The tobacco epidemic curve in Brazil: Where are we going?

Background: Brazil experienced a robust decline in smoking prevalence rates as a consequence of public policies. Since lung cancer is strongly associated with smoking, trends in lung cancer mortality rates may be used as a delayed effectiveness indicator of smoking prevention interventions. Objectives: The aim of this study was to estimate lung cancer mortality trends from 1980 through 2017 and to predict temporal trends in lung cancer mortality rates, in Brazil from 2016 through 2040. Methods: Time trends in lung cancer mortality rates were evaluated using data from available public databases. Crude and age-standardized mortality rates were calculated for each year sex-specific mortality predictions were made for each five-year period from 2016 to 2020 through 2036–2040 using an age-period-cohort (APC) model. Sex ratios were estimated using age-standardized lung cancer mortality rates. Results: A decline in age-standardized lung cancer mortality rates has been observed for males since 2005 and for all predicted periods. It is expected that females aged 55 or younger will experience a reduction in lung cancer mortality from 2021 to 2026 onwards, but for those aged 75 or over rates are predicted to continue increasing through 2036–2040. Conclusion: Smoking prevention and cessation policies are essential, and it is important to commit to an ethical framework whereby equity in tobacco control activities between genders is achieved. This will avert many premature and preventable smoking-related deaths in the next decades.