Tem sido observada uma importante redução da mortalidade por esta neoplasia nas úl-timas décadas em países desenvolvidos, especialmente após a introdução dos programas de rastreamento da doença nas décadas de 1960 e 1970 2 . Estudos mostram tal redução em países europeus como Finlândia 4 , Islândia 5 , Bélgica 6,7 , Escócia 8 e Reino Unido 9 , contudo, tem sido observado um aumento na sua incidência nas faixas etárias mais jovens. Na Finlândia, por exemplo, foi evidenciado um decréscimo na mortalidade pela doença de cerca de 80% no período compreendido entre 1963-1995 4 . Em comum, estes paí-ses já apresentam um programa de rastreamento organizado há pelo menos três décadas.Nos Estados Unidos 10 e Canadá 11 , foi observada redução da mortalidade por câncer de colo uterino nas últimas décadas, apesar do aumento da incidência do adenocarcinoma de colo uterino 12 .ARTIGO ARTICLE

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In studies of cancer survival, Population-Based Cancer Registries (PBCRs) can provide an overview of the disease for places that have this source of information available. In Brazil, PBCR is officially available in 22 state capitals and 8 cities in the interior of the country. PBCR data from Cuiabá and Várzea Grande, state of Mato Grosso, in Midwestern Brazil, were used to estimate the survival rate of colon (C18), rectosigmoid junction (C19) and rectum (C20) cancer cases diagnosed in 2000-2009 according to the International Classification of Diseases, 10th Revision. Five-year survival rate was estimated by the unbiased and consistent net survival estimator, which is used in the country estimates of the global surveillance of cancer survival programme CONCORD Group, for all cases, and also by sex, age group, diagnosis period and place of residence. The probability of death and the number of years of life lost to illness were also estimated. The estimated standardised 5-year survival rate for colorectal cancer was 45.46% (95% CI: 43.09%-47.96%) in the cities of Cuiabá and Várzea Grande. There was no difference between the curves when the survival rate was assessed by diagnostic period (2000-2004 and 2005-2009), sex, age group or city of residence. The gross 5-year probability of death from the disease was 51.2%, accounting for 6.4% of the gross probability of death from other causes, with 2.07 being the years of life lost to illness. The results obtained for Cuiabá and Várzea Grande are compatible with survival rates estimated for Brazil in the CONCORD study, but demonstrate the need to identify reasons why we continue to have low survival rates when compared to most countries involved in the global study mentioned. The results may reflect late diagnosis, difficult access and delays in starting treatment.

Mortality due to colorectal cancer is increasing in Brazil, but an organised approach to screening and prevention is lacking. Considering the importance of this disease, the present study examines recent mortality trends of colorectal cancer mortality in the meso- and microregions in the state of Mato Grosso with the objective of analysing spatiotemporal trends to help guide the allocation of health services related to this type of cancer. Mortality data from the Brazilian national public health system from 1996 to 2015 were analysed investigating spatiotemporal trends using Conditional Autoregressive (CAR) models, a class of Bayesian hierarchical models that rely on Markov Chain Monte Carlo (MCMC) simulations. Convergence issues arose with several types of CAR models, but notably not with the linear variant, which models the mortality within each spatial region as a linear function of time. Men and women of all ages displayed higher and increasing mortality rates in the Cuiabá and Rondonópolis microregions. Additional regions of increasing mortality were found for specific age and gender strata. It was concluded that spatiotemporal modelling is a useful tool for the characterisation of diseases, including cancer, which are influenced by several factors and need to be monitored over space and time. The combination of spatial and temporal analyses of mortality shown in this paper unveils important information regarding the small areas dynamics, which may guide discussions, regulation and application of decentralised public health policies.