Qu Zheng, Li Zheng, Pei Shengbin, Lu Ye, Liu Qiang, Ding Peikai, Yang Yazhe, Zhang Luxiao, Wang Jing, Fang Yi
Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Nutrition Harvard T.H. Chan School of Public Health Boston USA.
Cancer Innov. 2025 Jun 6;4(4):e70016. doi: 10.1002/cai2.70016. eCollection 2025 Aug.
Breast cancer (BC) remains a significant global public health challenge, and its incidence and mortality rates among adolescents and young adults (AYAs) aged 15-39 years are increasing. Compared with older adults, AYAs often face poorer prognoses and a higher disease burden. Understanding the trends and determinants of BC burden in AYAs is crucial for guiding preventive measures, early detection programs, and treatment strategies. The aim of this study is to systematically investigate the trends and distribution of the BC burden among AYAs aged 15-39 years across regions and countries and identify the contributing risk factors and disparities in incidence, mortality, and disability-adjusted life years (DALYs).
Data on BC were collected from the Global Burden of Disease (GBD) 2021 database. The number of cases, age-standardized rates, mortality, and DALYs for BC were assessed for 204 countries and territories from 1990 to 2021. Joinpoint regression analysis was used to calculate the average annual percentage changes (AAPCs) in incidence, mortality, and DALYs. Risk factors that contribute to the BC burden were also evaluated.
According to GBD 2021 estimates, 180,791 new BC cases and 42,055 related deaths were observed among AYAs globally. Between 1990 and 2021, the global incidence rate increased by 33.4%, with the highest incidence observed in regions with a high sociodemographic index (SDI) and the highest mortality rates in low-SDI regions. Incidence rates in women showed a significant upward trend (AAPC, 3.03) and peaked in North Africa and the Middle East, whereas the most rapid increase in incidence in men was noted in East Asia (AAPC, 4.87). Projections indicated a decline in age-standardized incidence rates across most European countries by 2050, in contrast to rising trends in Asia and Africa. Risk factor analysis identified dietary risks (10.5%), tobacco smoking (2%), and high fasting plasma glucose (1.6%) as major contributors to DALYs.
The global burden of AYA BC has increased significantly, particularly in regions with a middle and low SDI. The findings highlight the need for targeted preventive interventions for high-risk populations and provide critical insights for developing regional control strategies.
乳腺癌仍然是一项重大的全球公共卫生挑战，15至39岁青少年及青年成年人（AYA）中的乳腺癌发病率和死亡率正在上升。与老年人相比，AYA往往面临更差的预后和更高的疾病负担。了解AYA中乳腺癌负担的趋势和决定因素对于指导预防措施、早期检测计划和治疗策略至关重要。本研究的目的是系统地调查15至39岁AYA中乳腺癌负担在各地区和国家的趋势及分布情况，并确定发病率、死亡率和伤残调整生命年（DALY）的促成风险因素及差异。
从《2021年全球疾病负担（GBD）》数据库收集乳腺癌数据。评估了1990年至2021年期间204个国家和地区的乳腺癌病例数、年龄标准化率、死亡率和DALY。采用Joinpoint回归分析计算发病率、死亡率和DALY的年均百分比变化（AAPC）。还评估了导致乳腺癌负担的风险因素。
根据《2021年全球疾病负担》的估计，全球AYA中观察到180,791例新发乳腺癌病例和42,055例相关死亡。1990年至2021年期间，全球发病率上升了33.4%，社会人口学指数（SDI）高的地区发病率最高，SDI低的地区死亡率最高。女性发病率呈显著上升趋势（AAPC为3.03），在北非和中东达到峰值，而男性发病率上升最快的是东亚（AAPC为4.87）。预测表明，到2050年，大多数欧洲国家的年龄标准化发病率将下降，而亚洲和非洲则呈上升趋势。风险因素分析确定饮食风险（10.5%）、吸烟（2%）和空腹血糖高（1.6%）是DALY的主要促成因素。
全球AYA乳腺癌负担显著增加，特别是在SDI中低的地区。研究结果凸显了对高危人群进行有针对性预防干预的必要性，并为制定区域控制策略提供了关键见解。
