Nasopharyngeal Carcinoma in a Low-Incidence Country: The Brazilian Experience and Gaps in Care

Abstract Nasopharyngeal carcinoma (NPC) is a rare head and neck malignancy with striking geographic variation, being endemic in East and Southeast Asia and uncommon in Western countries. Its etiology combines Epstein-Barr virus (EBV) infection, genetic susceptibility, dietary factors, and environmental exposures. In non-endemic settings, the nonspecific nature of early symptoms frequently leads to delayed diagnosis and advanced-stage presentation. This narrative review was developed through two complementary methods: a structured expert meeting convened in São Paulo, Brazil, in which head and neck oncology specialists addressed predefined clinical and epidemiological questions on NPC care in Brazil; and a literature review in PubMed/MEDLINE, Embase, and SciELO, supplemented by Brazilian institutional reports (INCA, CNEN, DATASUS, and GLOBOCAN). Brazil exemplifies what we herein propose as the low-incidence, rising-burden paradox: despite an increase in NPC incidence and mortality between 1990 and 2019—contrary to trends observed for other head and neck cancers—the country lacks the epidemiological infrastructure, diagnostic capacity, and treatment equity required to respond adequately. Critical barriers identified include the absence of robust national epidemiological data and standardized protocols, unequal geographic distribution of oncology centers, restricted access to advanced imaging (MRI and PET), non-standardized EBV testing, limited availability of intensity-modulated radiotherapy (IMRT) within the public health system (SUS), and absence of immunotherapy coverage through SUS. These gaps result in predominantly late-stage diagnosis, treatment variability across regions, and potentially worse outcomes for patients dependent on public healthcare. Addressing these challenges requires targeted public health policies to strengthen epidemiological surveillance, expand diagnostic and therapeutic infrastructure, standardize EBV testing, and promote equitable access to modern oncologic care across Brazil's public and private healthcare sectors.