Three-decade evolution of global burden of cancer among women of child-bearing age (1990—2021): an age-stratified and socio-demographic index-based analysis based on GBD data

Malignant neoplasms represent a major public health threat to women of child-bearing age (WCBA) worldwide, with incidence rates significantly higher than those in men of comparable age. However, systematic research remains lacking regarding the long-term evolution patterns of WCBA-specific cancer disease burden and their socioeconomic determinants across extended timeframes. This study aims to comprehensively evaluate the disease burden and spatiotemporal trends of 30 cancer types among global WCBA from 1990 to 2021, providing scientific evidence for developing targeted precision prevention and control strategies for female malignancies.

A cross-sectional design was adopted in this study, and the data from the Global Burden of Disease Study (GBD) 2021 on the incidence, prevalence, and disability-adjusted life-years (DALYs) of 30 cancers among WCBA from 1990 to 2021 were extracted. Stratification was performed by age groups (15 to 29 and 30 to 49 years old) and socio-demographic index (SDI). Incidence rates, DALYs rates, and their estimated annual percentage change (EAPC) with 95%CI were calculated. Spearman correlation analysis and restricted cubic spline (RCS) models were applied to fit the non-linear relationship between disease burden and SDI (significance level P<0. 05).

In 2021, the 3 leading cancers by incidence among global WCBA were breast cancer (28. 81/100000, 95%UI: 26. 84 to 30. 94), cervical cancer (15. 77/100000, 95%UI: 14. 40 to 17. 23), and ovarian cancer (4. 40/100000, 95%UI: 3. 86 to 4. 88). From 1990 to 2021, the incidence of colorectal cancer demonstrated a significant upward trend (EAPC=0. 48, 95%CI: 0. 42 to 0. 55, P<0. 05), whereas the burden of stomach cancer (EAPC=-2. 01, 95%CI: -2. 07 to -1. 95, P<0. 05) and leukemia (EAPC=-0. 90, 95%CI: -0. 97 to -0. 83, P<0. 05) declined significantly. RCS fitting revealed significant non-linear correlations between disease burden of tracheal, bronchial, and lung cancer and SDI (P for non-linearity <0. 05), with the incidence peaking at an SDI of approximately 0. 8. Age-stratified analysis indicated that the 15 to 29 years age group was predominantly affected by leukemia and central nervous system tumors, while the burden in the 30 to 49 years age group concentrated on breast cancer, cervical cancer, and colorectal cancer.

Between 1990 and 2021, the overall cancer burden among global WCBA remained substantial, with significant evolutionary shifts in the disease spectrum. Cancer incidences demonstrate close associations with socio-economic development levels, characterized by high incidence in high-SDI regions coupled with low DALYs. This study provides macro-level data support for developing intervention strategies that integrate cancer prevention and control with reproductive health management.

Health policymakers are recommended to implement stratified precision prevention and control policies based on age and regional SDI levels: for the 15- to 29-years-old population, priority should be given to promoting HPV vaccination and implementing fertility preservation measures during antineoplastic therapy; for those aged 30 to 49 years, coverage of combined breast and cervical cancer screening should be expanded, and early intervention for metabolic-related tumors such as colorectal cancer should be incorporated into workplace and community health management systems.