Introduction. Research into the structure of cancer mortality and indicators of cancer care quality (one-year mortality, proportion of postmortem cases) is essential for assessing the effectiveness of the federal project "Fight Against Cancer" at the regional level. Objective: to analyze the mortality structure, one-year mortality and the frequency of postmortem diagnosis of malignant neoplasms (MN) in the Karachay-Cherkess Republic (KCR) for 2019–2024. Materials and Methods. We used official statistics from the Ministry of Health of the Karachay-Cherkessia Republic, Form No. 7 "Information on Malignant Neoplasms" for 2019–2024. We analyzed the mortality structure by main localizations, one-year mortality (by municipal district and localization), the proportion of patients who died from malignant neoplasms and were not registered (postmortem diagnosis), and the dynamics of mortality from neoplasms not classified as malignant (D00–D48). Methods of descriptive statistics, comparative and graphical analysis were used. Results and discussion. From 2019 to 2024, the structure of the leading causes of cancer mortality in the Karachay-Cherkessia Republic remained unchanged: 1st place – cancer of the trachea, bronchus, and lung (18.36 per 100,000 in 2024); 2nd – breast cancer (7.47); 3rd – stomach cancer (6.61). One-year mortality decreased from 23.6% to 12.8%, which was lower than the average values for the North Caucasus Federal District (16.1%) and the Russian Federation (17.3%). Moreover, mortality from lung cancer reached its maximum value for the period (30.1%). The proportion of patients who died from malignant neoplasms and were not registered decreased from 10.28% to 2.00% (more than a fivefold decrease). Mortality from category D00–D48 neoplasms decreased by a factor of 3.1 (from 3.7 to 1.2 per 100,000), most significantly for benign cervical lesions (from 2.8 to 0.2). Significant regional differences in one-year mortality were found: from 9.4% in the Urupsky District to 27.7% in the Nogaysky District. Conclusion. The federal project "Fight Against Cancer" in the Karachay-Cherkessia Republic has led to a significant reduction in one-year mortality and a fivefold decrease in the proportion of postmortem cancers, indicating increased cancer awareness and access to specialized care. Late diagnosis of lung cancer (mortality rate 30.1%) remains a key problem, requiring the implementation of active screening. Persistent regional disparities (Nogai District) require targeted management solutions.