Why the Azores Must Confront Cancer with Science, Prevention, and Courage

Some statistics demand more than attention. They demand humility. Others demand urgency. And then there are those rare figures that oblige an entire society to ask itself difficult questions—not because the answers are already known, but because failing to seek them would itself become a form of negligence.

The latest analysis presented by the AIM CancerCenter belongs firmly in that final category. Its conclusions are sobering, not because they offer certainty, but because they illuminate uncertainty. The Azores, despite possessing the youngest population in Portugal, continue to record the country’s highest mortality rate from cancer. At first glance, this appears paradoxical. Demography should suggest the opposite. Younger populations generally experience lower cancer mortality than older ones. Yet between 2017 and 2022, cancer accounted for approximately 27 percent of all deaths in the archipelago, and, unlike mainland Portugal, mortality has continued to rise since 2020. Even after adjusting for age—thereby allowing fair comparisons with older populations elsewhere—the disparity remains.

Such numbers resist simplistic explanations.

The first instinct in situations like these is often to question the healthcare system itself. Are patients diagnosed too late? Are treatments inadequate? Are specialist services insufficient? Yet the available evidence suggests otherwise. According to the National Oncology Registry, five-year cancer survival in the Azores stands at roughly 66 percent, essentially identical to the Portuguese national average. Once diagnosed, Azorean patients appear to receive treatment outcomes comparable to those elsewhere in the country. This distinction is crucial because it shifts the conversation away from what happens inside hospitals toward everything that happens before patients ever reach them.

The problem, therefore, may not primarily be one of treatment.

It may be one of prevention.

The data point consistently toward risk factors that have long been present across the islands. The Azores now report Portugal’s highest prevalence of obesity, affecting more than thirty percent of adults. Smoking remains above the national average. Alcohol consumption also exceeds mainland levels. None of these realities is new, and none produces immediate consequences. Cancer develops quietly, often over decades, through countless small exposures and lifestyle choices that accumulate invisibly before eventually revealing themselves in diagnosis. If mortality begins before diagnosis, prevention must begin long before symptoms.

The report also reminds us of another uncomfortable truth: screening, while enormously valuable, has limits. The Region performs well in organized colorectal cancer screening, with participation rates among the highest in Portugal. Yet two of the cancers responsible for many of the archipelago’s deaths—lung cancer and pancreatic cancer—still lack effective population-wide screening programs anywhere in the world. Good participation in available screening cannot prevent deaths from diseases for which early detection remains scientifically elusive. This is not a failure of the Azorean healthcare system but rather a reminder that medicine itself continues to face profound limitations.

Perhaps even more troubling is the uncertainty surrounding the Region’s own cancer statistics.

According to a 2024 audit by Portugal’s Court of Auditors, the Azores may actually experience more than one thousand new cancer cases annually, while official registries record only around half that number. If confirmed, such discrepancies would have implications extending far beyond statistics. Public health planning depends upon accurate information. Resources, prevention strategies, research priorities, and healthcare investments all begin with reliable data. A society cannot fully understand a disease whose true dimensions remain only partially measured.

Yet it is impossible to discuss cancer in the Azores without confronting another subject that has lingered for decades beneath public debate: the environmental legacy of Lajes Air Base.

Few issues have generated as much speculation, frustration, and unanswered questions.

The historical facts themselves are not disputed. Decades of military operations left documented contamination in soils and groundwater surrounding portions of the base. Environmental assessments commissioned by the United States military identified numerous contaminated locations and acknowledged elevated theoretical cancer risks for certain occupational exposures. The contamination itself exists within the public record.

What remains unresolved is whether those environmental exposures translated into measurable increases in cancer among nearby communities.

That distinction matters profoundly.

Over the years, scientific investigations have attempted to explore the relationship, including collaborative research involving the University of the Azores and Boston University. Some preliminary observations suggested elevated disease patterns among certain populations. Yet no definitive epidemiological study has ever fully resolved the question. Regional health authorities have consistently maintained that available island-wide cancer data do not demonstrate unusually high incidence on Terceira compared with the rest of the archipelago. At the same time, they acknowledge an important limitation: existing statistics cannot reliably examine disease occurrence at the neighborhood or parish level, precisely where localized environmental exposure would most likely become visible.

Recently, the conversation acquired renewed attention after researchers from the University of Coimbra reported higher concentrations of lead in skeletal remains recovered from Praia da Vitória than from neighboring Angra do Heroísmo. The researchers themselves have emphasized that these findings remain preliminary and have called for studies involving living populations before drawing conclusions. Such scientific caution deserves respect.

Because good science is neither driven by denial nor by assumption.

It advances through evidence.

This is perhaps the central lesson emerging from the AIM CancerCenter’s analysis. Responsible public health requires holding two truths simultaneously. On one hand, no credible evidence presently establishes a definitive causal relationship between environmental contamination around Lajes and elevated cancer incidence among surrounding communities. On the other hand, the documented history of contamination, combined with continuing scientific uncertainty, fully justifies comprehensive, transparent, and methodologically rigorous epidemiological research capable of finally answering questions that have remained unresolved for far too long.

Communities deserve neither false reassurance nor unfounded alarm. They deserve knowledge.

Ultimately, however, the report argues that the greatest opportunities for reducing cancer mortality lie elsewhere—and immediately within reach. Smoking cessation, obesity prevention, healthier nutrition, physical activity, earlier diagnosis, stronger cancer registries, and continued scientific investigation represent interventions capable of saving lives regardless of what future environmental research may ultimately reveal.

Cancer rarely begins inside an operating room or an oncology clinic. It often begins years earlier—in habits quietly repeated, in risks insufficiently understood, in diseases discovered too late, in information never fully collected, and sometimes in environmental questions left unanswered because asking them proved politically or scientifically inconvenient.

The Azores have every reason to confront this challenge with confidence rather than fear. Their healthcare outcomes demonstrate resilience. Their medical professionals have shown excellence. Their scientific institutions possess the expertise necessary to deepen understanding. What remains essential is the collective determination to invest not only in treating cancer, but in understanding why it appears, how it can be prevented, and where knowledge still falls short.

Because every statistic represents a human life. And every unanswered question is, ultimately, an invitation—not to speculation, but to science.

Based on an article in Diário Insular-José Lourenço-director. Photos from DI and JEdgardo Vieira Photography.