Between 2017 and 2022, cancer was one of the main causes of death in the Azores (27% of the 14,329 deaths recorded in that period), only surpassed by diseases of the circulatory system (29.3% of those deaths), reveals an audit by the Court of Auditors of the Azores Cancer Center.
Concerning cancer mortality, the Azores recorded the highest rates (gross and standardized) in the country despite having a younger population profile.
In fact, between 2017 and 2022, the standardized mortality rate in the region fluctuated between 185.8 and 200.8 per 100,000 people/year, significantly higher than in Madeira (between 147.3 and 158.9 per 100,000 people/year) and the mainland (between 134.8 and 146.8 per 100,000 people/year), and has been increasing since 2020, against the trend in the rest of the country.
Safeguarding the future adjustments that will necessarily have to be made to the information provided by the Azores Cancer Center given its dependence on the mainland from 2018 onwards, it can be seen that between 2017 and 2023, 3,450 new cases of cancer were diagnosed and registered in the region, corresponding to an average of 493 new cases per year.
The number of cancer cases diagnosed in men (1,759; 51%) was slightly higher than in women (1,691; 49%).
In both sexes, the 60-74 age group accounted for the largest cases – 805 (45.8%) in men and 608 (36.0%) in women.
However, in the younger age groups, the risk of contracting cancer is higher in women, with the 30-44 age group standing out in this context, where the number of diagnosed cases (248; 14.7%) was more than double that recorded in men (117 cases; 6.7%).
Cancers of the prostate (279 cases; 15.9%), trachea, bronchi, and lungs (185 cases; 10.5%), and colon and rectum (135 cases; 7.7%) were the most common in men. In women, breast cancer was the most prevalent (448 cases; 26.5%), followed by thyroid cancer (108 cases; 6.4%) and cancer of the uterus (86 cases; 5.1%).
Based on the data obtained, it was concluded that, between 1997 and 2016, the most common cancer was breast cancer, with 3,074 cases (11.7%); followed by cancer of the trachea, lungs, and bronchi, with 2,870 cases (10.9%); and prostate cancer, with 2,428 cases (9.3%). This is followed by colorectal cancer, with 2,209 cases (8.4%); stomach cancer, with 1,354 cases (5.2%); cancer of the lip, oral cavity, and pharynx, with 1,175 cases (4.5%); bladder cancer, with 838 cases (3.2%); and, finally, other types of cancer – 12,274 cases, corresponding to 46.8% of the total.
Between 2021 and 2023, 3,450 new cancer cases were recorded in the Azores – an average of around 493 new cases per year – of which 1,759 were in men (51%) and 1,691 in women (49%). These figures translated into an overall incidence rate (HM) of 111.6 and 458.6 per 100,000 people yearly.

Cancer affects younger groups in the Azores.

Except for 2020 and 2021, the incidence rate was higher in men than in women. However, in all cases, this indicator reached its minimum in 2023, at 114.8 and 108.6 per 100,000 people/year, respectively.
In comparative terms with the rest of the country, and safeguarding the adjustments that would need to be made to the latest available data to update it, it can be seen that the Azores had the lowest cancer incidence rates in the period from 2018 to 2020, a circumstance not unrelated to the fact that the region has the youngest population in the country.
Concerning the distribution of the number of new cases by age group, there is a higher incidence, in descending order, in the 60 to 74 age group (41%), the 45 to 59 age group (27.0%) and the over 75 age group (18.3%).
Thus, in the period in question, 86.3% of the new cases diagnosed in the Azores and already registered occurred in individuals aged 45 or over, a distribution similar to that obtained considering only the data for the 2018-2020 triennium (84.7%).
However, in the same three-year period, both in Madeira and on the mainland, the age groups from 45 years onwards together accounted for 93% of the new cancer cases registered during the same period, a fact that indicates that cancer affects younger sections of the population in the Azores. This subject may be analyzed in the study on the causes of cancer in the Azores, which is currently underway.
Analyzing the incidence of cancer in the Azores by age group and sex, it can be seen that the 60-74 age group had the highest number of cases, both among women (608 cases; 36.0%) and men (805 cases; 45.8%).
However, in the 30-44 age group, the number of new cases in women (248 cases; 14.7%) was more than double that in men (117 cases; 6.7%).
On the other hand, up to the age of 59 – except for the 15-29 age group – the number of new cases diagnosed in women exceeds that of men, with this trend reversing after the age of 60.
In men, the highest incidence rate was in the 75-79 age group (910.7 per 100,000 people/year), while in women it was in the 65-69 age group (498.0 per 100,000 people/year).
The data presented also suggests that in younger age groups, the risk of contracting cancer is higher in women than in men. In this context, the 30-34 age group stood out, where the incidence rate in women (105.4 per 100,000 people/year) far exceeded that of men (39.9 per 100,000 people/year).
In the period under review (2021/2023), prostate cancer was the most common cancer in men, with 279 new cases recorded (15.9% of the total), translating into an incidence rate of 325.4 per 100,000 people/year.
This was followed by cancer of the trachea, bronchi, and lungs, with 185 cases (10.5% of the total), corresponding to an incidence rate of 215.8 per 100,000 people/year, and cancer of the colon and rectum, with 135 cases (7.7% of the total), with an incidence rate of 157.4 per 100,000 people/year. Taken together, these six sites (prostate, trachea, bronchi, lungs, colon, and rectum) accounted for 34.1% of the new cases of cancer diagnosed in men and registered.
In women, the most common cancer was breast cancer, with 448 new cases registered (26.5% of the total), giving an incidence rate of 547.2 per 100,000 people/year.
At a notable distance, thyroid cancer followed, with 108 new cases detected (6.4% of the total), reflecting an incidence rate of 131.9 per 100,000 people/year, and cancer of the body of the uterus, with 86 new cases diagnosed (5.1% of the total), reflecting an incidence rate of 105.1 per 100,000 people/year.
In females, the three most frequent sites (breast, thyroid, and body of the uterus) accounted for 38% of the new cases of cancer diagnosed and already registered.
10.3 Mortality Between 2017 and 2022, diseases of the circulatory system and malignant tumors (cancer) were the main causes of death in the Azores, as in the rest of Portugal.
In fact, in that period, of the 14,329 deaths recorded in the Azores, 4,202 (29.3%) were caused by diseases of the circulatory system and 3,867 (27%) by oncological diseases (cancer), with these two causes accounting for more than half of those deaths (56.3%).

More than a thousand new cancers per year in the Azores

In its conclusions, the Regional Section of the Court of Auditors notes that in the period covered by the audit (2021/2023), the Region “did not have a Regional Health Plan, but did develop measures specifically aimed at the prevention and control of cancer, included in other regional planning instruments.” Meanwhile, the Regional Health Plan 2020-2030 was recently approved, which includes the Regional Strategy to Combat Oncological Diseases, to be implemented in a regional program aligned with the National Strategy to Combat Cancer 2021-2030.
The Court of Auditors notes that the statistical information on cancer incidence in the Azores “is out of date.” According to information provided by the Azores Oncology Center Prof. Doutor José Conde (COA), “the number of new diagnoses is expected to exceed 1,000 cases per year, with only around 500 cases per year registered on the National Oncology Registry (RON) platform.”
In 2018, a study was commissioned on the specific risk factors for cancer in the Azores, which “could make a significant contribution to the definition/reformulation of public policies underlying the prevention and fight against cancer. The study has not yet been completed, and the COVID-19 pandemic continues to be cited as the reason for the delay, even though the contract was signed for a renewable period of 3 months”. However, according to the information provided, “steps are being taken with the co-contractor to complete the fieldwork.”
In its recommendations, the Court of Auditors asks the Centro Oncológico dos Açores to “take steps with the entities carrying out the study on specific risk factors for cancer in the Azores, in order to conclude it, so as to ensure compliance with the underlying objectives – the establishment and reinforcement of primary prevention measures.”

Screening programs

The Azores currently have four cancer screening programs covering the nine islands of the archipelago: breast cancer (ROCMA), cervical cancer (ROCCA), colon and rectal cancer (ROCCRA), and oral cavity cancer (PICCOA), highlighting “the innovative nature of the latter, unparalleled at national and international level.”
In the three years 2021-2023, the Azores Oncology Centre spent around 3.3 million euros on operating the screening programs and carrying out opportunistic screenings, corresponding to 96% of the total operating costs incurred by the entity in the same period. These costs were financed by resources from the regional budget, which amounted to 3.9 million euros in the period in question, including around 900,000 euros for investment.
Overall, from 2017 to 2023, 246,229 screenings were carried out under these four programs, of which 115,665 (47%) were carried out in the three years 2021-2023. The data for that extended horizon shows that, out of a total of 675 new cases diagnosed and already registered on the RON platform associated with breast, cervical, colon and rectum and oral cavity cancers, the respective screening programs were responsible for detecting 510 new cases (75.6% of the total), with ROCMA being the most significant (79.9%) and PICCOA the least (38.7%).
According to the Court of Auditors, “there is no formal evidence of the monitoring carried out by the COA in relation to the Maximum Guaranteed Response Times (TMRG) established for the various stages of the four screening programs, particularly the first consultation, which is crucial information for assessing the effectiveness of the public policies defined within the scope of the regional strategy for preventing and combating cancer, given the importance of early diagnosis for a favorable outcome.”

João Paz is a veteran and distinguished Correio dos Acores newspaper journalist. Natalino Viveiros, director.

Translated to English as a community outreach program from the Portuguese Beyond Borders Institute (PBBI) and the Modern and Classical Languages and Literatures Department (MCLL) as part of Bruma Publication and ADMA (Azores-Diaspora Media Alliance) at California State University, Fresno, PBBI thanks Luso Financial for sponsoring NOVIDADES.