Cancer is the second leading cause of death in Brazil, and its burden is projected to increase substantially in the coming decades, with significant social and economic consequences. The COVID-19 pandemic and the 2024 floods in Rio Grande do Sul revealed structural vulnerabilities in oncology services, particularly in the continuity and coordination of care. In response, a national workshop convened by the International Agency for Research on Cancer (IARC), the Pan American Health Organisation and the Brazilian National Cancer Institute brought together policymakers, clinicians, researchers, and civil society to identify priorities for strengthening resilience in cancer control within Brazil’s Unified Health System (SUS). Drawing on international evidence, findings from the IARC Initiative for Resilience in Cancer Control, and structured stakeholder deliberation, this Viewpoint outlines recommended actions across governance, service delivery, resources, and financing. Key priorities include integrating the cancer care continuum into national preparedness and response plans; strengthening interoperable cancer intelligence systems; safeguarding critical infrastructure and workforce capacity; embedding equity-oriented recovery strategies; and ensuring flexible financing mechanisms during crises. Strengthening these capabilities within the SUS offers an opportunity to protect access and equity in cancer control, and to inform discussions on health system resilience in an era of converging crises.
Introduction
Brazil, a country of approximately 203 million people, faces a substantial and rapidly growing cancer burden; cancer is now the second leading cause of death.1,2 The Brazilian National Cancer Institute (INCA) estimated approximately an annual 821,000 new cancer cases during the 2026–2028 triennium and the International Agency for Research on Cancer (IARC) projects an 84% increase in the annual number of new cases, and 99% increase in the number of cancer deaths between 2022 and 2050.2,3 The economic consequences of cancer are profound. Between 2001 and 2030, cancer is projected to result in 2.3 million premature deaths in Brazil, which translates into approximately US$141.3 billion in productivity losses.4
Cancer coexists with multiple crises that are increasingly frequent, prolonged, and interconnected, presenting substantial challenges for national and multisectoral actors in safeguarding the health of its population.5 Concurrent political and economic crises further threaten access to universal health coverage which may reverse the health gains achieved in Brazil during the last two decades.6–9 These challenges disproportionately affect the most vulnerable populations, highlighting the urgent need for resilient health systems.7,8,10
Diverse crises, ranging from prolonged events such as the COVID-19 pandemic to acute shocks such as the floods in Rio Grande do Sul, disrupt cancer control by undermining continuity of care across the cancer pathway. The resilience of Brazil’s Unified Health System (SUS) in the face of crises depends on pre-existing system capacities needed to preserve critical components of cancer control, such as interoperable health information systems. However, these capacities remain fragmented and inconsistently available, limiting the system’s ability to sustain continuity of care during crises.
The Brazilian Unified Health System (Sistema Único de Saúde, SUS) follows a universal tradition, providing comprehensive and free-of-charge access to healthcare at the point of use to the entire resident population through shared governance across federal, state, and municipal levels. Its primary care framework holds one of the largest community-based programmes in the world, and community health workers outreach approximately 66% of the population.11,12 The Brazilian National Cancer Institute (INCA), established in 1937, has served as the lead institution for coordinating cancer control policies since before the SUS itself was created. The current overarching legislative framework for cancer control is the Law 14.758/2023, which declares the National Policy for the Prevention and Control of Cancer, setting out principles and guidelines spanning health promotion, prevention, early detection, treatment, rehabilitation, and palliative care.13,14
These formal entitlements, however, coexist with persistent structural constraints that bear directly on cancer outcomes. Public financing remains comparatively low, with government and compulsory schemes accounting for only 45% of total health expenditure in 2022, against an OECD average of 75%.11 The system also relies on a parallel private financing, with voluntary health insurance and out-of-pocket payments each accounting for approximately 27% of total spending.11 Chronic underfunding, marked regional inequalities, and barriers to timely specialist access continue to constrain system performance.15,16
Strengthening cancer control requires integrating resilience into health system governance, ensuring continuity of care across primary health care and specialised oncology services through coordinated delivery and crisis-adapted pathways. Periods of system strain disproportionately affect oncological services, where delays in diagnosis and treatment carry direct consequences on people with cancer. This entails embedding preparedness, response, recovery, and learning within a continuous policy cycle to build back better and safer,17 with gains in cancer care capacity generating shared benefits across non communicable diseases that share common risk factors and care pathways.
Unlike the cure-centred approach usually referred to as the “fight against cancer”, cancer control encompasses systemic actions to reduce incidence and mortality, improve quality of life, and involves epidemiological surveillance, prevention, early detection, and palliative care. Hence, the cancer control continuum aligns with the concept of resilience, which goes beyond response towards continuous adaptation to complexities while sustaining regular assistance. Existing resilience models have applied the concept across varying health system contexts, and even to specific settings such as Brazil and Europe. However, none focus specifically on cancer control, a field that demands coordinated, resource-intensive, and longitudinal care pathways, and that requires health systems to withstand and adapt to shocks while maintaining continuity across the full cancer pathway.18–20
Recognising the urgent need to invest in a resilient health system, a national workshop on resilient cancer control in crisis was held on 4 December 2025 in Rio de Janeiro. The workshop was organised by the IARC/WHO, the Pan American Health Organization/World Health Organization (PAHO/WHO), and the INCA. It sought to co-develop strategic actions to strengthen cancer control in future crises based on national-specific context with key stakeholders in Brazil. The workshop was preceded with a presentation of the results from our desktop review and qualitative study of the IARC Initiative for Resilience in Cancer Control (IRCC) to contextualise the growing cancer burden in crisis settings. Particular emphasis was given to the Brazilian case study (Agreli et al., unpublished), which examined resilience in cancer control during two crises: the COVID-19 pandemic and the 2024 floods in Rio Grande do Sul. The study used an exploratory qualitative design, comprising semi-structured interviews with key stakeholders across Brazil, including policymakers, health managers, clinicians, civil society representatives, and a patient advocate. Data were analysed thematically using the WHO Health Systems Performance Assessment (HSPA) and Health System Resilience frameworks.20,21 Key findings identified four interrelated system-level configurations as the primary drivers of reduced resilience in cancer control during crises.
Following the IRCC presentation, participants were organised into four groups aligned with the domains of the HSPA framework and engaged in structured discussions using a World Café format.22–24 Each group was facilitated by a trained moderator and supported by a designated rapporteur responsible for capturing key points. Group discussions explored strategies to strengthen resilience in cancer control. A plenary debriefing session followed, during which groups reported back and divergent perspectives were resolved through deliberative discussion. Analysis was conducted by the IARC research team using an emergent–systematic design, drawing on rapporteurs’ notes, moderator observations, and iterative comparison across groups to derive key themes. Convergent themes informed the final recommendations, which were formulated for policymakers, health system managers, clinicians, public health practitioners, and civil society, and designed to operate within and strengthen existing SUS infrastructure, building on primary care networks and regional health care arrangements already in place.
This viewpoint summarises the outcomes of the workshop, which brought together stakeholders from UN agencies, cancer care providers, policymakers, researchers, cancer data experts, and civil society organisations. The recommendations presented emerge from the triangulation of two complementary sources: our Brazilian qualitative study examining resilience in cancer control and the structured deliberation among workshop participants.
Recommendations
Based on identified gaps in cancer control during crises and lessons learnt, key priority areas are presented in Table 1 for practical actions across the health system functions of governance, service delivery, resource generation, and financing. Key priorities include integrating the cancer care continuum into national preparedness and response plans; strengthening interoperable cancer intelligence systems; safeguarding critical infrastructure and workforce capacity; embedding equity-oriented recovery strategies; and ensuring flexible financing mechanisms during crises.