The global, regional, and national disease burden of breast cancer attributable to behavioral risks from 1990 to 2021 and projections to 2035: a systematic analysis of the Global Burden of Disease Study 2021.
Fu Ye, Xiaojing Chen, Yuchen Cao, Zhengneng You, Jianguo Lai
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Abstract
Background: Behavioral factors have been identified as crucial contributors to breast cancer (BC) risk, exhibiting distinct patterns across different regions, sexes, and age demographics. This study aims to analyze the spatiotemporal trends of behavior-related breast cancer (BRBC) at the global, regional, and national scales from 1990 to 2021, while also forecasting its future trajectory up to 2035.
Methods: Utilizing the Global Burden of Disease 2021 data, we assessed BC mortality and disability-adjusted life years (DALYs) attributable to tobacco, alcohol, diet, and physical inactivity. Age-standardized rates (ASMR/ASDR) and estimated annual percentage change (EAPC) were calculated. Risk contributions, sociodemographic correlations, and population drivers were analyzed. Bayesian modeling projected future trends.
Results: Global ASMR and ASDR declined slightly (EAPC: - 1.04/- 0.98), but absolute deaths rose 65.4% (125,701 in 2021). High-SDI regions showed declining rates, contrasting increases in low-middle SDI areas. Western Europe had the highest ASMR (7.43/100,000 in Nauru), while China reported maximal deaths (573,281). Dietary risks dominated BRBC burdens (48.2% deaths), followed by alcohol (21.6%), smoking (18.1%), and inactivity (12.1%). Alcohol-related risks exhibited the widest regional variability. Projections suggest ASMR declines by 2035 (8.16% female; 10% male), yet global deaths may reach 129,175 (female) and 2905 (male).
Conclusions: This study first systematically analyzes behavioral risk factors' heterogeneous contributions to BC across socioeconomic levels and cultural contexts, revealing rising burdens, geographic disparities, resource inefficiencies, supporting precision interventions, and strategy translation.
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