INEQUALITIES IN PROSTATE CANCER DIAGNOSIS AND TREATMENT IN THE NORTHERN REGION OF BRAZIL AND THEIR IMPACTS ON ONCOLOGICAL OUTCOMES: A SYSTEMATIC REVIEW PROTOCOL
Abstract
Prostate cancer presents significant disparities in Brazil, especially in the Northern region, where geographical and structural barriers impact oncological care. This protocol describes a systematic review aiming to analyze inequalities in the diagnosis and treatment of the disease in the states of the Legal Amazon and their impacts on clinical outcomes (staging, time to treatment, and mortality). The search will be conducted in PubMed, Embase, Scopus, Web of Science, LILACS, and SciELO databases, including observational studies published since 2000. Study selection and data extraction will be performed by independent pairs, with bias assessment using specific scales (NOS and JBI). Results will be presented through narrative synthesis and, if there is homogeneity, through meta-analysis. This study will provide evidence for planning public health policies aimed at reducing inequities in regional oncology.
References
ALLEMANI, C. et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, v. 391, n. 10125, p. 1023-1075, 2018. Disponível em: https://doi.org/10.1016/S0140-6736(17)33326-3 DOI: https://doi.org/10.1016/S0140-6736(17)33326-3
BARRIOS, C. H. et al. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. The Lancet Oncology, v. 22, n. 11, p. e474-e487, 2021. Disponível em: https://doi.org/10.1016/S1470-2045(21)00492-7 DOI: https://doi.org/10.1016/S1470-2045(21)00492-7
BRAGA, S. F. M.; DE SOUZA, M. C.; CHERCHIGLIA, M. L. Time trends for prostate cancer mortality in Brazil and its geographic regions: an age-period-cohort analysis. Cancer Epidemiology, v. 50, Pt A, p. 53-59, 2017. Disponível em: https://doi.org/10.1016/j.canep.2017.07.016 DOI: https://doi.org/10.1016/j.canep.2017.07.016
COELHO, R. et al. Racial inequalities in access to healthcare services in Brazil (2019): a decomposition analysis. BMC Health Services Research, v. 25, n. 1, p. 1573, 2025. Disponível em: https://doi.org/10.1186/s12913-025-13527-6 DOI: https://doi.org/10.1186/s12913-025-13527-6
CONSTANTE, H. M.; BASTOS, J. L. Mapping the margins in health services research: how does race intersect with gender and socioeconomic status to shape difficulty accessing healthcare among unequal Brazilian states? International Journal of Health Services, v. 51, n. 2, p. 155-166, 2021. Disponível em: https://doi.org/10.1177/0020731420979808 DOI: https://doi.org/10.1177/0020731420979808
DA SILVA, D. C. B.; GARNELO, L.; HERKRATH, F. J. Barriers to access the Pap smear test for cervical cancer screening in rural riverside populations covered by a fluvial primary healthcare team in the Amazon. International Journal of Environmental Research and Public Health, v. 19, n. 7, p. 4193, 2022. Disponível em: https://doi.org/10.3390/ijerph19074193 DOI: https://doi.org/10.3390/ijerph19074193
DE SOUZA, A. B. et al. High incidence of prostate cancer metastasis in Afro-Brazilian men with low educational levels: a retrospective observational study. BMC Public Health, v. 13, p. 537, 2013. Disponível em: https://doi.org/10.1186/1471-2458-13-537 DOI: https://doi.org/10.1186/1471-2458-13-537
FONSECA, B. P. et al. Geographic accessibility to cancer treatment in Brazil: a network analysis. Lancet Regional Health Americas, v. 7, p. 100153, 2022. Disponível em: https://doi.org/10.1016/j.lana.2021.100153 DOI: https://doi.org/10.1016/j.lana.2021.100153
HONE, T. et al. Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals. BMC Public Health, v. 21, n. 1, p. 1287, 2021. Disponível em: https://doi.org/10.1186/s12889-021-11328-0 DOI: https://doi.org/10.1186/s12889-021-11328-0
JARDIM, B. C. et al. Estimation of cancer incidence in Brazil and its regions in 2018: methodological aspects. Cadernos de Saúde Pública, v. 40, n. 6, p. e00131623, 2024. Disponível em: https://doi.org/10.1590/0102-311XPT131623 DOI: https://doi.org/10.1590/0102-311xpt131623
LEE, B. L. et al. Breast cancer in Brazil: present status and future goals. The Lancet Oncology, v. 13, n. 3, p. e95-e102, 2012. Disponível em: https://doi.org/10.1016/S1470-2045(11)70323-0 DOI: https://doi.org/10.1016/S1470-2045(11)70323-0
MALUF, F. C.; DE OLIVEIRA, C. S. K. S.; ZIEGELMANN, P. K. Impact of funding source on long-term outcomes in prostate cancer: analysis of a large public database from São Paulo, Brazil. JCO Global Oncology, v. 11, p. e2400271, 2025. Disponível em: https://doi.org/10.1200/GO-24-00271 DOI: https://doi.org/10.1200/GO-24-00271
MOHER, D. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, v. 4, p. 1, 2015. Disponível em: https://doi.org/10.1186/2046-4053-4-1 DOI: https://doi.org/10.1186/2046-4053-4-1
MONTEIRO, F. S. M. et al. Optimizing the systemic treatment for metastatic castration-resistant prostate cancer in lower-middle-income countries: a 7-year analysis of the Brazilian public health system. JCO Global Oncology, v. 12, n. 3, p. e2500683, 2026. Disponível em: https://doi.org/10.1200/GO-25-00683 DOI: https://doi.org/10.1200/GO-25-00683
OLIVEIRA, M. H. R. et al. Barriers to accessing cervical cancer screening and treatment in the Amazon region: a systematic review. Journal of Clinical Medicine, v. 15, n. 3, p. 1206, 2026. Disponível em: https://doi.org/10.3390/jcm15031206 DOI: https://doi.org/10.3390/jcm15031206
PAGE, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Journal of Clinical Epidemiology, v. 134, p. 178-189, 2021. Disponível em: https://doi.org/10.1016/j.jclinepi.2021.03.001 DOI: https://doi.org/10.1016/j.jclinepi.2021.03.001
ROSA, A. A. et al. Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030. The Lancet Oncology, v. 24, n. 8, p. 903-912, 2023. Disponível em: https://doi.org/10.1016/S1470-2045(23)00284-X DOI: https://doi.org/10.1016/S1470-2045(23)00284-X
SHAMSEER, L. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ, v. 350, p. g7647, 2015. Disponível em: https://doi.org/10.1136/bmj.g7647 DOI: https://doi.org/10.1136/bmj.g7647
SUNG, H. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, v. 71, n. 3, p. 209-249, 2021. Disponível em: https://doi.org/10.3322/caac.21660 DOI: https://doi.org/10.3322/caac.21660
TORRES, K. L. et al. Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city: lessons learned from the Amazon city of Manaus, Brazil. PLoS One, v. 16, n. 10, p. e0258539, 2021. Disponível em: https://doi.org/10.1371/journal.pone.0258539 DOI: https://doi.org/10.1371/journal.pone.0258539
VIANI, G. A. et al. Prioritising locations for radiotherapy equipment in Brazil: a cross-sectional, population-based study and development of a LINAC shortage index. The Lancet Oncology, v. 23, n. 4, p. 531-539, 2022. Disponível em: https://doi.org/10.1016/S1470-2045(22)00123-1 DOI: https://doi.org/10.1016/S1470-2045(22)00123-1
License
Copyright (c) 2026 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
This work is licensed under a Creative Commons Attribution 4.0 International License.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.