Trends, Risk Factors, and Future Burden of Female Breast Cancer in China and Other G20 Countries, 1990–2050: A Comparative Global Burden of Disease 2023 Analysis

Xubin Dong,1,* Xiyu Kang,1,* Zeyu Wu,2,* Guangyu Li,1 Jiaxian Yue,1 Jiaxiang Liu,1 Qingyao Shang,1 Tianxiao Wang,1 Dongmin Yang,1 Jiayi Ma,1 Huiming Wu,1 Chenxuan Yang,1 Xin Wang11Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China; 2Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chenxuan Yang, Email [email protected]; Xin Wang, Email [email protected]: This study analyzes the burden of female breast cancer in China and other G20 countries from 1990 to 2023, characterizes its trends and risk factors, and projects the burden to 2050.Methods: Using Global Burden of Disease (GBD) 2023 estimates, we evaluated age-standardized rates of incidence, mortality, and disability-adjusted life years (DALYs), the mortality-to-incidence ratio (MIR), and trends (estimated annual percentage change, EAPC); applied Das Gupta decomposition, sociodemographic index (SDI) gradient, attributable-risk, and socioeconomic-inequality analyses, with stratification by premenopausal (20– 54 years) and postmenopausal (≥ 55 years) age groups; and used autoregressive integrated moving average (ARIMA) models to forecast to 2050.Results: In 2023, China’s age-standardized incidence rate (ASIR) was 31.6 per 100,000, the second lowest among G20 members (range: India 29.4 to France 114.6), yet China recorded the largest absolute burden (342,725 cases and 76,589 deaths). Between 1990 and 2023, China’s age-standardized mortality rate (ASMR) declined far more rapidly than in the rest of the G20 (EAPC − 1.92 vs − 0.23), whereas its ASIR rose only modestly (EAPC 0.40 vs 1.05); China’s MIR fell to the eighth lowest by 2023. Across members, SDI correlated positively with ASIR (r = 0.74) but inversely with MIR (r = − 0.84). Decomposition attributed China’s rising deaths chiefly to population aging, partly offset by declining age-specific rates. Rates in the postmenopausal age group exceeded those in the premenopausal age group in all 19 members. By 2050, China’s ASIR is projected to remain broadly stable, while absolute cases rise by approximately 131%.Conclusions: Across the G20, female breast-cancer burden is undergoing an epidemiological transition: absolute burden is rising as populations grow and age, while age-standardized mortality is declining in most members, with marked heterogeneity across the G20. The burden is shifting toward older women in the postmenopausal age group, while the mortality-to-incidence ratio remains higher in lower-SDI members. These patterns argue for G20-coordinated, equity-focused prevention and survival care.Keywords: breast cancer, global burden of disease, G20, menopausal status, sociodemographic index