, enabling the estimation of underreporting and a more accurate assessment of access to treatment. Mortality rates, treatment initiation patterns, interstate travel for care, and sociodemographic characteristics were analyzed by FU.
Results: In the study period, 206,828 LC deaths were recorded in Brazil, corresponding to an overall mortality rate of 108.2 per 100,000 inhabitants. Substantial regional variation was observed, with rates ranging from 46.3 per 100,000 in Amapá to 216.1 per 100,000 in Rio Grande do Sul State. LC underreporting was estimated at 36%, indicating a significant underestimation of the number of LC cases. Among patients registered in the RHC, approximately 30% initiated treatment with radiotherapy and 48% with chemotherapy. Access to both treatments was marked by pronounced regional inequalities, with significant interstate patient mobility. In FU without local radiotherapy or chemotherapy services, 100% of patients had to travel to other states to receive care. Additionally, lower proportions of white patients were observed in the North and Northeast regions, even when considering the ethnic distribution in the population, highlighting racial and regional disparities in treatment access.
Conclusion/Implications: Significant LC underreporting and profound regional and racial inequalities in access to radiotherapy and chemotherapy were found. These findings emphasize the need to strengthen mortality surveillance, expand and decentralize oncological treatment services, and increase early detection strategies. Addressing these disparities is essential to promote equity, enhancing the effectiveness of LC control policies and lowering preventable LC deaths in Brazil.