In several countries, such as Brazil, the oncological diagnosis usually occurs at an advanced stage of the disease. Thus, the aim of this study was to investigate temporal trends and factors associated with the cancer diagnosed at stage IV in Brazil in two decades.
Secondary-based study, with time series analysis for trend assessment and cross-sectional of factors associated with diagnosis of female breast, prostate, cervix uteri, colorectal, lung, stomach, lip and oral cavity, thyroid, esophagus or corpus uteri at stage IV.
1,218,322 cases were evaluated. The types of cancer with the highest proportion of stage IV at diagnosis in men and women, respectively, were: lung (53.7% and 57.4%), stomach (48.4% and 45.0%) and lip/oral cavity (53.5% and 43.4%). Most showed an increasing trend of annual percent change of cancer diagnosed at stage IV, being more pronounced in corpus uteri cancer (2013–2019: +7.4%, p < 0.001). The odds of cancer diagnosed at stage IV were associated with different factors, according to primary tumor site, but marked by the inverse association with female sex [odds ratio (OR) ranging from 0.42 to 0.91, p < 0.001] and direct association in cases with < 7 years of study (OR ranging from 1.08 to 1.81, p < 0.001), living without a partner (OR ranging from 1.06, p < 0.050 to1.27, p < 0.001), living in the South and Southeast regions (OR ranging from 1.04 to 1.13, p < 0.001), with more than one tumor (OR ranging from 1.19, p < 0.050 to 1.54, p < 0.001) and treated in Centers of High Complexity in Oncology (OR ranging from 1.03, p < 0.050 to1.24, p < 0.001).
There was a high frequency of cancer diagnosed at stage IV and an increasing trend in different cancer types, which were associated with distinct sociodemographic, lifestyle, and clinical factors.
- • Lung cancer had the highest proportion of diagnoses in stage IV.
- • Most types of cancer showed an increasing trend of annual percent change of diagnoses in stage IV.
- • The greatest growth of cancer diagnosed at stage IV occurred in corpus uteri cancer.
- • The cancer diagnosed at stage IV was associated to sociodemographic, lifestyle, and clinical factors.
- • Having social vulnerability was associated with the diagnoses in stage IV.
With increasing incidence, cancer is a public health problem and represents the second leading cause of death worldwide . In 2020, there were about 19.3 million new cases, and its global incidence is estimated to reach 28.4 million in 2040. The magnitude of this increase will be most notable in countries with low (95.0%) and medium (64.0%) Human Development Index (HDI) . In Brazil, the forecast for each year of the triennium 2020–2022 is that there will be about 625 thousand new cases .
In several countries, such as Brazil, the oncological diagnosis usually occurs at an advanced stage of the disease, and this epidemiological pattern is inﬂuenced by exposure to modifiable and non-modifiable risk factors, among which the barriers related to health services (difficult access, insufficient coverage of screening programs, and delays in diagnosis), as well as socioeconomic, cultural, and demographic inequities . Late diagnosis leads to higher morbidity and mortality , reaffirming the importance of early identification of the disease, reduction of delay in diagnosis and, consequently, the reduction of unfavorable outcomes.
Particularly in relation to cases of cancer diagnosed at stage IV, its magnitude is known to be expressive and variable according to the primary tumor site . Although analyzes of big data, such as the Integrator Module of Hospital Cancer Registries (HCR), can generate solid information on the clinical staging of the disease at diagnosis, the scientific literature lacks products from robust analyses of temporal trends and factors related to diagnosis at this stage of the disease to support the planning and readjustment of public health policies for cancer control in the country. Thus, the aim of the present study is to investigate the temporal trend and factors associated with the cancer diagnosed at stage IV in patients included in the integrated hospital-based cancer registry system in Brazil over two decades.