Evolution of uterine cervical cancer mortality from 1979 to 1998 in the State of Rio Grande do Sul, Brazil A evolução da mortalidade por câncer

A decrease in uterine cervical cancer (CC) mortality has been observed in developed countries. However, mortality data in Brazil suggest that CC is one of the most frequent causes of cancer death in women; it is the fourth cause of death from cancer in women in Rio Grande Sul State. A time-trend ecological study was performed to analyze CC mortality trends in Rio Grande do Sul from 1979 to 1998. Data were collected from the Mortality Information System, Brazilian Ministry of Health (DATASUS). Standardized mortality ratios were calculated and linear regression was used for time-trend analysis. The impact of cervical cancer death on life expectancy was also estimated for the study population using potential years of life lost (PYLL). Standardized mortality ratios during the study period revealed a positive linear trend of 0.17, and the mean annual mortality rate was 7.58/100,000. Cervical cancer accounted for 21.9 ± 1.33 PYLL during the period. In conclusion, although CC is a preventable and curable disease, an increase is observed in mortality from this cause in Rio Grande do Sul State, which may suggest failure in screening programs for cervical cancer. Cervical Intraepithelial Neoplasia; Mortality; Women’s Health Introduction Uterine cervical cancer is one of the types of cancer with the highest incidence in women, since more than 471 thousand new cases are diagnosed per year worldwide 1. However, a reduction has been observed in cervical cancer incidence and mortality in developed countries in the last 50 years due to systematic screening programs for the population at risk 2. The uterine cervical cancer mortality rate in Canada, for example, was 11/100 thousand women in 1951 and declined to 2.39/100 thousand by 1995 3,4. In the United States the incidence of cervical cancer was 32.6/100 thousand women in the late 1940s and dropped to 7.9/100 thousand in 1989-1991, while the mortality rates also decreased, especially during the 1960s and 70s, with a mean reduction in both incidence and mortality rates of some 4.0% per year until the 1980s 5. However, the situation has been different in developing countries, principally in Latin America, the Caribbean, and Asia, with an annual increase in both incidence and mortality rates. In such countries, cervical cancer is one of the most frequent types of cancer and accounts for more than 24.0% of all female cancers and for 6 deaths per 100 thousand women 6,7. In Brazil, uterine cervical cancer is fifth among all malignant neoplasms, with more than 16 thousand new cases per year, occupying secKalakun L, Bozzetti MC 300 Cad. Saúde Pública, Rio de Janeiro, 21(1):299-309, jan-fev, 2005 ond place among cancers in females. The highest incidence rates are in the North and Northeast regions 8. In Rio Grande do Sul (in the South), uterine cervical cancer also shows high mortality rates, occupying fifth place 9. Uterine cervical cancer thus poses a major public health problem, especially in developing regions and even where there are programs for prevention and early detection. Thus far the failure of screening programs has been considered one of the most important factors for high cervical cancer rates. In the United States it has been estimated that an interruption of such programs would lead to an increase of 200.0 to 300.0% in the risk of women developing this cancer over the course of their lives 10. Uterine cervical cancer can thus be seen as a common cause of female morbidity and mortality in Rio Grande do Sul State and Brazil as a whole, although it is one of the most curable cancers, since its initial stage is long and it is highly detectable, appearing to suggest that a large number of women lack access to detection methods or ignore the problem’s importance. The current study aims to determine the uterine cervical cancer mortality trend among women in Rio Grande do Sul from 1979 to 1998 and relate it to the existence of official screening programs in the State, besides comparing these rates other States in Brazil and other countries, as well as evaluating the potential years of life lost (PYLL) by women as a consequence of early death from this disease.