Temporal Trends in Lung Cancer Mortality Following Tobacco Control Policy Implementation in Brazil: A Three-Decade Population Analysis
Fernando Augusto Siuta dos Santos, Pedro Dytz Marin, Giulia Scain, Isabela Alicia Fink, Isadora Cristyne Parise, Julia Loureiro Chaves Cé, Stéphanie Klein Brum, Mariana Weremeier Weber, Martina de Sá, Rafaela Sumienski Girardi, Solana de MeloPURPOSE
Brazil is internationally recognized for implementing one of the world’s most successful tobacco control programs. This study aimed to evaluate the long-term epidemiological impact of comprehensive tobacco control policies on smoking prevalence and lung cancer mortality in Brazil over the past three decades, with emphasis on sex-specific and regional disparities relevant to global cancer prevention strategies.
METHODS
An ecological and temporal trend analysis was conducted using publicly available national data from Brazil’s Mortality Information System, National Cancer Institute, VIGITEL surveillance reports, and national health surveys from 1989 to 2023. Trends in adult smoking prevalence and age-standardized lung cancer mortality rates were analyzed by sex and macro-region to assess the long-term population health effects of national tobacco control policies.
RESULTS
Brazil achieved a major decline in adult smoking prevalence, decreasing from 34.8% in 1989 to approximately 9.3% in 2023 through sustained taxation, advertising restrictions, smoke-free legislation, and public health campaigns. Correspondingly, lung cancer mortality among men has demonstrated consistent reductions since the mid-2000s, reflecting the delayed but substantial benefits of reduced tobacco exposure. In contrast, female lung cancer mortality has shown slower declines, with stabilization or modest increases in specific age cohorts, likely reflecting later historical peaks in smoking prevalence among women. Regional disparities remain substantial: the South and Southeast continue to bear the highest absolute mortality burdens due to historical smoking concentration, while the North and Northeast demonstrate emerging vulnerabilities associated with socioeconomic inequities, changing tobacco exposure patterns, and reduced oncology access. These findings highlight both the success and the uneven distribution of long-term policy benefits.
CONCLUSION
Brazil’s tobacco control trajectory demonstrates that sustained, multisectoral public health interventions can significantly reduce smoking prevalence and reshape national lung cancer mortality patterns. However, persistent gender and regional disparities underscore the need for targeted cessation strategies, surveillance of emerging nicotine delivery systems, and equitable implementation of prevention and early detection policies. Brazil’s experience offers an important public health framework for other middle-income countries seeking to reduce tobacco-related cancer burdens.