Trends and projections of early-onset breast cancer from 1990 to 2021: evidence from the global burden of disease study 2021_Chinese Journal of Evidence-Based Medicine

Authors：

XU Yehan , XU Runbing , PAN Jiajun , ZHAI Miaojie , TONG Hezixiao ,  DONG Qing

Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China;

Corresponding?author：

DONG Qing, Email: dr_dongqing@163.com

Keywords：

Early onset breast cancer; Incidence; Mortality; Disability-adjusted life-years; Trends

DOI：

10.7507/1672-2531.202508130

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective Using the GBD 2021 database, this study assessed the global burden and temporal trends of early onset breast cancer (EOBC) and projected future trajectories to 2046. Methods Data on EOBC incidence, mortality, and DALYs were extracted from the GBD 2021 study, covering 204 countries and territories. Trends were analyzed using joinpoint regression, APC models, inequality indices and Nordpred method. Results In 2021, EOBC accounted for 567 903 incident cases and 131 024 deaths globally, contributing to 6 743 070 DALYs. The ASIR reached 24.56 per 100 000 population, with corresponding ASMR and ASDR of 7.9 and 239.03 per 100 000, respectively. Temporal trends revealed a modest global increase in ASIR (EAPC: +0.38%), contrasted by declines in ASMR and ASDR (EAPC: ?0.59% and ?0.46%, respectively). The APC model showed that the relative risk of EOBC increased with age and period effects and decreased with cohort effects. Although differences in EOBC burden between different SDI quintiles have narrowed slightly, significant inequities remain, with low SDI areas disproportionately affected. Projections for the year 2046 indicate that the burden of disease will continue to trend upwards. Conclusion EOBC burden has risen significantly, with marked inequalities across regions and SDI levels, which underscores the need for targeted early screening and equitable healthcare strategies. Global efforts must prioritize preventive measures, access to diagnostics, and tailored therapies to mitigate the projected increase in EOBC cases and reduce health inequities.

Citation： XU Yehan, XU Runbing, PAN Jiajun, ZHAI Miaojie, TONG Hezixiao, DONG Qing. Trends and projections of early-onset breast cancer from 1990 to 2021: evidence from the global burden of disease study 2021. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 383-389. doi: 10.7507/1672-2531.202508130 Copy

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2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3.	Huang Z, Wang J, Liu H, et al. Global trends in adolescent and young adult female cancer burden, 1990-2021: insights from the global burden of disease study. ESMO Open, 2024, 9(11): 103958.
4.	Yan W, Liu M, Jing W, et al. Disparities in the incidence, mortality and disability-adjusted life years of 33 early-onset cancer groups globally, 2012-2021: a systematic analysis. Exp Hematol Oncol, 2025, 14(1): 38.
5.	Koh B, Tan DJH, Ng CH, et al. Patterns in cancer incidence among people younger than 50 years in the US, 2010 to 2019. JAMA Netw Open, 2023, 6(8): e2328171.
6.	Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol, 2008, 26(20): 3324-3330.
7.	Brenner DR, Brockton NT, Kotsopoulos J, et al. Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control, 2016, 27(4): 459-472.
8.	Basmadjian RB, Chow K, Kim D, et al. The association between early-onset diagnosis and clinical outcomes in triple-negative breast cancer: a systematic review and meta-analysis. Cancers (Basel), 2023, 15(7): 1923.
9.	Dufour O, Houvenaeghel G, Classe JM, et al. Early breast cancer in women aged 35 years or younger: a large national multicenter French population-based case control-matched analysis. Breast, 2023, 68: 163-172.
10.	Sha R, Kong XM, Li XY, et al. Global burden of breast cancer and attributable risk factors in 204 countries and territories, from 1990 to 2021: results from the global burden of disease study 2021. Biomark Res, 2024, 12(1): 87.
11.	IHME. Global burden of disease 2021: findings from the GBD 2021 study. 2024.
12.	Feng S, Wang T, Su Y, et al. Global burden, risk factors, and projections of early-onset dementia: insights from the global burden of disease study 2021. Ageing Res Rev, 2025, 104: 102644.
13.	Siddig A, Tengku Din TADA, Mohd Nafi SN, et al. The unique biology behind the early onset of breast cancer. Genes (Basel), 2021, 12(3): 372.
14.	Yoon KA, Kim Y, Jung SY, et al. Proteogenomic analysis dissects early-onset breast cancer patients with prognostic relevance. Exp Mol Med, 2024, 56(11): 2382-2394.
15.	Rantala J, Sepp? K, Eriksson J, et al. Incidence trends of early-onset breast cancer by lifestyle risk factors. BMC Cancer, 2025, 25(1): 326.
16.	Zhao J, Xu L, Sun J, et al. Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019. BMJ Oncol, 2023, 2(1): e000049.
17.	GBD 2021 demographics collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 1989-2056.
18.	Tan Z, Meng Y, Wu Y, et al. The burden and temporal trend of early onset pancreatic cancer based on the GBD 2021. NPJ Precis Oncol, 2025, 9(1): 32.
19.	Cao F, Xu Z, Li XX, et al. Trends and cross-country inequalities in the global burden of osteoarthritis, 1990-2019: a population-based study. Ageing Res Rev, 2024, 99: 102382.
20.	World Health Organization. Handbook on health inequality monitoring with a special focus on low- and middle-income countries. 2013.
21.	Ordunez P, Martinez R, Soliz P, et al. Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990-2017: a population-based study. Lancet Glob Health, 2019, 7(10): e1388-e1397.
22.	Huang G, Wang Y, Qin B, et al. Global, regional and national burdens of Nasopharynx cancer in the adolescents and young adults from 1990 to 2019 and its predictions. BMC Cancer, 2024, 24(1): 720.
23.	Deng Z, Visvanathan K. Patterns of subsequent cancer incidence over time in patients with breast cancer. Cancer Epidemiol Biomarkers Prev, 2025, 34(2): 246-259.
24.	Pader J, Basmadjian RB, O'Sullivan DE, et al. Examining the etiology of early-onset breast cancer in the Canadian Partnership for Tomorrow's Health (CanPath). Cancer Causes Control, 2021, 32(10): 1117-1128.
25.	Lin H, Zhang F, Wang L, et al. Use of clinical nomograms for predicting survival outcomes in young women with breast cancer. Oncol Lett, 2019, 17(2): 1505-1516.
26.	Chelmow D, Pearlman MD, Young A, et al. Executive summary of the early-onset breast cancer evidence review conference. Obstet Gynecol, 2020, 135(6): 1457-1478.
27.	Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med, 2015, 372(24): 2353-2358.
28.	DeSantis C, Siegel R, Bandi P, et al. Breast cancer statistics, 2011. CA Cancer J Clin, 2011, 61(6): 409-418.
29.	Paluch-Shimon S, Cardoso F, Partridge AH, et al. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5). Ann Oncol, 2022, 33(11): 1097-1118.
30.	Veronesi U, Boyle P, Goldhirsch A, et al. Breast cancer. Lancet, 2005, 365(9472): 1727-1741.
31.	Kim J, Harper A, McCormack V, et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nat Med, 2025, 31(4): 1154-1162.
32.	Mubarik S, Yu Y, Wang F, et al. Epidemiological and sociodemographic transitions of female breast cancer incidence, death, case fatality and DALYs in 21 world regions and globally, from 1990 to 2017: an age-period-cohort analysis. J Adv Res, 2021, 37: 185-196.
33.	Beaber EF, Buist DS, Barlow WE, et al. Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age. Cancer Res, 2014, 74(15): 4078-4089.
34.	Pragout D, Laurence V, Baffet H, et al. Contraception and cancer: CNGOF contraception guidelines. Gynecol Obstet Fertil Senol, 2018, 46(12): 834-844.
35.	Althuis MD, Brogan DR, Coates RJ, et al. Hormonal content and potency of oral contraceptives and breast cancer risk among young women. Br J Cancer, 2003, 88(1): 50-57.
36.	Rosenberg SM, Ruddy KJ, Tamimi RM, et al. BRCA1 and BRCA2 mutation testing in young women with breast cancer. JAMA Oncol, 2016, 2(6): 730-736.
37.	Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q, 2005, 83(3): 457-502.
38.	Heer E, Ruan Y, Mealey N, et al. The incidence of breast cancer in Canada 1971-2015: trends in screening-eligible and young-onset age groups. Can J Public Health, 2020, 111(5): 787-793.
39.	Abdel-Wahab M, Giammarile F, Carrara M, et al. Radiotherapy and theranostics: a lancet oncology commission. Lancet Oncol, 2024, 25(11): e545-e580.
40.	Tfayli A, Temraz S, Abou Mrad R, et al. Breast cancer in low- and middle-income countries: an emerging and challenging epidemic. J Oncol, 2010, 2010: 490631.
41.	Foerster M, Anderson BO, McKenzie F, et al. Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study. Breast Cancer Res, 2019, 21(1): 93.
42.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
43.	Trapani D, Ginsburg O, Fadelu T, et al. Global challenges and policy solutions in breast cancer control. Cancer Treat Rev, 2022, 104: 102339.
44.	Onishi N, Kataoka M. Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies. Breast Cancer, 2021, 28(6): 1195-1211.
45.	Morin S, Segafredo G, Piccolis M, et al. Expanding access to biotherapeutics in low-income and middle-income countries through public health non-exclusive voluntary intellectual property licensing: considerations, requirements, and opportunities. Lancet Glob Health, 2023, 11(1): e145-e154.
46.	Morin S, Moak HB, Bubb-Humfryes O, et al. The economic and public health impact of intellectual property licensing of medicines for low-income and middle-income countries: a modelling study. Lancet Public Health, 2022, 7(2): e169-e176.
47.	Laskar SG, Sinha S, Krishnatry R, et al. Access to radiation therapy: from local to global and equality to equity. JCO Glob Oncol, 2022, 8: e2100358.
48.	Sechopoulos I, Teuwen J, Mann R. Artificial intelligence for breast cancer detection in mammography and digital breast tomosynthesis: state of the art. Semin Cancer Biol, 2021, 72: 214-225.

1. Wu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021. J Hematol Oncol, 2024, 17(1): 119.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3. Huang Z, Wang J, Liu H, et al. Global trends in adolescent and young adult female cancer burden, 1990-2021: insights from the global burden of disease study. ESMO Open, 2024, 9(11): 103958.
4. Yan W, Liu M, Jing W, et al. Disparities in the incidence, mortality and disability-adjusted life years of 33 early-onset cancer groups globally, 2012-2021: a systematic analysis. Exp Hematol Oncol, 2025, 14(1): 38.
5. Koh B, Tan DJH, Ng CH, et al. Patterns in cancer incidence among people younger than 50 years in the US, 2010 to 2019. JAMA Netw Open, 2023, 6(8): e2328171.
6. Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol, 2008, 26(20): 3324-3330.
7. Brenner DR, Brockton NT, Kotsopoulos J, et al. Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control, 2016, 27(4): 459-472.
8. Basmadjian RB, Chow K, Kim D, et al. The association between early-onset diagnosis and clinical outcomes in triple-negative breast cancer: a systematic review and meta-analysis. Cancers (Basel), 2023, 15(7): 1923.
9. Dufour O, Houvenaeghel G, Classe JM, et al. Early breast cancer in women aged 35 years or younger: a large national multicenter French population-based case control-matched analysis. Breast, 2023, 68: 163-172.
10. Sha R, Kong XM, Li XY, et al. Global burden of breast cancer and attributable risk factors in 204 countries and territories, from 1990 to 2021: results from the global burden of disease study 2021. Biomark Res, 2024, 12(1): 87.
11. IHME. Global burden of disease 2021: findings from the GBD 2021 study. 2024.
12. Feng S, Wang T, Su Y, et al. Global burden, risk factors, and projections of early-onset dementia: insights from the global burden of disease study 2021. Ageing Res Rev, 2025, 104: 102644.
13. Siddig A, Tengku Din TADA, Mohd Nafi SN, et al. The unique biology behind the early onset of breast cancer. Genes (Basel), 2021, 12(3): 372.
14. Yoon KA, Kim Y, Jung SY, et al. Proteogenomic analysis dissects early-onset breast cancer patients with prognostic relevance. Exp Mol Med, 2024, 56(11): 2382-2394.
15. Rantala J, Sepp? K, Eriksson J, et al. Incidence trends of early-onset breast cancer by lifestyle risk factors. BMC Cancer, 2025, 25(1): 326.
16. Zhao J, Xu L, Sun J, et al. Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019. BMJ Oncol, 2023, 2(1): e000049.
17. GBD 2021 demographics collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 1989-2056.
18. Tan Z, Meng Y, Wu Y, et al. The burden and temporal trend of early onset pancreatic cancer based on the GBD 2021. NPJ Precis Oncol, 2025, 9(1): 32.
19. Cao F, Xu Z, Li XX, et al. Trends and cross-country inequalities in the global burden of osteoarthritis, 1990-2019: a population-based study. Ageing Res Rev, 2024, 99: 102382.
20. World Health Organization. Handbook on health inequality monitoring with a special focus on low- and middle-income countries. 2013.
21. Ordunez P, Martinez R, Soliz P, et al. Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990-2017: a population-based study. Lancet Glob Health, 2019, 7(10): e1388-e1397.
22. Huang G, Wang Y, Qin B, et al. Global, regional and national burdens of Nasopharynx cancer in the adolescents and young adults from 1990 to 2019 and its predictions. BMC Cancer, 2024, 24(1): 720.
23. Deng Z, Visvanathan K. Patterns of subsequent cancer incidence over time in patients with breast cancer. Cancer Epidemiol Biomarkers Prev, 2025, 34(2): 246-259.
24. Pader J, Basmadjian RB, O'Sullivan DE, et al. Examining the etiology of early-onset breast cancer in the Canadian Partnership for Tomorrow's Health (CanPath). Cancer Causes Control, 2021, 32(10): 1117-1128.
25. Lin H, Zhang F, Wang L, et al. Use of clinical nomograms for predicting survival outcomes in young women with breast cancer. Oncol Lett, 2019, 17(2): 1505-1516.
26. Chelmow D, Pearlman MD, Young A, et al. Executive summary of the early-onset breast cancer evidence review conference. Obstet Gynecol, 2020, 135(6): 1457-1478.
27. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med, 2015, 372(24): 2353-2358.
28. DeSantis C, Siegel R, Bandi P, et al. Breast cancer statistics, 2011. CA Cancer J Clin, 2011, 61(6): 409-418.
29. Paluch-Shimon S, Cardoso F, Partridge AH, et al. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5). Ann Oncol, 2022, 33(11): 1097-1118.
30. Veronesi U, Boyle P, Goldhirsch A, et al. Breast cancer. Lancet, 2005, 365(9472): 1727-1741.
31. Kim J, Harper A, McCormack V, et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nat Med, 2025, 31(4): 1154-1162.
32. Mubarik S, Yu Y, Wang F, et al. Epidemiological and sociodemographic transitions of female breast cancer incidence, death, case fatality and DALYs in 21 world regions and globally, from 1990 to 2017: an age-period-cohort analysis. J Adv Res, 2021, 37: 185-196.
33. Beaber EF, Buist DS, Barlow WE, et al. Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age. Cancer Res, 2014, 74(15): 4078-4089.
34. Pragout D, Laurence V, Baffet H, et al. Contraception and cancer: CNGOF contraception guidelines. Gynecol Obstet Fertil Senol, 2018, 46(12): 834-844.
35. Althuis MD, Brogan DR, Coates RJ, et al. Hormonal content and potency of oral contraceptives and breast cancer risk among young women. Br J Cancer, 2003, 88(1): 50-57.
36. Rosenberg SM, Ruddy KJ, Tamimi RM, et al. BRCA1 and BRCA2 mutation testing in young women with breast cancer. JAMA Oncol, 2016, 2(6): 730-736.
37. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q, 2005, 83(3): 457-502.
38. Heer E, Ruan Y, Mealey N, et al. The incidence of breast cancer in Canada 1971-2015: trends in screening-eligible and young-onset age groups. Can J Public Health, 2020, 111(5): 787-793.
39. Abdel-Wahab M, Giammarile F, Carrara M, et al. Radiotherapy and theranostics: a lancet oncology commission. Lancet Oncol, 2024, 25(11): e545-e580.
40. Tfayli A, Temraz S, Abou Mrad R, et al. Breast cancer in low- and middle-income countries: an emerging and challenging epidemic. J Oncol, 2010, 2010: 490631.
41. Foerster M, Anderson BO, McKenzie F, et al. Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study. Breast Cancer Res, 2019, 21(1): 93.
42. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
43. Trapani D, Ginsburg O, Fadelu T, et al. Global challenges and policy solutions in breast cancer control. Cancer Treat Rev, 2022, 104: 102339.
44. Onishi N, Kataoka M. Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies. Breast Cancer, 2021, 28(6): 1195-1211.
45. Morin S, Segafredo G, Piccolis M, et al. Expanding access to biotherapeutics in low-income and middle-income countries through public health non-exclusive voluntary intellectual property licensing: considerations, requirements, and opportunities. Lancet Glob Health, 2023, 11(1): e145-e154.
46. Morin S, Moak HB, Bubb-Humfryes O, et al. The economic and public health impact of intellectual property licensing of medicines for low-income and middle-income countries: a modelling study. Lancet Public Health, 2022, 7(2): e169-e176.
47. Laskar SG, Sinha S, Krishnatry R, et al. Access to radiation therapy: from local to global and equality to equity. JCO Glob Oncol, 2022, 8: e2100358.
48. Sechopoulos I, Teuwen J, Mann R. Artificial intelligence for breast cancer detection in mammography and digital breast tomosynthesis: state of the art. Semin Cancer Biol, 2021, 72: 214-225.

Chinese Journal of Evidence-Based Medicine

Trends and projections of early-onset breast cancer from 1990 to 2021: evidence from the global burden of disease study 2021

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