Cancer in My Community is a Cancer.Net Blog series that shows the global impact of cancer and how people work to care for those with cancer in their region. Fernanda Cano Casarotto, MD, is a medical oncologist based in Porto Alegre, Rio Grande do Sul, Brazil. She obtained her medical degree at Federal University of Rio Grande do Sul and completed her oncology fellowship program at Hospital de Clínicas de Porto Alegre. During the last 8 years, Dr. Casarotto has been working in the field of medical oncology with a special focus on gynecological, head and neck, and human papillomavirus (HPV)-related cancers. She is currently a member of the Diversity Committee from the Brazilian Society of Clinical Oncology and a medical advisor in gynecological cancers at the Cancer Governance and Control Institute (IGCC). You can follow Dr. Casarotto on Twitter. View Dr. Casarotto’s disclosures.
Why I care for people with cancer
Deciding to treat people with cancer was one of the most important choices of my life. And frequently, I get asked the question: “Why oncology? Why treat people with cancer? Why choose such a difficult area, with such seriously ill patients, a specialty where death is often seen so closely? Why?" The truth is that I have never been able to fully understand why so many people cannot understand the draw of oncology. Working with people with cancer can be hard, but at the same time, it is an extremely fulfilling experience.
I see clinical oncology as a challenging career, both because of the complexity of the diseases and because the field is constantly changing as new cancer treatments emerge each year. I don't believe that within medicine there is any other field as dynamic as clinical oncology. Cancer care evolves so often and so quickly that it can be hard to keep up with all of the innovations.
In addition, clinical oncology acts as a great hub between other medical specialties and non-medical health professions. We as oncologists have daily contact with countless other colleagues focused on patient care, and we can learn a lot from them. Treating people with serious and often incurable illnesses also gives us a very different perspective on our own lives. It not only brings us technical knowledge, but it also brings us more humanity and a broader view of living, priorities, and relationships. Being an oncologist has this other bright side, too: we learn a lot from our patients and their families and friends.
However, sometimes we do face difficulties as oncologists that disappoint us, whether that is having a patient whose treatment is not working or who is experiencing challenges in accessing new technologies. Even so, we move forward.
What cancer is like in Brazil
Brazil is the fifth largest country in the world in terms of land area and has a population of around 215 million people. According to current estimates published by the National Cancer Institute in Brazil (INCA), from 2023 to 2025, it is estimated that there will be around 704,000 new cancer cases diagnosed in the country. Most of these cases will occur in the south and southeast regions of the country.
With the exception of non-melanoma skin cancer, the most common cancers in Brazil during this period are projected to be breast cancer, prostate cancer, colorectal cancer, lung cancer, and stomach cancer. In men, prostate cancer, colorectal cancer, lung cancer, stomach cancer, and oral cancer are projected to be the most common cancers diagnosed. In women, breast cancer, colorectal cancer, cervical cancer, lung cancer, and thyroid cancer are projected to be the most common cancers.
Brazil is a place of huge social gaps. It is one of the most unequal countries in the world, according to data from the World Bank and the United Nations. In Brazil, the richest 1% of the population owns almost one-third of the country's wealth. This social inequality has major effects in health care.
In Brazil, we have a free universal health care system for the entire population called Sistema Único de Saúde (SUS). Even so, around 50 million people in the country receive private health care, according to data from the National Supplementary Health Agency (ANS). This creates a very large medical care gap, especially in the area of oncology. As an example, trastuzumab (now available as a biosimilar drug), a revolutionary drug in the treatment of breast cancer, was registered by the National Health Surveillance Agency (ANVISA) in 1999. However, it was only incorporated into the SUS in 2012 for adjuvant treatment of breast cancer and in 2018 for the treatment of people with metastatic disease. This social inequality that exists forces us to deal with the reality of having 2 distinct “Brazils”: one for private medicine and one for public medicine, both in the very same country.
The prevention and timely treatment of cancer in Brazil
According to estimates by the World Health Organization, 30% to 50% of all cancer cases could be preventable. It is important that people know the factors that increase the chances of developing cancer and know how to avoid them. For example, in Brazil, HPV vaccination (through the quadrivalent vaccine) is available and free for children ages 9 to 14 and for immunocompromised patients up to 45 years old. This is a safe and effective way to prevent cervical cancer, a disease that killed more than 9,000 people in Brazil in 2020. Knowing and engaging in screening and prevention programs offered by the public health care system is also very useful. Some health care facilities even offer support groups for people who want to quit smoking.
In addition to knowing how we can act to prevent this disease, we must also understand that cancer treatment is time sensitive. If you live in Brazil and have symptoms you suspect may be related to cancer or have already received a cancer diagnosis, seek assistance immediately. The 60-day law has been in effect in Brazil since 2013 and states that a person who has been diagnosed with cancer must start receiving treatment through the public health system within 60 days. If you plan to be treated in the public health system, remember that you must go to the basic health unit closest to your residence. From there, a medical appointment will be scheduled, and you will receive the proper referral at that point. If you plan to be treated in the private health system, you can look for the specialist of your choice.
Where patients can find local resources and support in Brazil
There are several websites that can be useful to people with cancer in Brazil that offer information and support:
- InstitutoOncoguia. This is a nonprofit, nongovernmental organization focused on supporting people with cancer and providing useful information, in addition to promoting advocacy and educational projects for people with cancer.
- Todos Juntos Contra o Câncer. This is a civil initiative that brings together more than 300 representatives from different sectors focused on the care of people with cancer, such as health managers, medical entities, hospitals, health care professionals, researchers, press professionals, patient associations, and others. The initiative is committed to the guarantee of the patient's right to universal and equal access to health care.
- Brazilian Federation of Philanthropic Institutions Supporting Breast Health (FEMAMA). This group brings together more than 70 nongovernmental organizations in Brazil. They focus on advocacy, patients' rights, and access to information.
- INCA. This agency, which is part of the Ministry of Health, aids in the prevention and control of cancer in Brazil. On the INCA website, you can find where you can get cancer treatments in Brazil by state.
The author has no relevant relationships to disclose.