Melanoma mortality in Brazil: Insights from over 25 years of data and the impact of limited immunotherapy access in the public health system.

Abstract

e22582 Background: Skin cancer is the most common cancer globally and in Brazil – and melanoma, its deadliest form. Despite advancements in Immunotherapy (IO) and Target-therapy (TT), these are mostly unavailable in Brazil’s Public Health System (PHS). Methods: Ecological study using secondary data (1996-2023) from Brazil’s PHS. Mortality rates were standardized by WHO’s population and calculated per 100,000 inhabitants. Linear regression analyzed mortality trends by region, using 2011 as a cutoff (IO and TT year of approval). Results: Between 1996-2023, 39,606 deaths occurred due to melanoma in Brazil – mostly in males (57.3%). Deaths were higher among elderly patients (16.2% males; 22.6% females), with the Southeast leading (46.6%). Mortality decreased in males ≤54 years and increased in ≥70 years (p<0.01), with similar trends found for females. Only the Southeast showed declining mortality (β -0.013; r² 0.60; p<0.001); other regions increased (p<0.001). After 2012, both genders showed downward trends. Conclusions: Despite advances, mortality rates due to melanoma increased until 2012 but declined thereafter, underscoring the possible impact of IO/TT and highlighting the need for expanded its access, especially for men and elderly citizens. Variable APC (1996-2023) MalesStandardized mortality rates by age β 95% CI Adjusted r² p*  25-29 -.022 -.040 -.004 .161 .020  30-34 -.041 -.061 -.022 .401 < .001  35-39 -.057 -.087 -.028 .355 < .001  40-44 -.108 -.138 -.077 .658 < .001  45-69 p > 0.05  70 -74 .106 .034 .178 .230 .006  75-79 .134 .069 .199 .385 < .001  ≥80 .596 .470 .723 .775 < .001 Variable APC (1996-2023) FemalesStandardized mortality rates by age β 95% CI Adjusted r² p*  20-24 -.011 -.019 -.003 .203 .009  25-29 -.015 -.028 -.002 .138 .029  30-34 -.030 -.045 -.014 .356 <.001  35-39 -.051 -.078 -.024 .347 .001  40-44 -.065 -.096 -.034 .225 <.001  45-49 -.048 -.082 -.015 .029 .006  50-54 p > 0.05  55-59 -.040 -.080 -.001 .038 .047  60-79 p > 0.05  ≥80 .195 .139 .252 .002 <.001 Variable APC (1996-2023) MalesStandardized mortality rates β 95% CI Adjusted r² p*  North .014 .006 .023 .29 .002  Northeast .027 .022 .033 .79 <.001  Southeast -.013 -.018 -.009 .60 <.001  South .017 .006 .028 .26 .003  Midwest .014 .004 .024 .22 .006  Brazil .007 .002 .011 .24 .005 Variable APC (1996-2023) FemalesStandardized mortality rates β 95% CI Adjusted r² p*  North .013 .009 .017 .62 <.001  Northeast .012 .010 .014 .80 <.001  Southeast -.012 -.015 -.009 .67 <.001  South .000 -.008 .009 -.04 .926  Midwest .008 .001 .015 .15 .026  Brazil -.001 -.004 .001 .00 .316 Variable APC (1996-2011) MalesStandardized mortality rates β 95% CI Adjusted r² p* Brazil .016 .010 .023 .64 <0.001 Variable APC (1996-2011) FemalesStandardized mortality rates β 95% CI Adjusted r² p* Brazil .003 -.002 .008 .07 0.162 Variable APC (2012-2023) MalesStandardized mortality rates β 95% CI Adjusted r² p* Brazil -.018 -.032 -.004 .39 0.018 FemalesStandardized mortality rates β 95% CI Adjusted r² p* Brazil -.009 -.019 .000 .25 0.056