Introduction {#Sec1} ============ It has been reported that the occurrence of cancer has increased over the last decade and is expected to increase further in the near future due to the increase in the global incidence of cancer, as a result of population growth, aging, and changes in lifestyle \[[@CR1]\]. A total of 14.1 million new cancer cases were reported worldwide in 2008, of which 7.4 million occurred in less developed regions, and of which 3.7 million were in the least developed regions of the world \[[@CR2]\]. Worldwide, it is estimated that the incidence of cancer is expected to increase by 50 % between 2005 and 2015 \[[@CR2]\]. In addition, the growing incidence and prevalence of cancer is associated with considerable healthcare costs, which increased from US\$90 billion in 1970 to over US\$120 billion in 2007 \[[@CR3]\]. For this reason, cancer research is a worldwide concern, especially in Latin America, a region that still faces an enormous economic challenge. As a consequence, the burden of cancer in Latin America is immense, with more than 60 % of cancer deaths in this region \[[@CR4]\]. Brazil, the largest and most populous country in South America, provides a significant source of insight into cancer patterns in Latin America. One in five people will be diagnosed with cancer during their lifetime \[[@CR5]\]. In Brazil, a total of 860 thousand people were estimated to be diagnosed with cancer in 2014, with a mean prevalence of 160 new cases per 100,000 inhabitants. These new cases represent a prevalence rate of 0.2 % \[[@CR6]\]. Brazil faces many challenges as regards its provision of healthcare services and its access to cancer diagnosis and treatment. In this context, it is important to monitor and evaluate national policies, to plan actions that enable proper organization of services and to encourage public investments in science and technology. These public investments are essential to accelerate Brazil's entry into the global arena as a strong nation in cancer research, diagnosis, and treatment. This article is the result of an analysis that examined Brazilian scientific articles about cancer published in PubMed from 2001 to 2012. Brazil is the largest Latin American country, with the second-largest gross national product in Latin America \[[@CR7]\]. Brazil has a population of over 200 million, with an estimated one-third living in urban areas. A large portion of the population is young and its life expectancy is close to 70 years \[[@CR8]\]. As a result of its cultural diversity and its social inequalities, Brazilian society and public services present challenges for the provision of healthcare services, with limited access to healthcare for many citizens \[[@CR9]\]. In addition, Brazil is undergoing a transformation in its health care policies \[[@CR10]\]. To this end, Brazil has undergone a political and economic crisis in the 1980s \[[@CR11]\]. Health policies were therefore designed to meet the needs of the population and included an expansion of both primary healthcare (health promotion, health promotion, and disease prevention) and public health (health services to the population) \[[@CR12]\]. The Brazilian government established an important national health program in 2001, the Unified Health System (Sistema Único de Saúde) \[[@CR13]\]. The SUS is a broad public health program that provides universal and free access to health care at both primary and secondary levels of care, including screening, diagnosis, treatment, and follow-up care. To guarantee free access to health services, the public funding of healthcare in Brazil is based on a mechanism of progressive tax and voluntary participation. It is important to highlight that private healthcare in Brazil is a strong economic activity that accounts for 80 % of total health care provision \[[@CR9]\]. This high market share is the result of the large number of private healthcare providers in Brazil (over 30,000 private clinics). The large volume of private healthcare services may also be explained by the lack of adequate public regulation of this sector \[[@CR14]\]. Currently, the Brazilian health system offers several health insurance policies \[[@CR9], [@CR15]\]. The SUS uses a policy-based approach to promote access to health services and treatment for all Brazilian citizens. More than 130 distinct health insurance plans have been developed since 1980 to respond to social needs. This large number of policies makes the system extremely complex and prevents the provision of continuous healthcare to all Brazilians. Despite the positive advances of the Brazilian health system in terms of services, access, and effectiveness \[[@CR9]\], the SUS does not control patients' financial expenditures \[[@CR16]\]. The use of private health services can be explained by the lack of availability of qualified health professionals and public healthcare coverage, including public hospitals and state insurance plans \[[@CR17]\]. This lack of public control has led to the development of private health services, which can be defined as a health system that offers health services in conditions of limited government regulation \[[@CR18]\]. In Brazil, private health services are a significant source of healthcare services for about 50 million people (20 % of the total population) \[[@CR19]\]. The growing interest in the healthcare system of Brazil is a strong indication of the urgency to investigate the quality of its healthcare services. However, little is known about the impact that the implementation of this healthcare system has had on health outcomes, and in particular on the Brazilian cancer experience. In this context, the objective of this study was to explore the role of health policy in the evolution of healthcare services in Brazil from 1996 to 2007 using scientific papers published in journals indexed in PubMed from 2001 to 2012. The main research question was the following: what was the impact of health policies in Brazil from 2001 to 2012 on the incidence of cancer and its consequences? Theoretical framework: Conceptual framework {#Sec2} ------------------------------------------- This analysis used the framework of the epidemiological triangle, developed by Bilsen and Amundsen \[[@CR20]\], which provides a synthesis of factors that are important to a society in responding to the challenges of a cancer epidemic. The framework consists of three factors, each of which indicates a potential cause of the spread of cancer in a given population (Fig. [1](#Fig1){ref-type="fig"}). The epidemiological triangle has been used in a wide range of different populations to analyse the factors that explain the occurrence of cancer \[[@CR21]--[@CR23]\]. The framework integrates four conditions that are related to biological, social, cultural, and economic dimensions of populations. Therefore, the framework provides a valuable tool for understanding health events, with emphasis on the social and economic dimensions of a society \[[@CR24]\].Fig. 1Conceptual framework for the spread of cancer in a society. *Source: Adapted from Bilsen and Amundsen's analysis* \[[@CR20]\] ### The biological dimension {#Sec3} Biological factors are important to understand the epidemiological evolution of cancer. Cancer rates can be influenced by individual characteristics (risk factors), which can be determined by the genetic and epigenetic profiles of individuals \[[@CR25], [@CR26]\]. However, it is important to stress that the development of cancer is not determined only by the biological dimension, as it is also influenced by the social and cultural dimensions. It is important to bear in mind that, in addition to individual characteristics, biological factors contribute to different susceptibility to the development of cancer \[[@CR27]\]. A number of studies have examined the risk factors associated with the development of cancer. However, in a population-based study it is impossible to study individual risk factors. For this reason, this study used the epidemiological triangle to focus on the social and cultural dimensions as a tool for reflecting the experience of Brazilian societies as they face cancer. ### The social and cultural dimensions {#Sec4} The second dimension of the framework is related to social and cultural conditions. This dimension includes the demographic structure of the population, which is closely related to individual lifestyles and environmental conditions. The social and cultural dimensions of cancer are very complex and include a wide range of social and cultural factors that may affect people's perception of health, such as: education, cultural traditions, religion, gender, ethnicity, and race \[[@CR28]--[@CR31]\]. The social and cultural dimensions also include medical care and support systems for individuals at risk of or with cancer. Cancer may also have implications for different cultural groups and minority populations that are members of vulnerable populations in terms of access to health services. Thus, access to health services and the availability of trained health professionals are fundamental for the proper development of cancer prevention strategies. ### The economic dimension {#Sec5} The third dimension of the framework is the economic dimension. This dimension can be analysed from the perspective of the government, healthcare policies, and/or the healthcare system. Each of these elements is closely related to the others. On one hand, it is necessary to improve health services and the quality of care provided to patients to prevent cancer and improve their health outcomes. On the other hand, the economic dimension is highly dependent on the amount of resources allocated to the healthcare system \[[@CR32]\]. Finally, in this context, this study examined the role of health policies as a key strategy in the prevention, control, and treatment of cancer in Brazil. Health policy can be defined as a government decision that influences the allocation of resources within a given country \[[@CR33]\]. In this context, health policy seeks to influence the organization, structure, and financing of the healthcare system. A well-regulated health system is central to the effective prevention, control, and treatment of cancer \[[@CR34]\]. The objective of this study was to analyse scientific publications about cancer published in PubMed over the period 2001--2012 in the field of health economics (HE) and health policy (HP) in Brazil. Methods {#Sec6} ======= Search strategy {#Sec7} --------------- A search of PubMed was