Burden and Survival of Solid Cancers Among Female Adolescents and Young Adults in Karachi: A Three- Year Retrospective Analysis

Abstract Background: Adolescents and young adults (AYAs, 15–39 years) represent a distinct population with unique cancer patterns and outcomes. Female AYAs face additional challenges related to reproductive health and fertility preservation. This study aimed to evaluate the distribution, histopathology, stage at diagnosis, and survival of solid tumors among female AYAs in Karachi. Methods: A retrospective analysis was conducted on 782 biopsy-confirmed female AYA patients presenting to Dow University Hospital between April 2022 and April 2025. Demographic, tumor, and survival data were extracted from the hospital registry. Tumor frequency, age-specific distribution, and stage were analyzed. Kaplan–Meier and Cox regression analyses assessed survival outcomes, and age-standardized incidence rates (ASIR) were calculated. Results: The mean patient age was 32.9 ± 6.1 years, with 52.3% aged 35–39 years. Breast cancer was the most common malignancy (50.0%), predominantly invasive ductal carcinoma, followed by central nervous system (16.6%) and gynecologic tumors (12.0%). Younger AYAs (15–24 years) more frequently presented with early-stage disease, while older patients (30–39 years) were predominantly diagnosed at Stage III–IV. Survival varied significantly by stage (p < 0.001) and tumor type. Stage IV patients had a median survival of 45 months (95% CI: 38.8–51.2). Breast cancer demonstrated excellent early survival, whereas gastrointestinal and CNS tumors showed marked early and mid-term mortality. Patients aged 35–39 years had nearly double the risk of death compared to those aged 15–19 years (HR = 1.97, 95% CI: 1.05–3.70, p = 0.036). Conclusions: Female AYAs in Karachi carry a substantial burden of solid tumors, with survival outcomes strongly influenced by tumor type and stage. Age-specific management, early detection, and fertility-preserving strategies are essential to improve outcomes in this vulnerable population.