Racial disparities in cancer burden, care pathways, and mortality among women in Brazil: a nationwide real-world analysis

Background Cancer outcomes are shaped not only by tumor biology but also by the performance of health systems, the patients they fail to reach and how late they respond. In Brazil, race intersects with deep regional and socioeconomic inequalities yet nationwide analyses integrating incidence, hospital-based care, and mortality remain limited. We evaluated racial disparities in the cancer burden among women in Brazil using three complementary national real-world data sources. Materials and methods This retrospective observational study was based on three independent national secondary data: the population-based cancer registries (PBCRs), the national hospital-based cancer registries (HBCRs), and the mortality information system (MIS). Women with malignant neoplasms (International Classification of Diseases, 10th edition, C00-C97), excluding nonmelanoma skin cancer (C44), were included. Women classified as white and black were compared, with the black category including black and mixed race/brown women. Crude incidence rates were estimated from 2010 to 2015. Hospital-based analyses assessed demographic, clinical, and care-pathway characteristics from 2000 to 2023. Mortality trends from 2000 to 2024 were evaluated using age-adjusted rates and Joinpoint regression. Results Among 221 661 women included in the incidence analysis, crude incidence was higher in white than in black women (309.4 versus 196.7 per 100 000), with stable trends in both groups. In the hospital-based cohort ( n = 1 601 829), Black women were younger at presentation and more frequently had markers of social vulnerability, advanced-stage disease, delays from symptoms to diagnosis and from diagnosis to treatment, lower treatment rates, and higher early death. Age-adjusted mortality increased in both groups, more sharply among black women (annual percentage change 1.26% versus 0.17%). Conclusions Black women with cancer in Brazil experienced less favorable care-related characteristics and a faster increase in age-adjusted mortality over time. These findings are consistent with persistent racial inequities in cancer care and highlight the need for more comprehensive race-disaggregated cancer surveillance.