Regional Disparities and Socioeconomic Determinants of Colorectal Cancer in Brazil: An Integrative Review of Surveillance and Access Barriers
Isabela Alicia Fink, Julia Loureiro Chaves Cé, Larissa Bettoni, Pietro Bica Belmonte, Izadora Luíza TramontiniPURPOSE
This study evaluated regional disparities in colorectal cancer (CRC) in Brazil, examining how cultural, socioeconomic, and structural factors influence epidemiologic patterns. The investigation focused on the interaction between geographic location and clinical outcomes, including incidence, mortality, staging at diagnosis, and treatment delays to inform evidence-based public health interventions within the Brazilian healthcare.
METHODS
An integrative literature review was conducted across PubMed, SciELO, and LILACS databases. Inclusion criteria focused on Brazilian CRC epidemiology and socioeconomic determinants. After screening, 20 studies were selected for final analysis. Findings were synthesized into four thematic domains: epidemiologic patterns, social determinants, behavioral risk factors, and healthcare system capacity following a systematic categorisation of identified evidence.
RESULTS
Marked asymmetries were identified across the four domains. Regarding epidemiologic patterns, a three-fold incidence disparity exists between the South/Southeast (25-30/100,000) and North/Northeast (10-15/100,000) regions. While incidence is higher in developed areas, mortality growth is significantly faster in the North and Northeast. Social determinants revealed that low educational attainment and public health system attendance predict higher probabilities of treatment delays exceeding 60 days. Behavioral risk factors, including high processed meat consumption and physical inactivity, account for annual costs to the public system of R$ 31 million and R$ 50.3 million, respectively, with higher prevalence in urbanized regions. Healthcare system capacity analysis showed that 37% of patients nationwide face treatment initiation delays >60 days. In specific regional cohorts, late-stage diagnosis (stages III-IV) reached 52.5% of cases. Although adenoma detection rates in Center-West services reached international standards (31-33%), structural barriers such as limited colonoscopy access and uneven oncology infrastructure persist as obstacles to early detection in historically underserved regions where health services remain structurally fragmented.
CONCLUSION
Colorectal cancer in Brazil is a phenomenon driven by economic transition and structural inequalities. While developed regions face a high burden associated with Westernized lifestyles, underserved areas suffer from diagnostic backlogs and rising mortality. These findings emphasize the need for equitable cancer control policies and intensified screening capacity in Low- and Middle-Income Countries (LMICs) to mitigate the impact of regional healthcare inequities and effectively optimize oncology resource allocation nationwide.