20.03.2025 Public Health

Cancer mortality on the rise

Epidemiological transition from cardiovascular disease to cancer is challenging researchers and health systems, says a Brazilian researcher

Moura Leite Netto

Cardiovascular diseases, such as hypertension and myocardial infarction, continue to be the main cause of death nationwide in Brazil. But a paper recently published in The Lancet Regional Health – Americas revealed that between 2000 and 2019, cancer took over as the leading cause of death in 727 Brazilian cities, equivalent to 13% of the country’s 5,570 municipalities.

In 2000, the cancer mortality rate was only higher than deaths from cardiovascular disease in 7% of Brazilian cities.

Leandro Rezende, a professor of physical education at the Paulista School of Medicine of the Federal University of São Paulo (UNIFESP) and coauthor of the article, explains that more economically developed regions of the country, like the Southeast, registered a more significant drop in deaths from cardiovascular disease.

Cancer, meanwhile, continues to rise in all regions, including areas with fewer resources and less access to health services.

In an interview with Science Arena, Rezende highlighted that the drop in deaths from cardiovascular diseases is largely due to anti-smoking policies and advances in primary healthcare, while cancer cases have increased due to factors such as aging populations and modern lifestyle habits, including the consumption of ultra-processed foods (usually high in fats, sugars, and preservatives).

Science Arena – What are the main factors behind the increase in deaths from cancer compared to cardiovascular diseases? Was there any specific factor that surprised the research team?

Leandro Rezende – The main explanation for the steep decline in deaths from cardiovascular disease is the reduction in smoking as a result of tobacco control policies implemented in Brazil since the 1990s (such as taxation, labeling, and smoke-free zones).

This reduction is more measurable in the short term for cardiovascular diseases, whereas for cancer, it will take a few more years before we can observe a significant drop—as we hope to see in deaths from lung cancer, for example.

Cancer is a heterogeneous disease, which makes it more challenging to treat.

Do these risk factors explain why municipalities with the highest per capita income have the greatest increase in cancer mortality?

The fact that we have shown that cancer has gradually become the leading cause of death in several municipalities in Brazil, especially in those with higher per capita income (in states such as São Paulo, Rio de Janeiro, and Rio Grande do Sul), is a reflection of the greater control of cardiovascular diseases in these populations.

In municipalities with a higher per capita household income, there was also an increase in cancer cases driven by factors such as aging populations and modern lifestyle choices, particularly the high consumption of ultra-processed foods.

Were there also positive advances in cardiology that contributed to the reduction in mortality from cardiovascular disease compared to deaths from cancer?

With the increase in primary healthcare coverage in Brazil, comorbidities such as hypertension and diabetes are now better managed, especially in higher-income municipalities.

Furthermore, earlier diagnosis and better treatment of cardiovascular diseases may have contributed to the epidemiological transition to cancer predominating in terms of mortality.

What are the main barriers to early diagnosis and adequate treatment of cancer in Brazil, especially in areas with more limited health infrastructure?

It is crucial that we improve primary cancer prevention, which means preventing the disease from occurring, in order to curb the rising mortality. In secondary prevention, which consists of early diagnosis, there are bottlenecks even in the country’s disease surveillance programs.

Prevention and early detection of cancer are fundamental to reducing mortality in cancer patients.
erogeneous disease, which makes it more challenging to treat.

At the same time, comprehensive policies that focus on modifiable risk factors [conditions or behaviors that can be altered by making lifestyle changes] are critical to substantially reducing mortality from all chronic noncommunicable diseases, including cancer and cardiovascular disease.

With cancer mortality surpassing deaths from cardiovascular disease in one in eight Brazilian cities, what structural changes do the public and private health systems need to adopt, taking into account the country’s social disparities?

Approximately one-third of cancer deaths could be prevented by reducing known risk factors. Public policies and programs are needed that not only encourage people to make individual changes, but that actually stimulate substantial transformations in the habits of the population.

Taxing and regulating the advertising of ultra-processed foods, for example. These are tools that need to be used to gain effective control over risk factors.

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