S1356
Interdisciplinary - Global health
ESTRO 2026
Digital Poster 1425 Impact of radiotherapy infrastructure on cancer mortality in Brazil: an ecological analysis Lucas Uglione Da Ros 1,2 , Valentina de Souza Stanham 1 , Arthur Bom Queiroz 1,3 , Laura Lessa Gaudie-Ley 1 , Lilian Faroni 4 , Daniela Vargas Barletta 1,5 , Marta Nassif Pereira Lima 1,5 , Daniela Dornelles Rosa 6 1 Radiotherapy, HCPA, Porto Alegre, Brazil. 2 PPGFT, UFRGS, Porto Alegre, Brazil. 3 PPGCM, HCPA, Porto Alegre, Brazil. 4 Radiotherapy, Clínica São Vicente - Oncologia D'Or, Rio de Janeiro, Brazil. 5 Radiotherapy, Hospital Moinhos de Vento, Porto Alegre, Brazil. 6 Oncology, HCPA, Porto Alegre, Brazil Purpose/Objective: Brazil maintains universal screening programs for cervical, breast, and colorectal cancers. Cervical cancer screening, primarily via Pap smear, demonstrates high adherence (~80%), offering a robust early detection pathway. In contrast, breast cancer screening adherence is moderate (~60%), and a structured national program for colorectal cancer screening remains absent despite clinical recommendations. Radiotherapy (RT) is a critical component across the multidisciplinary management of these malignancies, employed with diverse intents including neoadjuvant, radical, and adjuvant treatments. This study aimed to evaluate the ecological impact of radiotherapy infrastructure availability on state-level mortality rates for these cancers, particularly within the varied landscape of screening program effectiveness. Material/Methods: We conducted an ecological analysis utilizing publicly available government data on the distribution of RT centers, both in the public health system (SUS) and supplementary care, and state-specific mortality rates for cervical, breast, and colorectal cancers across Brazil. We adjusted mortality rates for incidence, to account for interstate differences in screening. Spearman correlation tests were performed to assess the relationship between RT availability and cancer mortality. A significance threshold of p < 0.05 was adopted. All statistical analyses were conducted using R. Results:
A significant inverse correlation was observed between the number of RT centers and reduced cervical cancer mortality among Brazilian states (r = - 0.53, p = 0.005). This finding suggests that greater radiotherapy capacity is associated with improved outcomes when robust early detection mechanisms are in place. Conversely, no significant correlation was found for colorectal (p = 0.419) or breast cancer (p = 0.690) mortality, aligning with the less established or structured nature of their respective screening initiatives. Similar trends were seen using both SUS and private RT centers. Conclusion: There is a need to equitably promote infrastructure expansion along the cancer control continuum, from the screening and early diagnosis to the treatment setting. Our findings critically demonstrate that the observed association between radiotherapy availability and reduced mortality is most evident for a malignancy with robust, widely adopted screening program for which radiotherapy is part of the radical treatment. In contexts of limited resources, this interdependence suggests that strategic investments in radiotherapy infrastructure should be coordinated with efforts to enhance early detection.
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