Brazilian Regional Disparities in Colorectal Cancer Screening and Mortality: A Nationwide Ecological Study (2016–2025)
Paula Lopes, Gonçalo Zardin Chechi, Karen Klein, Giovana RechPURPOSE
In Brazil, colorectal cancer screening with colonoscopy is not routinely performed, prioritizing symptomatic patients to optimize healthcare resources. This study aimed to evaluate the impact of regional colonoscopy distribution on colorectal cancer mortality rates in Brazil, in order to better understand the need for expanding resources for screening strategies.
METHODS
A retrospective ecological observational study was conducted using secondary data obtained from the DATASUS database. Data from 2016 to 2025 were analyzed and stratified across the five Brazilian macroregions. Individuals aged 30-69 years with a diagnosis of Colorectal Cancer were included. The analyzed variables comprised regional mortality rates and the number of colonoscopies standardized per 100,000 inhabitants, adjusted according to population estimates from the Instituto Brasileiro de Geografia e Estatística.
RESULTS
In 2016, 261,458 colonoscopies were approved nationwide, corresponding to a rate of 126.87 procedures per 100,000 inhabitants. By 2025, this rate had increased by 140.6%, reaching 305.20 colonoscopies per 100,000 inhabitants. The highest regional rates throughout the study period were observed in the South (n = 165.39 in 2016; n = 424.38 in 2025) and Southeast (n = 179.49 in 2016; n = 421.82 in 2025). The North region consistently presented the lowest rates (n = 33.96 in 2016; n = 117.28 in 2025). Regarding colorectal cancer mortality, the national mortality rate decreased from 6.68 in 2016 to 6.24 in 2025. The South region showed the lowest mortality rates (n = 5.01 in 2016; n = 3.92 in 2025), whereas the North region presented the highest rates (n = 10.31 in 2016; n = 10.56 in 2025).
CONCLUSION
Colonoscopy rates increased nationwide throughout the study period; however, substantial regional disparities persisted. The South and Southeast regions, which receive greater healthcare investment, demonstrated the highest procedure rates, whereas the North, historically affected by disparities in healthcare access, consistently showed the lowest rates. The South also presented the lowest colorectal cancer mortality rates, suggesting a possible positive impact of greater investment in screening strategies. In contrast, the North and Southeast maintained persistently elevated and stable mortality rates, possibly reflecting a predominantly diagnostic rather than screening-based use of colonoscopy. These findings highlight the need to expand and optimize colorectal cancer screening strategies in Brazil.