Objective  To analyze the breast cancer disease burden in Sinosphere countries from 1990 to 2021, and to provide evidence for the development of breast cancer prevention and control policies.

Methods  Using data from the Global Burden of Disease Study 2021, the incidence, mortality, disability-adjusted life years (DALYs), and average annual percent change (AAPC) were analyzed to assess the breast cancer burden in six Sinosphere countries (China, Japan, South Korea, Singapore, Vietnam, and North Korea) and globally. Joinpoint regression was used to evaluate temporal trends, age–period–cohort (APC) models to assess the independent effects of age, period, and birth cohort, and Bayesian APC models to project the burden from 2022 to 2036.

Results  In 2021, China reported the highest absolute numbers of new cases (402,800), deaths (91,500), and DALYs (3,029,400 person-years) among Sinosphere countries. Japan had the highest age-standardized incidence rate (ASIR, 31.93 per 100,000), Vietnam the highest age-standardized mortality rate (ASMR, 6.23 per 100,000), and North Korea the highest age-standardized DALY rate (ASDR, 201.05 per 100,000 person-years). From 1990 to 2021, ASIR increased in all Sinosphere countries, with the greatest increase observed in South Korea [AAPC=3.47%, 95%CI (3.26%, 3.68%)]. Japan showed the largest increases in ASMR [AAPC=1.00%, 95%CI (0.78%, 1.21%)] and ASDR [AAPC=0.75%, 95%CI (0.55%, 0.95%)]. The results of the APC model showed that the age effects of breast cancer incidence, mortality, and DALY rates in Sinosphere countries are all on the rise. The risk of developing breast cancer continued to increase among younger cohorts, while mortality and DALY risks in younger generations remained stable or declined in most countries. In contrast, Vietnam showed increasing mortality and DALY risks in younger cohorts. From 2022 to 2036, it is predicted that the breast cancer ASIR will continue to rise in China, Vietnam, and North Korea, while only China will show an increasing trend in breast cancer ASMR  and ASDR.

Conclusion  Breast cancer burden varies across the Sinosphere countries, with China carrying the highest absolute burden and showing the most pronounced upward trend over the next 15 years. Strengthened preventive strategies, enhanced public awareness, effective screening programs, and accelerated advances in medical technology are urgently needed to reduce disability and mortality rates in China. Lessons learned from successful experiences in other Sinosphere countries should be actively applied to mitigate the rising breast cancer burden.

1.Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263. DOI: 10.3322/caac.21834.

2.Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53. DOI: 10.1016/j.jncc.2024.01.006.

3.殷雨来, 江昕, 何晓阳, 等. 1990-2021年中国和全球乳腺癌疾病负担及未来15年预测[J]. 中华肿瘤防治杂志, 2025, 32(5): 275-283. [Yin YL, Jiang X, He XY, et al. Disease burden of breast cancer in China and the world from 1990 to 2021 and projections for the next 15 years[J]. Chinese Journal of Cancer Prevention and Treatment, 2025, 32(5): 275-283.] DOI: 10.16073/j.cnki.cjcpt.2025.05.03.

4.黄丹琪, 杨敏, 熊巍, 等. 1990—2021年中国与全球早发女性乳腺癌的疾病负担和归因风险因素分析[J]. 协和医学杂志, 2025, 16(3): 777-784. [Huang DQ, Yang M, Xiong W, et al. Analysis of disease burden and attributable risk factors of early-onset female breast cancer in China and globally from 1990 to 2021[J]. Medical Journal of Peking Union Medical College Hospital, 2025, 16(3): 777-784.] DOI: 10.12290/xhyxzz.2024-1083.

5.Chu NHS, Yao CK, Tan VPY. Food therapy in Sinosphere Asia[J]. J Clin Gastroenterol, 2018, 52(2): 105-113. DOI: 10.1097/MCG.0000000000000932.

6.GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2100-2132. DOI: 10.1016/S0140-6736(24)00367-2.

7.Smith L, Shin JI, Hwang SY. Global Burden of Disease study at the World Health Organization: research methods for the most comprehensive global study of disease and underlying health policies[J]. Life Cycle, 2022, 2(e8): 1-10. DOI: 10.54724/lc.2022.e8.

8.张洁, 路孟鑫, 文峻, 等. 1990—2021年东亚五国归因于吸烟和高空腹血糖的膀胱癌疾病负担分析[J]. 医学新知, 2024, 34(11): 1199-1209. [Zhang J, Lu MX, Wen J, et al. Analysis of the disease burden of bladder cancer attributed to smoking and high fasting blood glucose in five East Asian countries from 1990 to 2021[J]. Yixue Xinzhi Zazhi, 2024, 34(11): 1199-1209.] DOI: 10.12173/j.issn.1004-5511.202409132.

9.Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000, 19(3): 335-51. DOI: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z.

10.Clegg LX, Hankey BF, Tiwari R, et al. Estimating average annual per cent change in trend analysis[J]. Stat Med, 2009, 28(29): 3670-82. DOI: 10.1002/sim.3733.

11.Lan T, Lu Y, He J, et al. Global, reginal, national burden and risk factors in female breast cancer from 1990 to 2021[J]. iScience, 2024, 27(10): 111045. DOI: 10.1016/j.isci.2024.111045.

12.Gedfew M, Getie A, Akalu TY, et al. Recurrence and associated factors of breast cancer among women in Sub Saharan Africa, systematic review and Meta-analysis[J]. Eur J Surg Oncol, 2024, 50(9): 108528. DOI: 10.1016/j.ejso.2024.108528.

13.Amaeze FN, Amaeze AA, Ifionu BI, et al. Therapeutic targets in breast cancer signaling: a review[J]. Journal of Pharmaceutical Research International, 2021, 33(56A): 82-99. DOI: 10.9734/jpri/2021/v33i56A33889.

14.Aizaz M, Khan M, Khan F, et al. Burden of breast cancer: developing countries perspective[J]. International Journal of Innovative and Applied Research, 2023, 11(1): 31-37. https://journalijiar.com/article/920/burden-of-breast-cancer:-developing-countries-perspective/

15.Ibekwe AM, Obeagu EI, Ibekwe CE, et al. Challenges of exclusive breastfeeding among working class women in a teaching hospital South East, Nigeria[J]. Journal of Pharmaceutical Research International, 2022, 34(46A): 1-10. DOI: 10.9734/jpri/2022/v34i46A36371.

16.Sun YS, Zhao Z, Yang ZN, et al. Risk factors and preventions of breast cancer[J]. Int J Biol Sci, 2017, 13(11): 1387-1397. DOI: 10.7150/ijbs.21635.

17.潘锋. 综合防控推动"两癌"防治事业高质量发展[J]. 妇儿健康导刊, 2025, 4(1): 9-11. [Pan F. Comprehensive prevention and control promotes high-quality development of the prevention and treatment of "two cancers"[J]. Journal of Women and Children's Health Guide, 2025, 4(1): 9-11.] https://d.wanfangdata.com.cn/periodical/ChVQZXJpb2RpY2FsQ0hJMjAyNTA2MjISDXdoYmIyMDI1MDEwMDMaCHQ5dnBpanhh

18.王宝华. 中国恶性肿瘤及危险因素流行病学调查回顾与展望[J]. 环境卫生学杂志, 2024, 14(10): 793-801. [Wang  BH. Retrospect and prospect on epidemiological investigation of malignant tumors and risk factors in China[J]. Journal of Environmental Hygiene, 2024, 14(10): 793-801] DOI: 10.13421/j.cnki.hjwsxzz.2024.10.001.

19.覃诚, 王雪薏. 人口老龄化背景下日本医疗保险制度经验镜鉴[J]. 日本问题研究, 2025, 39(2): 67-80. [Qian C, Wang  XY. Lessons from Japan's medical insurance system under the background of population aging[J]. Japanese Research, 2025, 39(2): 67-80.] DOI: 10.14156/j.cnki.rbwtyj.2025.02.006.

20.Porter P. "Westernizing" women's risks? Breast cancer in lower-income countries[J]. N Engl J Med, 2008, 358(3): 213-216. DOI: 10.1056/NEJMp0708307.

21.Li Y, Zheng J, Deng Y, et al. Global burden of female breast cancer: age-period-cohort analysis of incidence trends from 1990 to 2019 and forecasts for 2035[J]. Front Oncol, 2022, 12: 891824. DOI: 10.3389/fonc.2022.891824.

22.Wilkinson L, Gathani T. Understanding breast cancer as a global health concern[J]. Br J Radiol, 2022, 95(1130): 20211033. DOI: 10.1259/bjr.20211033.

23.Xiong X, Zheng LW, Ding Y, et al. Breast cancer: pathogenesis and treatments[J]. Signal Transduct Target Ther, 2025, 10(1): 49. DOI: 10.1038/s41392-024-02108-4.

24.Hwang MJ. Demographic change in East Asia: cultural legacies, contemporary challenges, and strategic responses[J]. China Population and Development Studies, 2025, 9(2): 142-150. DOI: 10.1007/s42379-025-00198-3.

25.冯新熠, 陆苏, 刘红. 亚洲国家及地区乳腺癌筛查指南的发展和实践[J]. 中国肿瘤临床, 2015, 42(8): 451-454. [Feng  XY, Lu S, Liu H. Development and implementation of guidelines for breast cancer screening: Asian experience[J]. Chinese Journal of Clinical Oncology, 2015, 42(8): 451-454.] DOI: 10.3969/j.issn.1000-8179.20141857.

26.Loy EY, Molinar D, Chow KY, et al. National breast cancer screening programme, Singapore: evaluation of participation and performance indicators[J]. J Med Screen, 2015, 22(4): 194-200. DOI: 10.1177/0969141315589644.

27.Sha R, Kong XM, Li XY, et al. Global burden of breast cancer and attributable risk factors in 204 countries and territories, from 1990 to 2021: results from the Global Burden of Disease Study 2021[J]. Biomark Res, 2024, 12(1): 87. DOI: 10.1186/s40364-024-00631-8.

28.Clarke TL, Mostoslavsky R. DNA repair as a shared hallmark in cancer and ageing[J]. Mol Oncol, 2022, 16(18): 3352-3379. DOI: 10.1002/1878-0261.13285.

29.Dehesh T, Fadaghi S, Seyedi M, et al. The relation between obesity and breast cancer risk in women by considering menstruation status and geographical variations: a systematic review and Meta-analysis[J]. BMC Womens Health, 2023, 23(1): 392. DOI: 10.1186/s12905-023-02543-5.