The global burden of early-onset cancer in women, 1990–2021: findings from the GBD 2021 with focus on China

Background: Early-onset cancer is a significant public health threat in females, yet comprehensive data on its global burden and temporal trends remain limited. Our study aimed to provide a comprehensive assessment of global burden of female early-onset cancer from 1990 to 2021, and to project its change to 2050. Methods: This study analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of female early-onset cancers (ages 15-49 years) from 1990 to 2021, with projections to 2050, using Global Burden of Disease (GBD) 2021 data. We presented absolute counts and age-standardized rates (ASRs) per 100,000 population for 31 malignancies with 95% uncertainty intervals (UIs). Estimated annual percentage changes (EAPCs) quantified temporal trends in ASRs, while Autoregressive Integrated Moving Average (ARIMA) models projected future burden. Countries were stratified by socio-demographic index (SDI) quintiles, and Spearman rank correlation analysis and Frontier analysis were used to explore the relationship between SDI and disease burden. Risk-attributable burden was assessed through GBD's comparative risk framework. Results: From 1990 to 2021, the number of global new cases of female early-onset cancers rose from 11.49 to 17.06 million, and the number of deaths increased from 0.40 million to 0.51 million. Early-onset breast cancer had the highest burden, followed by cervical cancer. Globally, the age-standardized incidence rate (ASIR) showed a slight decline with the EAPC of -0.13%, whereas the United States saw a significant rise (EAPC = 1.36%). The age-standardized mortality rate (ASMR) declined significantly (EAPC = -1.14%), with China experiencing a steep reduction (EAPC = -2.09%). Modifiable risk factors accounted for 31.44% of total deaths in 2021, concentrated in cervical (100% of its deaths attributable to modifiable risk factors), lung (50.05%), and colorectal cancers (50.85%). Projections indicated that ASIR would peak at 880.95 per 100,000 by 2027 and subsequently stabilize, while ASMR would decline to 23.74 per 100,000 by 2050. Conclusions: The findings of this study characterize the global disease burden of early-onset cancers in women, encompassing temporal trends, regional disparities, risk attribution, and future projections, further validating the significance of preventive strategies including screening. Our results provide insights for targeted preventive strategies of early-onset cancers for female populations.