Analysis of Disease Burden and Attributable Risk Factors of Early-onset Female Breast Cancer in China and Globally from 1990 to 2021

Objective To analyze the disease burden， trends， and attributable risk factors of early-onset female breast cancer in China and globally from 1990 to 2021. Methods Data on the number and crude rates of incidence， death， and disability adjusted life year (DALY)， and attributable proportion for DALY of five specific risk factors (tobacco， alcohol use， low physical activity， diet high in red meat， and high fasting plasma glucose) and all risk factors were extracted from the Global Burden of Disease 2021 (GBD 2021). The Joinpoint regression model was used to analyze the trends through annual percentage change (APC) and average annual percentage change (AAPC) on the trends of age-standardized rates. Results From 1990 to 2021， the age-standardized incidence rates in China and globally showed an overall upward trend (China: AAPC = 2.25%； Globally: AAPC = 0.64%; Pairwise comparison， P < 0.001). The age-standardized mortality rates (China: AAPC = -0.82%; Globally: AAPC = -0.26%; Pairwise comparison， P < 0.001) and agestandardized DALY rates (China: AAPC = -0.63%; Globally: AAPC = -0.18%; Pairwise comparison， P = 0.004) showed an overall downward trend. The age-standardized mortality rates (APC = 0.78%) and age-standardized DALY rates (APC = 1.38%) in China have shown a gradually upward trend since 2014 and 2015， respectively. The proportion of DALY attributed to diet high in red meat was relatively highest in China (13.55%) and globally (11.20%). Conclusion From 1990 to 2021， the age-standardized incidence rates of early-onset female breast cancer in China and globally showed an overall upward trend， and the age-standardized mortality rates and age-standardized DALY rates showed an overall downward trend. The age-standardized incidence rates in China was approaching to the global level， and the age-standardized mortality rates and age-standardized DALY rates have shown an upward trend in the past decade. The prevention and treatment of early-onset female breast cancer in China is in a serious situation. In the future， further expanding the promotion scope of female breast cancer screening programs， optimizing the female breast cancer screening programs， and improving residents' awareness of cancer prevention and treatment knowledge will help reduce the growing disease burden of early-onset female breast cancer in China.