title: Disparities in time trends of cervical cancer mortality rates in Brazil.
abstract: This study aimed to correct and describe cervical cancer mortality rates and trends by regions and age-groups in Brazil. It may help planning and implementing policies for cervical cancer control.
  
  
  
  Data from 2003 to 2012 were accessed through the centralized national mortality database. Correction of the age-specific mortality rates was done by proportional redistribution of ill-defined causes of death and deaths coded as 'uterine, part unspecified'. Annual percentage change (APC) was obtained by trend analysis (Joinpoint regression).
  
  
  
  In the 10-year period, cancer and ill-defined causes corresponded, respectively, to 18.9 and 10.8 % of all deaths (except injuries). The proportion of ill-defined causes was reduced by more than a half in the period. The age-standardized cervical cancer mortality rate was 7.2 per 100,000 women-years after correction. The total increase in rates after corrections was 50.5 %. A significant decreasing trend in rates was observed at the national level (APC = -0.17, p < 0.001). North was the only region that did not show a decreasing significant trend (APC + 0.07, p = 0.28). Decreasing trends were restricted to age-groups over 40 years.
  
  
  
  A consistent decreasing trend of cervical cancer mortality rates in Brazil from 2003 to 2012 was observed, although this was not consistent in all regions and restricted to older age-groups. Quality of data needs to be improved. Cancer control policies may consider the differences in access to care and the characteristics of regions to improve their efficiency.
authors.affiliation: Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France. valed@fellows.iarc.fr.|Department of Obstetrics and Gynecology, State University of Campinas, Caixa Postal 6111, Campinas, 13081-970, Brazil. valed@fellows.iarc.fr.
authors.forename: Diama Bhadra
authors.initials: DB
authors.lastname: Vale
authors.affiliation: Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sauvaget
authors.affiliation: Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Ferlay
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas, Caixa Postal 6111, Campinas, 13081-970, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Zeferino
authors.affiliation: Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Raul
authors.initials: R
authors.lastname: Murillo
authors.affiliation: Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D002583:Uterine Cervical Neoplasms / Q000401:mortality*
keywords: Healthcare disparities; Mortality; Population register; Uterine cervical neoplasms