Risk factors for cancer and screening tests in the population of the Pantanal, a rural region of Brazil: An update from the cohort study.

Abstract

e13826 Background: Cancer remains a major public health challenge in Brazil, where disparities in access to prevention and screening persist despite national guidelines. The Alma Pantaneira initiative, a non-governmental and interdisciplinary expedition, provides essential healthcare to a rural community of 25,000 people in the Pantanal region of Mato Grosso do Sul. Conducted for over a decade along a predefined route, this expedition aims to bridge healthcare gaps. Methods: This retrospective epidemiological study analyzed data collected via questionnaires during the Alma Pantaneira Expedition, with prior ethical approval. Six volunteer physicians interviewed patients aged ≥18 years. Participants were selected by convenience sampling, covering all individuals attended by the expedition from October 23 to November 5, 2023. Results: A total of 205 patients were interviewed (median age 46 ± 15.5 years; 63.4% male, 36.6% female). Most self-identified as mixed-race (69.1%), followed by Black (17.8%) and White (12.6%). The majority (89.1%) were from Mato Grosso do Sul. Comorbidities were present in 80%, with 55.2% overweight (29.3%) or obese (25.9%). Hypertension (23.7%) and diabetes (3.2%) were reported. Tobacco use was noted in 63% (32.5% current, 30.5% former smokers), predominantly men (69.0%, p = 0.048). Alcohol use (current or past) was reported by 69.2%, mainly men (73.0%, p < 0.001). Screening rates were low: only 59.6% of women > 25 years had a Pap smear in the past 3 years, and 32.4% of women > 40 years had a mammogram in the past year. Among women > 50 years, only 30% had a mammogram in the past year. For men, only 36% had PSA testing and/or a digital rectal exam. A rapid PSA test (performed in 45 men) was positive (≥4 ng/mL) in 88.9%. Family history of cancer (first-degree relatives) was reported by 9%, with 60% occurring in relatives < 50 years. Serologic tests for HIV, Hepatitis B/C, and Syphilis were performed. No positive results were found for HIV or hepatitis; 2.4% tested positive for syphilis. Conclusions: This study expands epidemiological knowledge of cancer risk factors and screening adherence in the Pantanal region. Screening rates remain below WHO targets, and risk factors such as smoking and alcohol use are concerning. The findings highlight the need for public policies to improve access to prevention, early detection, and treatment in underserved regions. The study update incorporated epidemiological testing and expanded the initial sample, demonstrating both the challenges and opportunities of implementing cancer screening in hard-to-reach areas of Brazil.