More and more young women are developing breast cancer in regions that until recently carried a lighter load. An analysis of the Global Burden of Disease (GBD) database charts how the burden in young women changed between 1990 and 2019, which risk factors it is attributed to, and how well each world region delivers care.
What was already known
Breast cancer arising in young women tends to show more aggressive biological features and is less often picked up by screening programmes, which are designed for older ages. Even so, the true scale of this burden and how it is distributed geographically were poorly estimated: the discussion focused mainly on high-income countries, without a comparable worldwide picture across regions.
What this work adds
The authors draw incidence, mortality and disability-adjusted life-years (DALYs) for young-onset breast cancer from the GBD 1990-2019 database and break them down by World Health Organization region. They also analyse the trend over that period and attribute the burden to specific risk factors. To assess health care, they build a quality-of-care index (QCI) using principal component analysis.
Main results
In 2019 there were 168,775 new cases of breast cancer in young women worldwide, 42,742 deaths and 2,468,523 DALYs due to the disease; in 2010 the figures were 89,174 cases, 29,759 deaths and 1,692,549 DALYs. Age-standardised rates in 2019 were 11.5 cases, 2.9 deaths and 168.5 DALYs per 100,000 women. Growth is concentrated mainly in the African and Eastern Mediterranean regions. The burden is shifting from Europe towards Asia-Pacific, in parallel with a similar shift in the burden attributable to smoking and alcohol consumption. The global quality-of-care index was 77, while the African region recorded the lowest value, 31.
What it means
The map of young-onset breast cancer no longer matches the map of income: the disease is growing fastest where health systems have the fewest resources to handle it, and that is where the quality index shows the widest gaps. The fact that the burden attributable to smoking and alcohol moves at the same time as the overall burden points to preventable factors gaining ground in those regions. For health planning, the message is that early diagnosis, access to treatment and outcome registration are not the concern of a single country: what matters is identifying where care is falling behind.
A view from the breast unit
Quality-of-care indices and age-standardised rates are standard tools for comparing services and spotting inequalities between territories. This work is a reminder that breast units are not only competing to treat better, but to reach earlier those populations that the diagnostic pathway and treatment take longest to reach.
Reference: Wong ZY, Ou KQ, Wong ZN, Faderani R, Kanapathy M, Mosahebi A. Global Burden, Quality of Care, and Attributable Risk Factors of Young-Onset Breast Cancer (YOBC) by WHO Regions: A Systematic Analysis for the Global Burden of Disease Study 2019. Asia-Pacific Journal of Clinical Oncology, 2026. https://doi.org/10.1111/ajco.70085
