Trends in the disease burden of early-onset cancers in China from 1990 to 2021: a systematic analysis of the 2021 Global Burden of Disease study

Our plain-English summary of Trends in the disease burden of early-onset cancers in China from 1990 to 2021: a systematic analysis of the 2021 Global Burden of Disease study, by J. Zhu, T. Li, J. Chen, et al (BMC Cancer, 2025).

The study

• Authors: J. Zhu, T. Li, J. Chen, W. Xue, S. Liang, C. Xie, X. Han, W. Hao, Y. He, G. Qiao, X. Duan, L. Li, J. Zhao
• Journal: BMC Cancer
• Published: 2025;25(1):1168
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In recent years, the incidence of early-onset cancers among individuals under 50 years of age has been on the rise. We aimed to analyze the disease burden and temporal trends of early-onset cancers in China, providing a basis for policymakers to develop appropriate strategies.

Methods: We utilized data from the 2021 Global Burden of Disease (GBD) study to describe the changes in early-onset cancers in China from 1990 to 2021, including incidence, mortality and disability-adjusted life years (DALYs). The age-standardized average annual percentage change (AAPC) was estimated using the Joinpoint regression program.

Results: From 1990 to 2021, the incidence rate of all early-onset cancers in China increased by 150.72 per 100,000, while the mortality and DALY rates decreased by 4.30 per 100,000 and 279.34 per 100,000, respectively. In 2021, early-onset breast cancer had the highest incidence rate (17.14 per 100,000), and trachea/bronchus/lung cancer had the highest mortality rate (6.15 per 100,000) and DALY rate (292.48 per 100,000). The standardized DALY rate of all early-onset cancers decreased (AAPC = -1.49%, 95% CI: -1.51% to -1.46%), while multiple myeloma, neuroblastoma and other peripheral nervous cell tumors, malignant neoplasm of bone and articular cartilage, kidney cancer, and mesothelioma showed significant increases with AAPC of 4.14% (4.01-4.28%), 3.83% (3.77-3.88%), 1.20% (1.16-1.25%), 0.65% (0.58-0.73%), and 0.33% (0.29-0.37%), respectively. Tobacco consumption (23.01%) was the primary contributor to the disease burden of early-onset cancers in males, whereas unsafe sexual behavior (10.53%) was the primary contributor in females.

Conclusion: The mortality and DALY rate of early-onset cancers in China decreased, while the incidence rate increased. Trachea/bronchus/lung cancer is one of the most severe early-onset cancers, and effective measures need to be taken against the main risk factors.

© 2025. The Author(s).

In plain English

This study used data from the Global Burden of Disease (GBD) 2021 study to describe cancers diagnosed between ages 15 and 49 ("early-onset cancers") in China from 1990 to 2021. It covered new cases, deaths and disability-adjusted life years (DALYs, a measure of healthy life lost). It did not study asbestos or any individual's exposure. For all early-onset cancers combined, the incidence rate rose from 671.51 to 822.23 per 100,000, while the death rate fell from 40.68 to 36.38 per 100,000. In 2021, breast cancer had the highest incidence rate, and trachea, bronchus and lung cancer had the highest death and DALY rates. For mesothelioma, the incidence rate rose from 0.05 to 0.08 per 100,000. Its age-standardized DALY rate rose by an average of 0.33% a year (95% CI 0.29% to 0.37%), which the authors marked as statistically significant, with a larger rise in males than females. Tobacco was the largest contributor to DALYs in males (23.01%) and unsafe sexual behavior in females (10.53%). The authors concluded that death and DALY rates fell while incidence rose.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Secondary analysis of Global Burden of Disease 2021 estimates, with Joinpoint regression of trends over time
• Who was studied: People in China diagnosed with cancer between ages 15 and 49, 1990 to 2021, as represented in GBD 2021 data
• Exposure: No specific exposure, fiber type or product was studied. The GBD risk-factor framework the authors used includes "occupational risks" among environmental factors, but the text gives no result for occupational risks and does not mention asbestos.
• Main results:
  • All early-onset cancers combined: the incidence rate rose from 671.51 per 100,000 in 1990 to 822.23 per 100,000 in 2021.
  • All early-onset cancers combined: the death rate fell from 40.68 per 100,000 in 1990 to 36.38 per 100,000 in 2021.
  • In 2021, breast cancer had the highest incidence rate (17.14 per 100,000). Trachea/bronchus/lung cancer had the highest death rate (6.15 per 100,000) and the highest DALY rate (292.48 per 100,000).
  • Mesothelioma, all early-onset cases: the incidence rate went from 0.05 (0.04, 0.06) per 100,000 in 1990 to 0.08 (0.07, 0.1) in 2021, a change of 65.74%. The death rate went from 0.05 to 0.07 per 100,000 (60.50%), and the DALY rate went from 2.36 to 3.59 per 100,000 (52.61%).
  • Mesothelioma, average annual percentage change (AAPC) in age-standardized rates, total population: incidence 0.44% (0.40, 0.47), mortality 0.34% (0.30, 0.38), DALY 0.33% (0.29, 0.37). All were marked statistically significant.
  • Mesothelioma AAPC by sex. Incidence: males 0.61% (0.57, 0.65), females 0.16% (0.11, 0.19). DALY rate: males 0.45% (0.42, 0.49), females 0.13% (0.08, 0.17).
  • Tobacco consumption accounted for the largest share of early-onset cancer DALYs in males (23.01%). Unsafe sexual behavior accounted for the largest share in females (10.53%).
• The authors' conclusion: The authors concluded that the death and DALY rates of early-onset cancers in China decreased while the incidence rate increased. They called trachea/bronchus/lung cancer one of the most severe early-onset cancers.
• Limitations the authors state:
  • There is no globally accepted definition of early-onset cancer.
  • The specific impact of individual exposures is still largely unknown.
  • Because the AAPC is a weighted average across trend segments, it may hide meaningful fluctuations.

Topics

Medical terms in this study, explained in our Lexicon: Incidence, Bronchus, Lung Cancer, Myeloma, Neoplasm, Mesothelioma.

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