A new Brazilian report has exposed an urgent challenge for the country’s public health system: the majority of colorectal cancer patients are only diagnosed once their disease has progressed to late clinical stages. The analysis, published on Brazil’s National Cancer Awareness Day, reviewed 177,000 confirmed cases treated across public and private hospitals between 2013 and 2022. According to the Fundação do Câncer, more than 60% of these patients received their diagnosis after the cancer had already advanced — a delay believed to significantly reduce the chance of cure.
Speaking to Agência Brasil, oncological surgeon Dr. Luiz Augusto Maltoni, Executive Director of the Fundação do Câncer, described the scenario as “catastrophic”. When looking at the country as a whole, approximately half of patients were diagnosed at stage four, when the disease has metastasised, and a further quarter at stage three. These findings reinforce what clinicians frequently stress: detecting colorectal cancer early is essential to improving survival.
Screening policies under scrutiny
Brazil, like other nations, employs faecal occult blood testing as a relatively low-cost initial screening measure. Those with positive results are referred for a diagnostic colonoscopy. However, screening typically begins at age 50, despite national data showing that the incidence peaks between 50 and 60 years old. Researchers argue that this timing risks missing early lesions.
The Fundação do Câncer recommends lowering the screening age to 45 — or possibly 40 — to catch precancerous polyps before they develop into malignancies. International evidence supports this shift: British and North American studies also show rising incidence of colorectal tumours in younger age groups, prompting adjustments to screening guidelines in several countries.
Lifestyle risk factors amplify the burden
The Brazilian analysis emphasises the importance of primary prevention strategies. Excess body weight and tobacco exposure were strongly associated with higher disease rates. Capitals with obesity rates above 24%, such as São Paulo, Rio de Janeiro and Porto Alegre, featured among those with the highest incidence of colorectal cancer. The same occurred in cities where smoking prevalence exceeded 12%.
Experts reiterate that avoiding smoking, maintaining a healthy weight, limiting alcohol intake and engaging in physical activity are proven protective measures against colorectal tumours — a point consistently reinforced in global oncology research.
Regional inequalities deepen barriers to care
Nearly half of reported cases were concentrated in Brazil’s Southeast, the region with the greatest diagnostic capacity. Yet disparities remain significant: almost 18% of patients living in the Central-West region needed to travel elsewhere for treatment, followed by 6.5% in the North. These mobility demands highlight long-standing inequalities in access to oncology services.
Sociodemographic indicators also reveal gaps. Almost 48% of affected patients had only primary education, and surgery remains the primary first-line treatment, either alone or combined with chemotherapy or radiotherapy.
Forecasts point to sharp increases
The Fundação do Câncer projects a 21% rise in colorectal cancer incidence between 2030 and 2040 in Brazil, reaching approximately 71,000 new cases annually and close to 40,000 deaths. Dr. Maltoni describes the projection as “alarming”, compounded by population ageing and insufficient prevention strategies.
The study argues that reversing this scenario requires sustained government policy rather than isolated campaigns. Brazil has previously demonstrated success with long-term tobacco control strategies — implemented consistently over decades regardless of political leadership. Health experts suggest colorectal cancer demands a similar state-level approach, including home testing kits such as those routinely delivered in England’s National Health Service.
For Dr. Maltoni, the message is clear: “If the decision is made and implemented, screening can be expanded — Brazil has the capacity to do so. But this must be a permanent state policy, not dependent on political cycles.”