Global burden of cancer among women of child-bearing age from 1990 to 2021: insights from the Global Burden of Disease Study 2021

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This study aimed to assess the burden and trend of cancers among WCBA from 1990 to 2021. Methods: This study retrieved 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. Estimated annual percentage changes (EAPC) and percentage change, by age and socio-demographic index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the correlation between burdens and SDI. Results: Our results showed that breast, cervical, ovarian, colon/rectum, thyroid, uterine, tracheal/bronchus/lung, brain/central nervous system (CNS), stomach, non-Hodgkin lymphoma, leukemia, and malignant skin melanoma had the highest global incidence rates respectively among WCBA in 2021. From 1990 to 2021, the incidence and prevalence rates of colon/rectum, thyroid, and brain/CNS cancers showed an upward trend, while the burdens of stomach cancer and leukemia significantly declined. In terms of SDI regions, the high and high-middle SDI regions had higher DALYs rstes of colon/rectum, brain/CNS, tracheal/bronchus/lung, and melanoma, the middle SDI regions had higher DALYs rstes of stomach cancer and leukemia, and the low SDI regions had higher DALYs rstes of thyroid cancers and non-Hodgkin lymphoma. Age distribution analysis indicated that the burden of major cancers increased with age, peaking in the 45 to 49 age group. Conclusion: This study reveals the global and regional distribution characteristics of cancer burden among WCBA and highlights the important impact of socio-economic factors on cancer burden. The findings provide a scientific basis for developing cancer prevention and control strategies, especially in high burden regions and specific age groups. global burden of disease study women of child-bearing age cancer Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Malignant neoplasm is one of the major public health problems in the world, the 2021 data estimated that cancer deaths accounted for 14.57% of all global deaths, second only to cardiovascular diseases [ 1 ]. In many high-income countries, cancer has surpassed cardiovascular diseases as the leading cause of death [ 2 ]. In 2021, cancer incidence was notably higher among women compared to men (923.44 versus 673.09, per 100,000), while mortality rates were lower in women (93.60 versus 145.69, per 100,000) [ 1 ]. According to the 2022 data, the top ten cancers for women in the global new cases were breast, lung, colon, cervical, thyroid, uterine, stomach, ovarian, liver, and non-Hodgkin lymphoma; the top ten cancers for female deaths worldwide were breast, lung, colon, cervical, liver, stomach, pancreatic, ovarian, leukemia, and esophageal cancer [ 3 ]. Although cancer mainly occurs in older age groups, the 2020 data showed 1,963,161 new cancer cases in women of child-bearing age (WCBA) aged 15 to 49 years, accounting for 1 in 5 of all cancer cases (9,227,484) in women [ 4 ]. In the United States, the burden of cancer has risen among younger women (less than 50 years), with an 82% higher incidence rate than men in 2022, up from 51% in 2002 [ 5 ]. Cancers among WCBA exhibit distinct clinical manifestations and tumor biological characteristics compared to cancers among children and the elderly [ 6 ]. Early-onset cancer may indicate poorly differentiated tumor cells, prolonged treatment duration, and increased physical, socioeconomic, and psychological burdens for WCBA patients [ 7 ]. Additionally, cancer survivors in this age group experience a significant reduction in fertility, with the likelihood of live birth decreasing by more than half for cancers such as brain, cervical, breast, colorectal, non-Hodgkin's lymphoma, and leukemia [ 8 ]. There is a substantial regional disparity in the global burden of cancer among women. The 2020 data showed that the mortality to incidence ratios of cancers among women was significantly higher in low Human Development Index (HDI) countries compared to high HDI countries (69% versus 30%) [ 4 ]. In underdeveloped regions, limited medical resources hinder timely screening, diagnosis, and treatment, contributing to higher mortality rates. A study of two million women across 81 countries with breast cancer found that nearly one-third of patients in sub-Saharan Africa had advanced disease, compared to one in ten in Europe and North America [ 9 ]. Another survey indicated that 94% of cervical cancer deaths occurred in low- and middle-income countries [ 10 ]. Unhealthy lifestyles and environmental pollution also contribute to the cancer burden in women. Air pollution and low fruit intake in less developed regions are associated with an increased incidence of lung cancer [ 11 ]. In 2019, a study on pancreatic cancer showed that its incidence and mortality initially increased with the Socio-demographic Index (SDI), peaked in Central Europe, and then decreased with further increases in SDI, which may be related to smoking, BMI, and fasting blood glucose levels in different regions [ 7 ]. In the present study, three main indicators related to cancers burden in WCBA, including incidence, prevalence, and Disability-Adjusted Life Years (DALYs), were extracted from the Global Burden of Disease (GBD) database from 1990 to 2021. Estimated annual percentage changes (EAPC) and percentage change were used to assess trend of cancers burden among WCBA. Spearman correlation analysis was used to examine the correlation between cancers burden and SDI. Given that breast, cervical, uterine, and ovarian cancers have been well studied in WCBA [ 10 ], this study focused on other major cancers such as gastrointestinal, lung, brain, and hematologic malignancies. Materials and methods Data source and disease defnition In this study, we analysed data on 30 level three causes of neoplasms from the GBD 2021, and excluded other four level three causes of neoplasms, i.e. non-melanoma skin cancer (basal and squamous), prostate cancer, testicular cancer, and other neoplasms (myelodysplastic, myeloproliferative, and other hemopoietic neoplasms, benign and in situ neoplasms). The included 30 cancers in GBD 2021 were defined using the Global Burden of Disease Study 2021 Causes of Death and Nonfatal Causes Mapped to ICD Codes ( https://ghdx.healthdata.org ). The use of GBD data did not require institutional review board approval or patient informed consent. Data collection According to the WHO definition, WCBA was defined as those aged 15 to 49 years. In this study, we extracted raw numbers and rates on the incidence, prevalence, and DALYs with 95% uncertainty intervals (UIs) of the 30 cancers at the age groups of 15 to 19, 20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, and 15 to 49 years from the GBD Results Tool ( https://vizhub.healthdata.org/gbdresults/ ). The GBD 2021 data evaluates disease burden of 204 countries and territories from 1990 to 2021, and the 204 countries and territories are classifed into 21 GBD regions and five SDI regions. The SDI is classified into five parts, i.e. low, low-middle, middle, high-middle, and high. This index reflects the overall social and economic development of a country or region, and exhibits a robust correlation with population health outcomes. Statistical analysis We calculated the EAPC in the rates of incidence, prevalence, and DALYs to evaluate the average changing trends from 1990 to 2021. The EAPC was calculated based on the natural logarithm rate fit the linear regressions model. y = α + βx + ε EAPC with 95% CI = 100 × (exp(β) − 1) x- year, y- the natural logarithm of rates (incidence, prevalence, and DALYs), α- the intercept, β- the slope, ε- the random error. We calculated the percentage change in the cases of prevalence, incidence, and DALYs by subtracting cases in 1990 from cases in 2021 and dividing the difference by cases in 1990. Percentage change = (2021 cases − 1990 cases) / 1990 cases We used spearman correlation analysis to assess the associations between the SDI and rates (incidence, prevalence, and DALYs) of cancer in WCBA across 21 GBD regions. All statistical analysis and graphic plotting were conducted using the R software package (version 4.3.2) and SPLS (Yanchang Technology Co., Ltd). p < 0.05 was statistical significance. Results Global landscape In 2021, the new cases of the 30 cancers were ranked from highest to lowest in Table 1 , S1, and S2. A signifcant increase in the cases of incident, prevalent, and DALYs of cancers among WCBA was reported globally, except for stomach with percentage change of -19% (incident), -10% (prevalent), -29% (DALYs) respectively, and leukemia, Hodgkin lymphoma, nasopharynx, esophageal with percentage change of -7%, -10%, -23%, -4% in DALYs respectively. Table 1 Global incidence for 30 cancers among women of child-bearing age in 1990 and 2021, and the trends from 1990 to 2021. Cancer type Number of cases, 1990 (95% UI) Number of cases, 2021 (95% UI) Percentage change (%) Rate per 100,000 people, 1990 (95% UI) Rate per 100,000 people, 2021 (95% UI) EAPC (95% CI) Breast cancer 256715.75 (246082.34 to 270223.8) 561438.09 (523146.53 to 602977.82) 1.19 19.2 (18.4 to 20.21) 28.81 (26.84 to 30.94) 1.16 (1.09 to 1.24) Cervical cancer 204495.07 (190489.68 to 219885.7) 307427.99 (280667.45 to 335692.27) 0.5 15.29 (14.24 to 16.44) 15.77 (14.4 to 17.23) 0.07 (0 to 0.14) Ovarian cancer 47982.63 (40523.31 to 55869.59) 85748.81 (75168.93 to 95089.83) 0.79 3.59 (3.03 to 4.18) 4.4 (3.86 to 4.88) 0.51 (0.44 to 0.58) Colon and rectum cancer 49209.67 (44835.47 to 53755.31) 85224.46 (77872.97 to 93406.82) 0.73 3.68 (3.35 to 4.02) 4.37 (4 to 4.79) 0.48 (0.42 to 0.55) Thyroid cancer 26301.79 (23536.46 to 29950.91) 67558.12 (57165.23 to 81809.16) 1.57 1.97 (1.76 to 2.24) 3.47 (2.93 to 4.2) 1.88 (1.74 to 2.01) Uterine cancer 27880.4 (23070.78 to 30840.26) 58860.14 (50765.39 to 65452.39) 1.11 2.08 (1.73 to 2.31) 3.02 (2.6 to 3.36) 1.16 (1.01 to 1.3) Tracheal, bronchus, and lung cancer 30716.06 (27911.32 to 34168.81) 45858.74 (40442.19 to 52380.91) 0.49 2.3 (2.09 to 2.55) 2.35 (2.08 to 2.69) -0.09 (-0.31 to 0.13) Brain and central nervous system cancer 24448.75 (20857.72 to 28110.75) 43720.89 (38768.1 to 50114) 0.79 1.83 (1.56 to 2.1) 2.24 (1.99 to 2.57) 0.66 (0.6 to 0.72) Stomach cancer 53702.95 (48307.5 to 59710.23) 43335.75 (38787.65 to 48812.97) -0.19 4.02 (3.61 to 4.46) 2.22 (1.99 to 2.5) -2.01 (-2.07 to -1.95) Non-Hodgkin lymphoma 22341.51 (20638.01 to 24385.65) 43124.23 (38990.43 to 47548.12) 0.93 1.67 (1.54 to 1.82) 2.21 (2 to 2.44) 0.55 (0.4 to 0.7) Leukemia 35843.67 (28175.4 to 40959.85) 40155.99 (31285.35 to 45120.72) 0.12 2.68 (2.11 to 3.06) 2.06 (1.61 to 2.32) -0.9 (-0.97 to -0.83) Malignant skin melanoma 24554.06 (23423.61 to 25413.72) 37518.16 (33557.14 to 40965.04) 0.53 1.84 (1.75 to 1.9) 1.93 (1.72 to 2.1) 0.14 (-0.15 to 0.43) Lip and oral cavity cancer 12104.05 (11353.35 to 12954.93) 28356.6 (25154.17 to 32365.76) 1.34 0.91 (0.85 to 0.97) 1.46 (1.29 to 1.66) 1.39 (1.29 to 1.49) Kidney cancer 9268.13 (8838.8 to 9701.16) 17867.1 (16577.63 to 19411.97) 0.93 0.69 (0.66 to 0.73) 0.92 (0.85 to 1) 0.89 (0.73 to 1.04) Liver cancer 11385.95 (9744.31 to 13129.02) 15911.25 (14229.31 to 17833.53) 0.4 0.85 (0.73 to 0.98) 0.82 (0.73 to 0.92) -0.4 (-0.56 to -0.24) Hodgkin lymphoma 13732.28 (11481.98 to 15144.22) 14930.27 (11546.75 to 17711.4) 0.09 1.03 (0.86 to 1.13) 0.77 (0.59 to 0.91) -1.05 (-1.17 to -0.94) Nasopharynx cancer 10163.96 (8577.84 to 11731.93) 12790.02 (10946.61 to 15348.16) 0.26 0.76 (0.64 to 0.88) 0.66 (0.56 to 0.79) -0.77 (-0.96 to -0.58) Malignant neoplasm of bone and articular cartilage 7060.09 (5983.85 to 9275.02) 11651.65 (9951.82 to 13722.92) 0.65 0.53 (0.45 to 0.69) 0.6 (0.51 to 0.7) 0.42 (0.3 to 0.53) Soft tissue and other extraosseous sarcomas 8023.27 (6305.14 to 9633.97) 11416.93 (9908.7 to 14633.73) 0.42 0.6 (0.47 to 0.72) 0.59 (0.51 to 0.75) -0.31 (-0.41 to -0.21) Pancreatic cancer 6357.42 (5822.03 to 7013.23) 10359.94 (9482.77 to 11205.03) 0.63 0.48 (0.44 to 0.52) 0.53 (0.49 to 0.57) 0.28 (0.19 to 0.37) Esophageal cancer 9232.87 (6238.88 to 10622.12) 9911.05 (8365.2 to 11798.71) 0.07 0.69 (0.47 to 0.79) 0.51 (0.43 to 0.61) -1.39 (-1.55 to -1.23) Bladder cancer 5014.36 (4471.04 to 5503.65) 7722.86 (7036.43 to 8567.79) 0.54 0.37 (0.33 to 0.41) 0.4 (0.36 to 0.44) -0.06 (-0.17 to 0.06) Gallbladder and biliary tract cancer 4648.95 (3710.07 to 5471.78) 6690.38 (5201.29 to 8149.55) 0.44 0.35 (0.28 to 0.41) 0.34 (0.27 to 0.42) -0.13 (-0.17 to -0.08) Other pharynx cancer 2276.49 (1854.72 to 2689.79) 5404.39 (4564.09 to 6702.35) 1.37 0.17 (0.14 to 0.2) 0.28 (0.23 to 0.34) 1.54 (1.47 to 1.6) Multiple myeloma 1705.32 (1466.15 to 2077.04) 4052.21 (3050.91 to 4912.27) 1.38 0.13 (0.11 to 0.16) 0.21 (0.16 to 0.25) 1.39 (1.19 to 1.6) Eye cancer 1939.06 (1460.02 to 2505.15) 3743.1 (2543 to 5294.83) 0.93 0.14 (0.11 to 0.19) 0.19 (0.13 to 0.27) 0.88 (0.8 to 0.96) Larynx cancer 2108.47 (1501.87 to 2398.27) 3341.11 (2772.9 to 4053.86) 0.58 0.16 (0.11 to 0.18) 0.17 (0.14 to 0.21) 0.07 (0 to 0.13) Mesothelioma 620.95 (542.72 to 855.14) 1150.05 (1027.09 to 1304.94) 0.85 0.05 (0.04 to 0.06) 0.06 (0.05 to 0.07) 0.68 (0.6 to 0.77) Neuroblastoma and other peripheral nervous cell tumors 364.26 (276.71 to 489.21) 890.86 (685.62 to 1124.61) 1.45 0.03 (0.02 to 0.04) 0.05 (0.04 to 0.06) 1.54 (1.34 to 1.75) Other malignant neoplasms 22176.56 (17948.86 to 25464.29) 37724.61 (32638.89 to 42737.14) 0.7 1.66 (1.34 to 1.9) 1.94 (1.67 to 2.19) 0.41 (0.29 to 0.53) UI: uncertainty intervals. EAPC: estimated annual percentage change. There were 12 cancers among WCBA with crude incidence rates of more than or close to 2 per 100,000 population, included breast (28.81 per 100,000), cervical (15.77), ovarian (4.4), colon/rectum (4.37), thyroid (3.47), uterine (3.02), tracheal/bronchus/lung (2.35), brain/central nervous system (CNS) (2.24), stomach (2.22), non-Hodgkin lymphoma (2.21), leukemia (2.06), and malignant skin melanoma (1.93) (Table 1 ). As four major female cancers (breast, cervical, uterine, and ovarian) have been well studied, this study focused on the remaining eight diseases. From 1990 to 2021, the incidence rates of diseases with an upward trend included colon/rectum (EAPC = 0.48), thyroid (1.88), brain/CNS (0.66), and non-Hodgkin lymphoma (0.55); diseases with a downward trend included stomach (-2.01) and leukemia (-0.9); diseases with no signifcant difference included tracheal/bronchus/lung (-0.09) and malignant skin melanoma (0.14) (Table 1 ). The prevalence rates of diseases with an upward trend included colon/rectum (0.99), thyroid (1.92), tracheal/bronchus/lung (0.49), brain/CNS (1.58), and non-Hodgkin lymphoma (0.99); stomach (-1.6) had a downward trend; diseases with no signifcant difference included lymphoma (0.14) and malignant skin melanoma (0.24) (Table S1 ). The DALYs rates of diseases with a downward trend included colon/rectum (-0.87), tracheal/bronchus/lung (-0.58), brain/CNS (-0.17), stomach (-2.51), non-Hodgkin lymphoma (-0.38), lymphoma (-1.55), and malignant skin melanoma (-0.83); thyroid (0.25) had an upward trend (Table S2 ). The details of the global and regional burden of 30 cancers are in the Supplementary Material 1. SDI regional level In 2021, for colon and rectum cancer, the higher incidence, prevalence and DALYs rates were reported in high and high-middle SDI regions; from 1990 to 2021, the low-middle, middle, high-middle and high SDI regions showed increases in the incidence and prevalence rates, and the low, middle, high-middle and high SDI regions showed decreases in the DALYs rates (Fig. 1 A and 2 A). For thyroid cancer, the higher incidence and prevalence rates were reported in high and high-middle SDI regions, and the higher DALYs rates were reported in low and low-middle SDI regions. All SDI regions showed increases in the incidence and prevalence rates, and the low and high-middle SDI regions showed decreases in the DALYs rates (Fig. 1 B and 2 B). For tracheal, bronchus, and lung cancer, the higher incidence and prevalence rates were reported in high and high-middle SDI regions, and the highest DALYs rate was reported in high-middle SDI region. The low and middle SDI regions showed increases in the incidence, prevalence, and DALYs rates, and the high SDI regions showed decreases in the incidence and DALYs rates (Fig. 1 C and 2 C). For brain and CNS cancer, the higher incidence and prevalence rates were reported in high and high-middle SDI regions, and the higher DALYs rates were reported in high, high-middle, and middle SDI regions. The low, low-middle, and middle SDI regions showed increases in the incidence, prevalence, and DALYs rates, the high-middle and high SDI regions showed increases in the incidence and prevalence rates, while decreases in the DALYs rates (Fig. 1 D and 2 D). For stomach cancer, the highest incidence, prevalence, and DALYs rates were reported in high-middle SDI regions, and all SDI regions showed decreases in the incidence, prevalence, and DALYs rates (Fig. 1 E and 2 E). For non-Hodgkin lymphoma, the highest incidence and prevalence rates were reported in high SDI region, and the highest DALYs rate was reported in low SDI region. The low, low-middle, middle, and high-middle SDI regions showed increases in the incidence and prevalence rates, and the middle, high-middle, and high SDI regions showed decreases in the DALYs rates (Fig. 1 F and 2 F). For leukemia, the higher incidence and prevalence rates were reported in high, high-middle, and middle SDI regions, and the higher DALYs rates were reported in low-middle, middle, and high-middle SDI regions. All SDI regions showed decreases in the incidence and DALYs rates, and the middle and high-middle SDI regions showed increases in the prevalence rates (Fig. 1 G and 2 G). For malignant skin melanoma, the highest incidence, prevalence, and DALYs rates were reported in high SDI region. The low, low-middle, middle, and high-middle SDI regions showed increases in the incidence and prevalence rates, and the high-middle and high SDI regions showed decreases in the DALYs rates (Fig. 1 H and 2 H). Temporal trend of 30 cancers in global and five SDI regions are in the Supplementary Material 1. The rates of incidence, prevalence, and DALYs of eight cancers from 1990 to 2021 are in the Supplementary Material 2. GBD regional level In 2021, for colon and rectum cancer, the highest incidence and prevalence rates were reported in Australasia, High-income Asia Pacific, and High-income North America, and the highest DALYs rates were reported in Eastern Europe, Tropical Latin America, and Southern Latin America; from 1990 to 2021, the incidence and prevalence rates increased across 19 regions with the highest increases in Central Latin America and Tropical Latin America, and the DALYs rates increased across nine regions and decreased across nine regions (Figure S1 A). For thyroid cancer, the highest incidence and prevalence rates were reported in High-income Asia Pacific, and the highest DALYs rates were reported in Eastern Sub-Saharan Africa and South Asia; the incidence and prevalence rates increased across 20 regions with the highest increases in High-income Asia Pacific, and the DALYs rates increased across nine regions and decreased across nine regions (Figure S1 B). For tracheal, bronchus, and lung cancer, the highest incidence and prevalence rates were reported in East Asia and Western Europe, and the highest DALYs rates were reported in East Asia and Central Europe; the incidence rates increased across 11 regions and decreased across four regions, the prevalence rates increased across 15 regions with the highest increases in Western Europe and East Asia, and the DALYs rates increased across nine regions and decreased across eight regions (Figure S1 C). For brain and CNS cancer, the highest incidence rates were reported in Western Europe and East Asia, the highest prevalence rates were reported in Western Europe, High-income Asia Pacific, and East Asia, and the highest DALYs rates were reported in Central Asia, Central Europe, Eastern Europe Tropical, and Latin America; the incidence and prevalence rates increased across 18 regions with the highest increases in East Asia, Andean Latin America, and High-income Asia Pacific, and the DALYs rates increased across 15 regions with the highest increases in Andean Latin America, Central Asia, and Caribbean (Figure S1 D). For stomach cancer, the highest incidence and prevalence rates were reported in High-income Asia Pacific, and the highest DALYs rates were reported in Andean Latin America, Oceania, East Asia, and Eastern Europe; the incidence, prevalence, DALYs rates decreased across 18 regions, the incidence rates only increased in Central Latin America, and the prevalence rates only increased in Central Latin America and High-income North America (Figure S1 E). For non-Hodgkin lymphoma, the highest incidence and prevalence rates were reported in Andean Latin America, Australasia, and Western Europe, and the highest DALYs rate was reported in Southern Sub-Saharan Africa; the incidence and prevalence rates increased across 19 region with the highest increases in Andean Latin America, and the DALYs rates increased across nine regions and decreased across seven regions (Figure S1 F). For leukemia, the highest incidence rates were reported in East Asia, Andean Latin America, and Central Latin America, the highest prevalence rates were reported in East Asia and Western Europe, and the highest DALYs rate was reported in Andean Latin America and Central Latin America; the incidence rates decreased across 15 regions, the prevalence rates increased across 11 regions and decreased across five regions, and the DALYs rates decreased across 19 regions (Figure S1 G). For malignant skin melanoma, the highest incidence and prevalence rates were reported in Australasia, Western Europe, and High-income North America, and the highest DALYs rates were reported in Australasia and Eastern Europe; the incidence and prevalence rates increased across 18 region with the highest increase in East Asia, and the DALYs rates increased across 10 regions and decreased across six regions (Figure S1 H). Temporal trend of 30 cancers in global and 21 GBD regions are in the Supplementary Material 1. Temporal trend of eight cancers across 204 countries and territories are in the Supplementary Material 3. Age-group patterns The age distributions of cases and rates were not always consistent for the cancers among WCBA globally. In 2021, the incidence (Fig. 3 ), prevalence (Figure S2 ), and DALYs (Figure S3 ) cases and rates increased with age and reached the highest at 45 to 49 years group in six diseases, i.e. colon/rectum, thyroid, tracheal/bronchus/lung, stomach, non-Hodgkin lymphoma, and malignant skin melanoma. For brain/CNS, the cases and rates of incidence and DALYs increased with age, while the prevalence cases reached the highest at 30 to 35 years group (Fig. 3 , S2 , S3 ). For leukemia, the cases and rates of incidence and prevalence increased with age, while the DALYs cases were the highest at 15 to 19 years group, followed by 20 to 24 years, and similar among other age groups (Fig. 3 , S2 , S3 ). From 1990 to 2021, the percentage changes in burdens of most cancers exhibited a steady upward trend among WCBA with age, except for malignant skin melanoma which showed similar percentage changes among the age groups under 45 to 49 years (Figure S4 A, B, C). The EAPC in burdens of most cancers exhibited similar changes among WCBA with age (Figure S4 D, E, F). For incidence rates, the percentage changes were lower than zero in colon/rectum at 15 to 19 years group, tracheal/bronchus/lung at 15 to 19 and 20 to 24 years groups, leukemia at 15 to 19, 20 to 24, and 25 to 29 years groups, and stomach at all age groups; the EAPC were lower than zero in tracheal/bronchus/lung, leukemia, and stomach at all age groups, and were more than zero in thyroid and brain/CNS at all age groups. For prevalence rates, the percentage changes were lower than zero in tracheal/bronchus/lung at 15 to 19 years group, and stomach at the age groups under 45 to 49 years; the EAPC were lower than zero in stomach cancer at all age groups, and were more than zero in thyroid, non-Hodgkin lymphoma, and brain/CNS at all age groups. For DALYs rates, the percentage changes were lower than zero in colon/rectum and tracheal/bronchus/lung at 15 to 19, 20 to 24, and 25 to 29 years groups, leukemia at 15 to 19, 20 to 24, 25 to 29, and 35 to 39 years groups, and stomach at all age groups; the EAPC were lower than zero in non-Hodgkin lymphoma, malignant skin melanoma, colon/rectum, tracheal/bronchus/lung, leukemia, and stomach at all age groups, in thyroid at 35 to 39, 40 to 44, and 45 to 49 years groups, and in brain/CNS at all age groups except for 25 to 29 years group. The association between burden and SDI In 2021, there were strong positive correlations between incidence rates and prevalence rates of major cancers and the SDI among WCBA globally, except for incidence rates of leukemia (moderate association) and stomach cancer (weak association), and prevalence rates of stomach cancer (moderate association). For incidence rates, the rates of colon/rectum, thyroid, and stomach increased with rising SDI; the rates of tracheal/bronchus/lung, non-Hodgkin lymphoma, and brain/CNS increased with rising SDI and then declined around an SDI of 0.8; the rates of leukemia initially increased with rising SDI, and were relatively stable with SDI of 0.5 to 0.7, and then declined around an SDI of 0.8 (Fig. 4 ). For prevalence rates, the rates of colon/rectum, thyroid, tracheal/bronchus/lung, brain/CNS, and stomach increased with rising SDI; the rates of non-Hodgkin lymphoma and leukemia increased with rising SDI and then declined around an SDI of 0.8. The incidence and prevalence rates of malignant skin melanoma were relatively stable with SDI less than 0.65, increased when the SDI reached about 0.7, and then declined around an SDI of 0.8. See Supplementary Material 4. There were strong positive correlations between DALY rates of three cancers and the SDI, including colon/rectum, tracheal/bronchus/lung, and brain/CNS, their rates increased with rising SDI and then declined around an SDI of 0.75. There was a moderate positive correlation between DALY rates of malignant skin melanoma and the SDI, the rates initially declined with rising SDI, and were relatively stable with SDI of 0.4 to 0.6, increased when the SDI reached about 0.65, and then declined around an SDI of 0.75. There was a weak positive correlation between DALY rates and the SDI for non-Hodgkin lymphoma, a very weak negative correlation for thyroid, and no correlation for leukemia or stomach. See Supplementary Material 4. The associations between the SDI and burden rates of eight cancers in WCBA across 21 GBD regions are in the Supplementary Material 4. Discussion Our study utilized comprehensive data from the GBD 2021 to analyze the incidence, prevalence, and DALYs rates of cancers among WCBA, as well as their temporal trends worldwide from 1990 to 2021. We confirmed that the incidence and prevalence cases of most cancers among WCBA have increased globally, except for that in stomach cancer; and the DALYs cases of most cancers in this demographic generally increased, except for those in stomach, leukemia, Hodgkin lymphoma, nasopharynx, and esophageal cancer. The cancer types distribution of WCBA was slightly different from that of the elderly, the common diseases including breast, gynecological, colon/rectum, tracheal/bronchus/lung, thyroid, stomach cancer, and non-Hodgkin lymphoma as the top 10 cancers were seen in both groups, and the proportion of brain/CNS cancer was higher in WCBA, while the proportion of liver cancer was relatively low. The incidence, prevalence, and DALY rates of cancers among WCBA demonstrated significant global variation from 1990 to 2021. In 2021, the burden of major cancers among WCBA increased with age groups, with the exception of DALYs for leukemia. We found that the SDI was positively correlated with the incidence, prevalence and DALYs rates of major cancers, while no or very weak correlations were observed for the DALYs rates of stomach, thyroid, leukemia, and non-Hodgkin lymphoma. Our study revealed a global rise in the incidence and prevalence rates of most cancers among WCBA over the past three decades. This trend was primarily driven by an increase in epithelial and gonadal cancers, including breast, colon/rectum, and gynecological cancers, while the DALYs rates in this demographic generally decreased over the past decade. From 1990 to 2021, the incidence and prevalence rates of colon/rectum, thyroid, and brain/CNS cancer increased annually. Since 2000, the DALYs rates of colon/rectum and brain/CNS cancer have been declining yearly, with colon/rectum cancer showing a more pronounced decrease, and the DALYs rate of thyroid cancer has seen a slight increase. The incidence, prevalence, and DALYs rates of tracheal/bronchus/lung cancer peaked at around 2000 and have gradually declined since then. These observed increases in burden of cancers may be associated with rising obesity rates, hormonal exposure, poor dietary habits, and environmental pollution among WCBA globally [ 6 , 12 ]. Advancements in early cancer screening techniques have significantly enhanced detection rates, while timely interventions have contributed to the reduction in DALYs rates [ 13 ]. However, it is crucial to note that overdiagnosis and overtreatment continue to pose challenges, particularly concerning slowly growing and stable tumors, such as certain types of thyroid, lung, and breast cancer [ 14 , 15 ]. In addition, the burden of some major cancers have decreased from 1990 to 2021. The incidence, prevalence and DALYs rate of stomach cancer have decreased significantly globally, which was generally believed to be related to low salt diet, fruit and vegetable intake, and reduced smoking [ 16 ]. The incidence and DALYs rates of leukemia have decreased significantly globally, and the prevalence rate reached its peak around 2010 then began to decline, which was related to the reduction of smoking, benzene and formaldehyde exposure [ 17 , 18 ]. The DALYs rate of melanoma has been slowly declining from 1990 to 2021, and the incidence and prevalence rates reached their peak around 2009 then began to slowly decline, which was related to the early detection and treatment [ 19 ]. The incidence, prevalence and DALYs rates of non-Hodgkin lymphoma showed declines from 1997 to 2007, but began to slowly increase after 2007, which may be related to specific virus infection, Helicobacter pylori infection, or environmental caused chromosome rearrangement and gene mutation [ 20 ]. Our study confirmed the existence of significant health disparities associated with regional development in cancer burden among WCBA. In 2021, the incidence rates of many cancers in high SDI regions were markedly higher than those in low SDI regions, i.e. malignant skin melanoma (22 times), tracheal/bronchus/lung (seven times), colon/rectum (seven times), brain/CNS (five times), non-Hodgkin lymphoma (three times), and thyroid (2.5 times). The incidence and prevalence rates of major cancers were elevated in high and high-middle SDI regions, while the DALYs rates exhibited varying trends. For instance, the incidence, prevalence, and DALYs rates of malignant skin melanoma, tracheal/bronchus/lung, colon/rectum, and brain/CNS were higher in high and high-middle SDI regions; the incidence and prevalence rates of leukemia, non-Hodgkin lymphoma, thyroid, and stomach were higher in high and high-middle SDI regions, while their DALYs rates were lower in high SDI regions. In 2021, the incidence and prevalence rates of major cancers across the 21 GBD regions were positively correlated with SDI. The incidence rates of tracheal/bronchus/lung and brain/CNS increased steadily with rising SDI, as did the incidence and prevalence rates of leukemia and non-Hodgkin lymphoma, the incidence and prevalence rates of malignant skin melanoma remained relatively low until an SDI of 0.65 after which they rose consistently between SDI of 0.65 to 0.8, the burdens of these cancers peaked at an SDI of about 0.8 and all eventually began to decline. Similarly, the DALYs rates of colon/rectum, tracheal/bronchus/lung, brain/CNS, and malignant skin melanoma initially increased with SDI but began to decline when SDI reached 0.7 to 0.8. While the DALYs rates of leukemia, non-Hodgkin lymphoma, thyroid, and stomach showed weak or no correlation with SDI. Despite genetic and environmental factors, high SDI regions benefit from superior disease screening and early diagnosis systems, as well as enhanced data collection capabilities [ 13 ]. A previous study indicated that the incidence rate of thyroid cancer was over ten times higher in high-income Western countries compared to East Asia over the past decades [ 21 ]. It is not unexpected that the DALYs rates of certain cancers were lower in high SDI regions. It has been proven that advanced healthcare systems in high SDI regions could substantially decrease mortality rates for specific cancers, including breast, gynecological, hematologic malignancies, and stomach cancer [ 22 ]. Our study revealed that the burden of major cancers among WCBA increased with age groups in 2021, except for the incidence case of brain/CNS cancer which was highest in the 30 to 35 years, and the DALYs cases of leukemia which was highest in the 15 to 19 years. From 1990 to 2021, the percentage change in the burden of cancers also increased roughly with age, except for malignant skin melanoma. The early onset malignancies in adolescents significantly affects their physical development, mental health, and academic performance, and those cancers occurring in young adults have a profound impact on marital prospects, fertility, and career development [ 22 – 25 ]. Studies have shown that female patients with cancer experience a higher frequency of adverse events during treatment compared to their male counterparts [ 26 ]. However, the lack of care for the WCBA was common, strengthening disease screening and early diagnosis in low and middle SDI regions is imperative, and clinical trials should aim to include more participants from this demographic [ 27 ]. This study has an important limitation. There are various age intervals in the GBD 2021, with the five year age group being the most frequently utilized. The primary objective of age-standardized rates is to eliminate the confounding effects of differing population structures when comparing incidence, prevalence, and mortality across different populations. Age standardization is employed in epidemiological studies because age-related differences influence the risk factors for numerous diseases, leading to variations in their burdens across different age groups. Age-standardized rates typically apply mean weighting by age category to mitigate the impact of population composition on comparative metrics. However, these standardized rates are artificial constructs, similar to DALYs, designed solely for comparability; their numerical values lose intrinsic significance [ 28 ]. In those studies examining secular trends, age-standardized rates may not always be appropriate and serve as a valid comparison method only when they exhibit temporal stability across all age groups [ 29 ]. We observed minimal discrepancy in the global crude versus age-standardized rates of the female cancer burdens among WCBA, with the incidence rates (crude versus age-standardized) of breast (28.81 versus 28.1 per 100000 population), cervical (15.77 versus 15.4), ovarian (4.4 versus 4.3), uterine (3.02 versus 2.9), and the DALYs rates of breast (341.7 versus 333.1), cervical (214.7 versus 209.8), ovarian (66.4 versus 65.1), uterine (19.1 versus 18.7) [ 10 ]. Our study utilized crude rates to more accurately reflect real-world conditions, rather than age-standardized rates. Conclusion This study examined the global cancer burden among WCBA to elucidate the disease burden of various cancer types across different regions and age groups, as well as the relationship between cancer burden and SDI. The findings of this study are crucial for formulating global and regional cancer prevention and control strategies tailored to WCBA. Future research should delve deeper into the factors influencing cancer burden and explore how to develop more effective prevention and control measures that account for regional characteristics. Abbreviations CNS central nervous system DALYs disability adjusted life-years EAPC estimated annual percentage changes GBD Global Burden of Disease Study HDI Human Development Index SDI socio-demographic index UIs uncertainty intervals WCBA women of child-bearing age Declarations Acknowledgements The authors appreciate the works of the GBD Study 2021 collaborators. Authors’ contributions Yunhai Chuai and Xia Zhang were involved in study design/planning. Yunhai Chuai, Xiaoli Zhang, Wen Jiang, and Xia Zhang performed data collection/entry. Yunhai Chuai and Xia Zhang performed data analysis/statistics. Yunhai Chuai and Xia Zhang interpreted the data. Yunhai Chuai prepared the draft manuscript. Xia Zhang revised this manuscript. Yunhai Chuai, Xiaoli Zhang, Wen Jiang, and Xia Zhang performed literature analysis/search. Funding This work is primarily supported by personal resources. Data availability Data used for the analyses are publicly available from the Institute of Health Metrics and Evaluation (http://www.healthdata.org/; http://ghdx.healthdata.org/gbd-results-tool). Ethics approval and consent to participate The use of Global Burden of Disease data did not require institutional review board approval or patient informed consent. The Institutional Review Board of the University of Washington reviewed and approved a waiver of informed consent (https://www.healthdata.org/research-analysis/gbd). Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Wu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021. J Hematol Oncol. 2024 Nov 29;17(1):119. Mahase E. Cancer overtakes CVD to become leading cause of death in high income countries. BMJ. 2019 Sep 3;366:l5368. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. Bizuayehu HM, Dadi AF, Hassen TA, Ketema DB, Ahmed KY, Kassa ZY, Amsalu E, Kibret GD, Alemu AA, Alebel A, Shifa JE, Assefa Y, Tessema GA, Sarich P, Gebremedhin AF, Bore MG. Global burden of 34 cancers among women in 2020 and projections to 2040: Population-based data from 185 countries/territories. Int J Cancer. 2024 Apr 15;154(8):1377-1393. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025 Jan-Feb;75(1):10-45. Li W, Liang H, Wang W, Liu J, Liu X, Lao S, Liang W, He J. Global cancer statistics for adolescents and young adults: population based study. J Hematol Oncol. 2024 Oct 21;17(1):99. Li Z, Zhang X, Sun C, Li Z, Fei H, Zhao D. Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of Disease Study 2019: a cross-sectional study. Int J Surg. 2024 Apr 1;110(4):1929-1940. Anderson RA, Kelsey TW, Morrison DS, Wallace WHB. Family size and duration of fertility in female cancer survivors: a population-based analysis. Fertil Steril. 2022 Feb;117(2):387-395. Benitez Fuentes JD, Morgan E, de Luna Aguilar A, Mafra A, Shah R, Giusti F, Vignat J, Znaor A, Musetti C, Yip CH, Van Eycken L, Jedy-Agba E, Piñeros M, Soerjomataram I. Global Stage Distribution of Breast Cancer at Diagnosis: A Systematic Review and Meta-Analysis. JAMA Oncol. 2024 Jan 1;10(1):71-78. Sun P, Yu C, Yin L, Chen Y, Sun Z, Zhang T, Shuai P, Zeng K, Yao X, Chen J, Liu Y, Wan Z. Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021. EClinicalMedicine. 2024 Jul 2;74:102713. Kuang Z, Wang J, Liu K, Wu J, Ge Y, Zhu G, Cao L, Ma X, Li J. Global, regional, and national burden of tracheal, bronchus, and lung cancer and its risk factors from 1990 to 2021: findings from the global burden of disease study 2021. EClinicalMedicine. 2024 Sep 5;75:102804. Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, Friedman ER, Slingerland JM. Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention. CA Cancer J Clin. 2017 Sep;67(5):378-397. Global Burden of Disease 2019 Cancer Collaboration. Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2022 Mar 1;8(3):420-444. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med. 2016 Aug 18;375(7):614-7. Patz EF Jr, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, Chiles C, Black WC, Aberle DR; NLST Overdiagnosis Manuscript Writing Team. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med. 2014 Feb 1;174(2):269-74. Qin N, Fan Y, Yang T, Yang Z, Fan D. The burden of Gastric Cancer and possible risk factors from 1990 to 2021, and projections until 2035: findings from the Global Burden of Disease Study 2021. Biomark Res. 2025 Jan 7;13(1):5. Zhou Y, Huang G, Cai X, Liu Y, Qian B, Li D. Global, regional, and national burden of acute myeloid leukemia, 1990-2021: a systematic analysis for the global burden of disease study 2021. Biomark Res. 2024 Sep 11;12(1):101. Yi M, Li A, Zhou L, Chu Q, Song Y, Wu K. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. J Hematol Oncol. 2020 Jun 8;13(1):72. Sun Y, Shen Y, Liu Q, Zhang H, Jia L, Chai Y, Jiang H, Wu M, Li Y. Global trends in melanoma burden: A comprehensive analysis from the Global Burden of Disease Study, 1990-2021. J Am Acad Dermatol. 2025 Jan;92(1):100-107. Sun H, Xue L, Guo Y, Du J, Nan K, Li M. Global, regional and national burden of non-Hodgkin lymphoma from 1990 to 2017: estimates from global burden of disease study in 2017. Ann Med. 2022 Dec;54(1):633-645. Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. Lancet Oncol. 2017 Dec;18(12):1579-1589. GBD 2019 Adolescent Young Adult Cancer Collaborators. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Oncol. 2022 Jan;23(1):27-52. Teng H, Yan O, Xiao C, Wang X, Liu Z, Xu J. Trends, age shifts, and potential delayed peaks post-pandemic of early-onset brain and central nervous system cancers in individuals aged 20-49: a cross-sectional study. Int J Surg. 2024 Dec 24. Zhang J, Ou D, Xie A, Chen D, Li X. Global burden and cross-country health inequalities of early-onset colorectal cancer and its risk factors from 1990 to 2021 and its projection until 2036. BMC Public Health. 2024 Nov 12;24(1):3124. Ma J, Song YD, Bai XM. Global, regional, and national burden and trends of early-onset tracheal, bronchus, and lung cancer from 1990 to 2019. Thorac Cancer. 2024 Mar;15(8):601-613. Unger JM, Vaidya R, Albain KS, LeBlanc M, Minasian LM, Gotay CC, Henry NL, Fisch MJ, Lee SM, Blanke CD, Hershman DL. Sex Differences in Risk of Severe Adverse Events in Patients Receiving Immunotherapy, Targeted Therapy, or Chemotherapy in Cancer Clinical Trials. J Clin Oncol. 2022 May 1;40(13):1474-1486. Mattsson E, Ljungman L, Einhorn K, Sundström Poromaa I, Stålberg K, Wikman A. Perceptions of care after end-of-treatment among younger women with different gynecologic cancer diagnoses - a qualitative analysis of written responses submitted via a survey. BMC Womens Health. 2020 Dec 22;20(1):276. Zhu JIM. Availability for age-standardized rate in long period trend study [Article in Chinese]. Journal of Disease Control and Prevention. 2003;7(3):247-249. Choi BC, de Guia NA, Walsh P. Look before you leap: stratify before you standardize. Am J Epidemiol. 1999 Jun 15;149(12):1087-96. Additional Declarations No competing interests reported. Supplementary Files figureS1.zip Figure S1. Percentage change and estimated annual percentage changes (EAPC) of the burden of eight cancer among women of child-bearing age in 21 Global Burden of Disease Study (GBD) regions from 1990 and 2021. Colon and rectum cancer (A). Thyroid cancer (B). Tracheal, bronchus, and lung cancer (C). Brain and central nervous system cancer (D). Stomach cancer (E). Non-Hodgkin lymphoma (F). Leukemia (G). Malignant skin melanoma (H). Legend for the 21 GBD regions (I). figureS2.zip Figure S2. The prevalence cases and rates of eight cancers in age patterns in 2021. Colon and rectum cancer (A). Thyroid cancer (B). Tracheal, bronchus, and lung cancer (C). Brain and central nervous system cancer (D). Stomach cancer (E). Non-Hodgkin lymphoma (F). Leukemia (G). Malignant skin melanoma (H). figureS3.zip Figure S3. The disability-adjusted life years (DALYs) cases and rates of eight cancers in age patterns in 2021. Colon and rectum cancer (A). Thyroid cancer (B). Tracheal, bronchus, and lung cancer (C). Brain and central nervous system cancer (D). Stomach cancer (E). Non-Hodgkin lymphoma (F). Leukemia (G). Malignant skin melanoma (H). figureS4.zip Figure S4. Percentage change and estimated annual percentage changes (EAPC) of the burden of eight cancers among women of child-bearing age in age patterns from 1990 and 2021. Percentage changes of incidence (A), prevalence (B), and disability-adjusted life years (DALYs) (C) rates. EAPC of incidence (D), prevalence (E), and DALYs (F) rates. Legend for the eight cancers (G). SupplementaryMaterial1.zip SupplementaryMaterial2.zip SupplementaryMaterial4.zip SupplementaryMaterial3.zip TableS1.docx TableS2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6089535","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":420083384,"identity":"699b1128-4f68-473f-a831-bc967a0c6312","order_by":0,"name":"Yunhai Chuai","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yunhai","middleName":"","lastName":"Chuai","suffix":""},{"id":420083385,"identity":"4e3255bd-e478-461b-84b2-4b1230fbc234","order_by":1,"name":"Xiaoli Zhang","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Zhang","suffix":""},{"id":420083386,"identity":"5cfca8d2-19d1-4a13-a986-8d6801fd7ed5","order_by":2,"name":"Wen Jiang","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Jiang","suffix":""},{"id":420083387,"identity":"128d97cd-7cb5-464c-9612-0bbc7940c37a","order_by":3,"name":"Xia Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYFAC5gOHf/6x4bFvb2x8+IE4LWyJjxkb0mQMeA43G0sQp4VH2Zix4bCNgUR6mwAPMRrkZ+SwSRfuYOYxl3zYxiDBYCen20BAC2PP2WPSM8+w8VjOTmx7UMCQbGx2gIAWZva+NAkeNh4ehtuJ7QYSDAcStxHSwsbMYwbUIsHDcPNgG5AkQgsPe4+xMW+bAY/BDUYitUjwHEt8OONMAo9kTyIwkA2I8Iv8jOQDBz5U/LfnZz/+8OGHCjs5glrQgAFpykfBKBgFo2AU4AAAKWtAELlDsm0AAAAASUVORK5CYII=","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xia","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-02-23 10:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6089535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6089535/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77616519,"identity":"377d9ea9-92d1-40f2-8306-7150d8cbfdd9","added_by":"auto","created_at":"2025-03-03 15:04:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":615084,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage change and estimated annual percentage changes (EAPC) of the burden of eight cancer among women of child-bearing age in global and five socio-demographic index (SDI) territories from 1990 and 2021. 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Colon and rectum cancer (A). Thyroid cancer (B). Tracheal, bronchus, and lung cancer (C). Brain and central nervous system cancer (D). Stomach cancer (E). Non-Hodgkin lymphoma (F). Leukemia (G). Malignant skin melanoma (H). Legend for the 21 GBD regions (I).\u003c/p\u003e","description":"","filename":"figureS1.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/6136d1bb55156932222c950a.zip"},{"id":77616523,"identity":"a072c4e5-282c-43df-a572-98631acc3f35","added_by":"auto","created_at":"2025-03-03 15:04:39","extension":"zip","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":207699,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure S2. \u003c/strong\u003eThe prevalence cases and rates of eight cancers in age patterns in 2021. Colon and rectum cancer (A). Thyroid cancer (B). Tracheal, bronchus, and lung cancer (C). Brain and central nervous system cancer (D). Stomach cancer (E). Non-Hodgkin lymphoma (F). Leukemia (G). Malignant skin melanoma (H).\u003c/p\u003e","description":"","filename":"figureS2.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/8b258a91bd239b042527746a.zip"},{"id":77616499,"identity":"ca8284e6-9732-4583-bdcc-2af01f895662","added_by":"auto","created_at":"2025-03-03 15:04:36","extension":"zip","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":201036,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure S3.\u003c/strong\u003e The disability-adjusted life years (DALYs) cases and rates of eight cancers in age patterns in 2021. Colon and rectum cancer (A). Thyroid cancer (B). Tracheal, bronchus, and lung cancer (C). Brain and central nervous system cancer (D). Stomach cancer (E). Non-Hodgkin lymphoma (F). Leukemia (G). Malignant skin melanoma (H).\u003c/p\u003e","description":"","filename":"figureS3.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/9302b87d51e22469bd3cdfab.zip"},{"id":77616493,"identity":"56704ec1-fce1-4c46-b565-75b481f1045b","added_by":"auto","created_at":"2025-03-03 15:04:36","extension":"zip","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":685790,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure S4. \u003c/strong\u003ePercentage change and estimated annual percentage changes (EAPC) of the burden of eight cancers among women of child-bearing age in age patterns from 1990 and 2021. Percentage changes of incidence (A), prevalence (B), and disability-adjusted life years (DALYs) (C) rates. EAPC of incidence (D), prevalence (E), and DALYs (F) rates. Legend for the eight cancers (G).\u003c/p\u003e","description":"","filename":"figureS4.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/042f2c26b7cad0504e7f6782.zip"},{"id":77616492,"identity":"a18ea7ff-81de-41af-9c00-cf13e79dfe63","added_by":"auto","created_at":"2025-03-03 15:04:36","extension":"zip","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":533325,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/463a3779faf524dcda315215.zip"},{"id":77618282,"identity":"28d70142-9a37-4c60-8030-fbd12fe432c1","added_by":"auto","created_at":"2025-03-03 15:12:37","extension":"zip","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":5053827,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial2.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/45f7f161a667390b7c706b73.zip"},{"id":77616505,"identity":"a638b25f-aa8c-4e82-9bca-a00e33b74071","added_by":"auto","created_at":"2025-03-03 15:04:37","extension":"zip","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":11046571,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial4.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/b20bc88ec062191592e08498.zip"},{"id":77616524,"identity":"dad022c6-6f47-4a24-995f-adba1bf96f97","added_by":"auto","created_at":"2025-03-03 15:04:40","extension":"zip","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":43072293,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial3.zip","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/d61c7c7ee96c7bcbcac329de.zip"},{"id":77616495,"identity":"7de7ecdd-4457-434a-8fc1-e82e2f1c4d9f","added_by":"auto","created_at":"2025-03-03 15:04:36","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":25455,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/d45bea83107220fc44007e61.docx"},{"id":77616491,"identity":"ed4c2d94-f129-4785-886c-525cb645d16e","added_by":"auto","created_at":"2025-03-03 15:04:36","extension":"docx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":25346,"visible":true,"origin":"","legend":"","description":"","filename":"TableS2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6089535/v1/2bd42370576261b1fe54455b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global burden of cancer among women of child-bearing age from 1990 to 2021: insights from the Global Burden of Disease Study 2021","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalignant neoplasm is one of the major public health problems in the world, the 2021 data estimated that cancer deaths accounted for 14.57% of all global deaths, second only to cardiovascular diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In many high-income countries, cancer has surpassed cardiovascular diseases as the leading cause of death [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2021, cancer incidence was notably higher among women compared to men (923.44 versus 673.09, per 100,000), while mortality rates were lower in women (93.60 versus 145.69, per 100,000) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the 2022 data, the top ten cancers for women in the global new cases were breast, lung, colon, cervical, thyroid, uterine, stomach, ovarian, liver, and non-Hodgkin lymphoma; the top ten cancers for female deaths worldwide were breast, lung, colon, cervical, liver, stomach, pancreatic, ovarian, leukemia, and esophageal cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although cancer mainly occurs in older age groups, the 2020 data showed 1,963,161 new cancer cases in women of child-bearing age (WCBA) aged 15 to 49 years, accounting for 1 in 5 of all cancer cases (9,227,484) in women [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the United States, the burden of cancer has risen among younger women (less than 50 years), with an 82% higher incidence rate than men in 2022, up from 51% in 2002 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cancers among WCBA exhibit distinct clinical manifestations and tumor biological characteristics compared to cancers among children and the elderly [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Early-onset cancer may indicate poorly differentiated tumor cells, prolonged treatment duration, and increased physical, socioeconomic, and psychological burdens for WCBA patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Additionally, cancer survivors in this age group experience a significant reduction in fertility, with the likelihood of live birth decreasing by more than half for cancers such as brain, cervical, breast, colorectal, non-Hodgkin's lymphoma, and leukemia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is a substantial regional disparity in the global burden of cancer among women. The 2020 data showed that the mortality to incidence ratios of cancers among women was significantly higher in low Human Development Index (HDI) countries compared to high HDI countries (69% versus 30%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In underdeveloped regions, limited medical resources hinder timely screening, diagnosis, and treatment, contributing to higher mortality rates. A study of two million women across 81 countries with breast cancer found that nearly one-third of patients in sub-Saharan Africa had advanced disease, compared to one in ten in Europe and North America [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Another survey indicated that 94% of cervical cancer deaths occurred in low- and middle-income countries [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Unhealthy lifestyles and environmental pollution also contribute to the cancer burden in women. Air pollution and low fruit intake in less developed regions are associated with an increased incidence of lung cancer [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In 2019, a study on pancreatic cancer showed that its incidence and mortality initially increased with the Socio-demographic Index (SDI), peaked in Central Europe, and then decreased with further increases in SDI, which may be related to smoking, BMI, and fasting blood glucose levels in different regions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, three main indicators related to cancers burden in WCBA, including incidence, prevalence, and Disability-Adjusted Life Years (DALYs), were extracted from the Global Burden of Disease (GBD) database from 1990 to 2021. Estimated annual percentage changes (EAPC) and percentage change were used to assess trend of cancers burden among WCBA. Spearman correlation analysis was used to examine the correlation between cancers burden and SDI. Given that breast, cervical, uterine, and ovarian cancers have been well studied in WCBA [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], this study focused on other major cancers such as gastrointestinal, lung, brain, and hematologic malignancies.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eData source and disease defnition\u003c/p\u003e \u003cp\u003eIn this study, we analysed data on 30 level three causes of neoplasms from the GBD 2021, and excluded other four level three causes of neoplasms, i.e. non-melanoma skin cancer (basal and squamous), prostate cancer, testicular cancer, and other neoplasms (myelodysplastic, myeloproliferative, and other hemopoietic neoplasms, benign and in situ neoplasms). The included 30 cancers in GBD 2021 were defined using the Global Burden of Disease Study 2021 Causes of Death and Nonfatal Causes Mapped to ICD Codes (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ghdx.healthdata.org\u003c/span\u003e\u003cspan address=\"https://ghdx.healthdata.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The use of GBD data did not require institutional review board approval or patient informed consent.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eAccording to the WHO definition, WCBA was defined as those aged 15 to 49 years. In this study, we extracted raw numbers and rates on the incidence, prevalence, and DALYs with 95% uncertainty intervals (UIs) of the 30 cancers at the age groups of 15 to 19, 20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, and 15 to 49 years from the GBD Results Tool (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://vizhub.healthdata.org/gbdresults/\u003c/span\u003e\u003cspan address=\"https://vizhub.healthdata.org/gbdresults/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe GBD 2021 data evaluates disease burden of 204 countries and territories from 1990 to 2021, and the 204 countries and territories are classifed into 21 GBD regions and five SDI regions. The SDI is classified into five parts, i.e. low, low-middle, middle, high-middle, and high. This index reflects the overall social and economic development of a country or region, and exhibits a robust correlation with population health outcomes.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe calculated the EAPC in the rates of incidence, prevalence, and DALYs to evaluate the average changing trends from 1990 to 2021. The EAPC was calculated based on the natural logarithm rate fit the linear regressions model.\u003c/p\u003e \u003cp\u003ey\u0026thinsp;=\u0026thinsp;α\u0026thinsp;+\u0026thinsp;βx\u0026thinsp;+\u0026thinsp;ε\u003c/p\u003e \u003cp\u003eEAPC\u003csub\u003ewith 95% CI\u003c/sub\u003e = 100 \u0026times; (exp(β)\u0026thinsp;\u0026minus;\u0026thinsp;1)\u003c/p\u003e \u003cp\u003ex- year, y- the natural logarithm of rates (incidence, prevalence, and DALYs), α- the intercept, β- the slope, ε- the random error.\u003c/p\u003e \u003cp\u003eWe calculated the percentage change in the cases of prevalence, incidence, and DALYs by subtracting cases in 1990 from cases in 2021 and dividing the difference by cases in 1990.\u003c/p\u003e \u003cp\u003ePercentage change = (2021 cases \u0026minus;\u0026thinsp;1990 cases) / 1990 cases\u003c/p\u003e \u003cp\u003eWe used spearman correlation analysis to assess the associations between the SDI and rates (incidence, prevalence, and DALYs) of cancer in WCBA across 21 GBD regions.\u003c/p\u003e \u003cp\u003eAll statistical analysis and graphic plotting were conducted using the R software package (version 4.3.2) and SPLS (Yanchang Technology Co., Ltd). \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eGlobal landscape\u003c/p\u003e \u003cp\u003eIn 2021, the new cases of the 30 cancers were ranked from highest to lowest in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, S1, and S2. A signifcant increase in the cases of incident, prevalent, and DALYs of cancers among WCBA was reported globally, except for stomach with percentage change of -19% (incident), -10% (prevalent), -29% (DALYs) respectively, and leukemia, Hodgkin lymphoma, nasopharynx, esophageal with percentage change of -7%, -10%, -23%, -4% in DALYs respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGlobal incidence for 30 cancers among women of child-bearing age in 1990 and 2021, and the trends from 1990 to 2021.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cases, 1990 (95% UI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of cases, 2021 (95% UI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage change (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRate per 100,000 people, 1990 (95% UI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRate per 100,000 people, 2021 (95% UI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEAPC (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreast cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e256715.75 (246082.34 to 270223.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e561438.09 (523146.53 to 602977.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.2 (18.4 to 20.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.81 (26.84 to 30.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.16 (1.09 to 1.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCervical cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e204495.07 (190489.68 to 219885.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307427.99 (280667.45 to 335692.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.29 (14.24 to 16.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.77 (14.4 to 17.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07 (0 to 0.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOvarian cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47982.63 (40523.31 to 55869.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85748.81 (75168.93 to 95089.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.59 (3.03 to 4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.4 (3.86 to 4.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.51 (0.44 to 0.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eColon and rectum cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49209.67 (44835.47 to 53755.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85224.46 (77872.97 to 93406.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.68 (3.35 to 4.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.37 (4 to 4.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.48 (0.42 to 0.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThyroid cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26301.79 (23536.46 to 29950.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67558.12 (57165.23 to 81809.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.97 (1.76 to 2.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.47 (2.93 to 4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.88 (1.74 to 2.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUterine cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27880.4 (23070.78 to 30840.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58860.14 (50765.39 to 65452.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.08 (1.73 to 2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.02 (2.6 to 3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.16 (1.01 to 1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTracheal, bronchus, and lung cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30716.06 (27911.32 to 34168.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45858.74 (40442.19 to 52380.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3 (2.09 to 2.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.35 (2.08 to 2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.09 (-0.31 to 0.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBrain and central nervous system cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24448.75 (20857.72 to 28110.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43720.89 (38768.1 to 50114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.83 (1.56 to 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.24 (1.99 to 2.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.66 (0.6 to 0.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStomach cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53702.95 (48307.5 to 59710.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43335.75 (38787.65 to 48812.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.02 (3.61 to 4.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.22 (1.99 to 2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.01 (-2.07 to -1.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Hodgkin lymphoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22341.51 (20638.01 to 24385.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43124.23 (38990.43 to 47548.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.67 (1.54 to 1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.21 (2 to 2.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.55 (0.4 to 0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeukemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35843.67 (28175.4 to 40959.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40155.99 (31285.35 to 45120.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.68 (2.11 to 3.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.06 (1.61 to 2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.9 (-0.97 to -0.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalignant skin melanoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24554.06 (23423.61 to 25413.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37518.16 (33557.14 to 40965.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.84 (1.75 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.93 (1.72 to 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.14 (-0.15 to 0.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLip and oral cavity cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12104.05 (11353.35 to 12954.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28356.6 (25154.17 to 32365.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91 (0.85 to 0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.46 (1.29 to 1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.39 (1.29 to 1.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKidney cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9268.13 (8838.8 to 9701.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17867.1 (16577.63 to 19411.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69 (0.66 to 0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.92 (0.85 to 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.89 (0.73 to 1.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiver cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11385.95 (9744.31 to 13129.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15911.25 (14229.31 to 17833.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85 (0.73 to 0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82 (0.73 to 0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.4 (-0.56 to -0.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHodgkin lymphoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13732.28 (11481.98 to 15144.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14930.27 (11546.75 to 17711.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03 (0.86 to 1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77 (0.59 to 0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.05 (-1.17 to -0.94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNasopharynx cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10163.96 (8577.84 to 11731.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12790.02 (10946.61 to 15348.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76 (0.64 to 0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66 (0.56 to 0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.77 (-0.96 to -0.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalignant neoplasm of bone and articular cartilage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7060.09 (5983.85 to 9275.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11651.65 (9951.82 to 13722.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53 (0.45 to 0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6 (0.51 to 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.42 (0.3 to 0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSoft tissue and other extraosseous sarcomas\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8023.27 (6305.14 to 9633.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11416.93 (9908.7 to 14633.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6 (0.47 to 0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.59 (0.51 to 0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.31 (-0.41 to -0.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePancreatic cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6357.42 (5822.03 to 7013.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10359.94 (9482.77 to 11205.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48 (0.44 to 0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53 (0.49 to 0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.28 (0.19 to 0.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEsophageal cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9232.87 (6238.88 to 10622.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9911.05 (8365.2 to 11798.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69 (0.47 to 0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.51 (0.43 to 0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.39 (-1.55 to -1.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBladder cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5014.36 (4471.04 to 5503.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7722.86 (7036.43 to 8567.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37 (0.33 to 0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4 (0.36 to 0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.06 (-0.17 to 0.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGallbladder and biliary tract cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4648.95 (3710.07 to 5471.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6690.38 (5201.29 to 8149.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35 (0.28 to 0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.34 (0.27 to 0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.13 (-0.17 to -0.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther pharynx cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2276.49 (1854.72 to 2689.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5404.39 (4564.09 to 6702.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.17 (0.14 to 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28 (0.23 to 0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.54 (1.47 to 1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMultiple myeloma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1705.32 (1466.15 to 2077.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4052.21 (3050.91 to 4912.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.13 (0.11 to 0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21 (0.16 to 0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.39 (1.19 to 1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEye cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1939.06 (1460.02 to 2505.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3743.1 (2543 to 5294.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14 (0.11 to 0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.19 (0.13 to 0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.88 (0.8 to 0.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLarynx cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2108.47 (1501.87 to 2398.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3341.11 (2772.9 to 4053.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16 (0.11 to 0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.17 (0.14 to 0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07 (0 to 0.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMesothelioma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e620.95 (542.72 to 855.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1150.05 (1027.09 to 1304.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 (0.04 to 0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06 (0.05 to 0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.68 (0.6 to 0.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeuroblastoma and other peripheral nervous cell tumors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e364.26 (276.71 to 489.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e890.86 (685.62 to 1124.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03 (0.02 to 0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05 (0.04 to 0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.54 (1.34 to 1.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther malignant neoplasms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22176.56 (17948.86 to 25464.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37724.61 (32638.89 to 42737.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.66 (1.34 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.94 (1.67 to 2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.41 (0.29 to 0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eUI: uncertainty intervals. EAPC: estimated annual percentage change.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were 12 cancers among WCBA with crude incidence rates of more than or close to 2 per 100,000 population, included breast (28.81 per 100,000), cervical (15.77), ovarian (4.4), colon/rectum (4.37), thyroid (3.47), uterine (3.02), tracheal/bronchus/lung (2.35), brain/central nervous system (CNS) (2.24), stomach (2.22), non-Hodgkin lymphoma (2.21), leukemia (2.06), and malignant skin melanoma (1.93) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). As four major female cancers (breast, cervical, uterine, and ovarian) have been well studied, this study focused on the remaining eight diseases.\u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, the incidence rates of diseases with an upward trend included colon/rectum (EAPC\u0026thinsp;=\u0026thinsp;0.48), thyroid (1.88), brain/CNS (0.66), and non-Hodgkin lymphoma (0.55); diseases with a downward trend included stomach (-2.01) and leukemia (-0.9); diseases with no signifcant difference included tracheal/bronchus/lung (-0.09) and malignant skin melanoma (0.14) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The prevalence rates of diseases with an upward trend included colon/rectum (0.99), thyroid (1.92), tracheal/bronchus/lung (0.49), brain/CNS (1.58), and non-Hodgkin lymphoma (0.99); stomach (-1.6) had a downward trend; diseases with no signifcant difference included lymphoma (0.14) and malignant skin melanoma (0.24) (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). The DALYs rates of diseases with a downward trend included colon/rectum (-0.87), tracheal/bronchus/lung (-0.58), brain/CNS (-0.17), stomach (-2.51), non-Hodgkin lymphoma (-0.38), lymphoma (-1.55), and malignant skin melanoma (-0.83); thyroid (0.25) had an upward trend (Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe details of the global and regional burden of 30 cancers are in the Supplementary Material 1.\u003c/p\u003e \u003cp\u003eSDI regional level\u003c/p\u003e \u003cp\u003eIn 2021, for colon and rectum cancer, the higher incidence, prevalence and DALYs rates were reported in high and high-middle SDI regions; from 1990 to 2021, the low-middle, middle, high-middle and high SDI regions showed increases in the incidence and prevalence rates, and the low, middle, high-middle and high SDI regions showed decreases in the DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e\u003cp\u003eFor thyroid cancer, the higher incidence and prevalence rates were reported in high and high-middle SDI regions, and the higher DALYs rates were reported in low and low-middle SDI regions. All SDI regions showed increases in the incidence and prevalence rates, and the low and high-middle SDI regions showed decreases in the DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003eFor tracheal, bronchus, and lung cancer, the higher incidence and prevalence rates were reported in high and high-middle SDI regions, and the highest DALYs rate was reported in high-middle SDI region. The low and middle SDI regions showed increases in the incidence, prevalence, and DALYs rates, and the high SDI regions showed decreases in the incidence and DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003eFor brain and CNS cancer, the higher incidence and prevalence rates were reported in high and high-middle SDI regions, and the higher DALYs rates were reported in high, high-middle, and middle SDI regions. The low, low-middle, and middle SDI regions showed increases in the incidence, prevalence, and DALYs rates, the high-middle and high SDI regions showed increases in the incidence and prevalence rates, while decreases in the DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD).\u003c/p\u003e \u003cp\u003eFor stomach cancer, the highest incidence, prevalence, and DALYs rates were reported in high-middle SDI regions, and all SDI regions showed decreases in the incidence, prevalence, and DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE).\u003c/p\u003e \u003cp\u003eFor non-Hodgkin lymphoma, the highest incidence and prevalence rates were reported in high SDI region, and the highest DALYs rate was reported in low SDI region. The low, low-middle, middle, and high-middle SDI regions showed increases in the incidence and prevalence rates, and the middle, high-middle, and high SDI regions showed decreases in the DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF).\u003c/p\u003e \u003cp\u003eFor leukemia, the higher incidence and prevalence rates were reported in high, high-middle, and middle SDI regions, and the higher DALYs rates were reported in low-middle, middle, and high-middle SDI regions. All SDI regions showed decreases in the incidence and DALYs rates, and the middle and high-middle SDI regions showed increases in the prevalence rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eG).\u003c/p\u003e \u003cp\u003eFor malignant skin melanoma, the highest incidence, prevalence, and DALYs rates were reported in high SDI region. The low, low-middle, middle, and high-middle SDI regions showed increases in the incidence and prevalence rates, and the high-middle and high SDI regions showed decreases in the DALYs rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eH and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eH).\u003c/p\u003e \u003cp\u003eTemporal trend of 30 cancers in global and five SDI regions are in the Supplementary Material 1. The rates of incidence, prevalence, and DALYs of eight cancers from 1990 to 2021 are in the Supplementary Material 2.\u003c/p\u003e \u003cp\u003eGBD regional level\u003c/p\u003e \u003cp\u003eIn 2021, for colon and rectum cancer, the highest incidence and prevalence rates were reported in Australasia, High-income Asia Pacific, and High-income North America, and the highest DALYs rates were reported in Eastern Europe, Tropical Latin America, and Southern Latin America; from 1990 to 2021, the incidence and prevalence rates increased across 19 regions with the highest increases in Central Latin America and Tropical Latin America, and the DALYs rates increased across nine regions and decreased across nine regions (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor thyroid cancer, the highest incidence and prevalence rates were reported in High-income Asia Pacific, and the highest DALYs rates were reported in Eastern Sub-Saharan Africa and South Asia; the incidence and prevalence rates increased across 20 regions with the highest increases in High-income Asia Pacific, and the DALYs rates increased across nine regions and decreased across nine regions (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003eFor tracheal, bronchus, and lung cancer, the highest incidence and prevalence rates were reported in East Asia and Western Europe, and the highest DALYs rates were reported in East Asia and Central Europe; the incidence rates increased across 11 regions and decreased across four regions, the prevalence rates increased across 15 regions with the highest increases in Western Europe and East Asia, and the DALYs rates increased across nine regions and decreased across eight regions (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003eFor brain and CNS cancer, the highest incidence rates were reported in Western Europe and East Asia, the highest prevalence rates were reported in Western Europe, High-income Asia Pacific, and East Asia, and the highest DALYs rates were reported in Central Asia, Central Europe, Eastern Europe Tropical, and Latin America; the incidence and prevalence rates increased across 18 regions with the highest increases in East Asia, Andean Latin America, and High-income Asia Pacific, and the DALYs rates increased across 15 regions with the highest increases in Andean Latin America, Central Asia, and Caribbean (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eD).\u003c/p\u003e \u003cp\u003eFor stomach cancer, the highest incidence and prevalence rates were reported in High-income Asia Pacific, and the highest DALYs rates were reported in Andean Latin America, Oceania, East Asia, and Eastern Europe; the incidence, prevalence, DALYs rates decreased across 18 regions, the incidence rates only increased in Central Latin America, and the prevalence rates only increased in Central Latin America and High-income North America (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eE).\u003c/p\u003e \u003cp\u003eFor non-Hodgkin lymphoma, the highest incidence and prevalence rates were reported in Andean Latin America, Australasia, and Western Europe, and the highest DALYs rate was reported in Southern Sub-Saharan Africa; the incidence and prevalence rates increased across 19 region with the highest increases in Andean Latin America, and the DALYs rates increased across nine regions and decreased across seven regions (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eF).\u003c/p\u003e \u003cp\u003eFor leukemia, the highest incidence rates were reported in East Asia, Andean Latin America, and Central Latin America, the highest prevalence rates were reported in East Asia and Western Europe, and the highest DALYs rate was reported in Andean Latin America and Central Latin America; the incidence rates decreased across 15 regions, the prevalence rates increased across 11 regions and decreased across five regions, and the DALYs rates decreased across 19 regions (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eG).\u003c/p\u003e \u003cp\u003eFor malignant skin melanoma, the highest incidence and prevalence rates were reported in Australasia, Western Europe, and High-income North America, and the highest DALYs rates were reported in Australasia and Eastern Europe; the incidence and prevalence rates increased across 18 region with the highest increase in East Asia, and the DALYs rates increased across 10 regions and decreased across six regions (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003eH).\u003c/p\u003e \u003cp\u003eTemporal trend of 30 cancers in global and 21 GBD regions are in the Supplementary Material 1. Temporal trend of eight cancers across 204 countries and territories are in the Supplementary Material 3.\u003c/p\u003e \u003cp\u003eAge-group patterns\u003c/p\u003e \u003cp\u003eThe age distributions of cases and rates were not always consistent for the cancers among WCBA globally. In 2021, the incidence (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e), prevalence (Figure \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e), and DALYs (Figure \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e) cases and rates increased with age and reached the highest at 45 to 49 years group in six diseases, i.e. colon/rectum, thyroid, tracheal/bronchus/lung, stomach, non-Hodgkin lymphoma, and malignant skin melanoma. For brain/CNS, the cases and rates of incidence and DALYs increased with age, while the prevalence cases reached the highest at 30 to 35 years group (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e, \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003eS2\u003c/span\u003e, \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003eS3\u003c/span\u003e). For leukemia, the cases and rates of incidence and prevalence increased with age, while the DALYs cases were the highest at 15 to 19 years group, followed by 20 to 24 years, and similar among other age groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e, \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003eS2\u003c/span\u003e, \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003eS3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, the percentage changes in burdens of most cancers exhibited a steady upward trend among WCBA with age, except for malignant skin melanoma which showed similar percentage changes among the age groups under 45 to 49 years (Figure \u003cspan refid=\"MOESM4\" class=\"InternalRef\"\u003eS4\u003c/span\u003eA, B, C). The EAPC in burdens of most cancers exhibited similar changes among WCBA with age (Figure \u003cspan refid=\"MOESM4\" class=\"InternalRef\"\u003eS4\u003c/span\u003eD, E, F). For incidence rates, the percentage changes were lower than zero in colon/rectum at 15 to 19 years group, tracheal/bronchus/lung at 15 to 19 and 20 to 24 years groups, leukemia at 15 to 19, 20 to 24, and 25 to 29 years groups, and stomach at all age groups; the EAPC were lower than zero in tracheal/bronchus/lung, leukemia, and stomach at all age groups, and were more than zero in thyroid and brain/CNS at all age groups. For prevalence rates, the percentage changes were lower than zero in tracheal/bronchus/lung at 15 to 19 years group, and stomach at the age groups under 45 to 49 years; the EAPC were lower than zero in stomach cancer at all age groups, and were more than zero in thyroid, non-Hodgkin lymphoma, and brain/CNS at all age groups. For DALYs rates, the percentage changes were lower than zero in colon/rectum and tracheal/bronchus/lung at 15 to 19, 20 to 24, and 25 to 29 years groups, leukemia at 15 to 19, 20 to 24, 25 to 29, and 35 to 39 years groups, and stomach at all age groups; the EAPC were lower than zero in non-Hodgkin lymphoma, malignant skin melanoma, colon/rectum, tracheal/bronchus/lung, leukemia, and stomach at all age groups, in thyroid at 35 to 39, 40 to 44, and 45 to 49 years groups, and in brain/CNS at all age groups except for 25 to 29 years group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe association between burden and SDI\u003c/p\u003e \u003cp\u003eIn 2021, there were strong positive correlations between incidence rates and prevalence rates of major cancers and the SDI among WCBA globally, except for incidence rates of leukemia (moderate association) and stomach cancer (weak association), and prevalence rates of stomach cancer (moderate association). For incidence rates, the rates of colon/rectum, thyroid, and stomach increased with rising SDI; the rates of tracheal/bronchus/lung, non-Hodgkin lymphoma, and brain/CNS increased with rising SDI and then declined around an SDI of 0.8; the rates of leukemia initially increased with rising SDI, and were relatively stable with SDI of 0.5 to 0.7, and then declined around an SDI of 0.8 (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e4\u003c/span\u003e). For prevalence rates, the rates of colon/rectum, thyroid, tracheal/bronchus/lung, brain/CNS, and stomach increased with rising SDI; the rates of non-Hodgkin lymphoma and leukemia increased with rising SDI and then declined around an SDI of 0.8. The incidence and prevalence rates of malignant skin melanoma were relatively stable with SDI less than 0.65, increased when the SDI reached about 0.7, and then declined around an SDI of 0.8. See Supplementary Material 4.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThere were strong positive correlations between DALY rates of three cancers and the SDI, including colon/rectum, tracheal/bronchus/lung, and brain/CNS, their rates increased with rising SDI and then declined around an SDI of 0.75. There was a moderate positive correlation between DALY rates of malignant skin melanoma and the SDI, the rates initially declined with rising SDI, and were relatively stable with SDI of 0.4 to 0.6, increased when the SDI reached about 0.65, and then declined around an SDI of 0.75. There was a weak positive correlation between DALY rates and the SDI for non-Hodgkin lymphoma, a very weak negative correlation for thyroid, and no correlation for leukemia or stomach. See Supplementary Material 4.\u003c/p\u003e \u003cp\u003eThe associations between the SDI and burden rates of eight cancers in WCBA across 21 GBD regions are in the Supplementary Material 4.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study utilized comprehensive data from the GBD 2021 to analyze the incidence, prevalence, and DALYs rates of cancers among WCBA, as well as their temporal trends worldwide from 1990 to 2021. We confirmed that the incidence and prevalence cases of most cancers among WCBA have increased globally, except for that in stomach cancer; and the DALYs cases of most cancers in this demographic generally increased, except for those in stomach, leukemia, Hodgkin lymphoma, nasopharynx, and esophageal cancer. The cancer types distribution of WCBA was slightly different from that of the elderly, the common diseases including breast, gynecological, colon/rectum, tracheal/bronchus/lung, thyroid, stomach cancer, and non-Hodgkin lymphoma as the top 10 cancers were seen in both groups, and the proportion of brain/CNS cancer was higher in WCBA, while the proportion of liver cancer was relatively low. The incidence, prevalence, and DALY rates of cancers among WCBA demonstrated significant global variation from 1990 to 2021. In 2021, the burden of major cancers among WCBA increased with age groups, with the exception of DALYs for leukemia. We found that the SDI was positively correlated with the incidence, prevalence and DALYs rates of major cancers, while no or very weak correlations were observed for the DALYs rates of stomach, thyroid, leukemia, and non-Hodgkin lymphoma.\u003c/p\u003e \u003cp\u003eOur study revealed a global rise in the incidence and prevalence rates of most cancers among WCBA over the past three decades. This trend was primarily driven by an increase in epithelial and gonadal cancers, including breast, colon/rectum, and gynecological cancers, while the DALYs rates in this demographic generally decreased over the past decade. From 1990 to 2021, the incidence and prevalence rates of colon/rectum, thyroid, and brain/CNS cancer increased annually. Since 2000, the DALYs rates of colon/rectum and brain/CNS cancer have been declining yearly, with colon/rectum cancer showing a more pronounced decrease, and the DALYs rate of thyroid cancer has seen a slight increase. The incidence, prevalence, and DALYs rates of tracheal/bronchus/lung cancer peaked at around 2000 and have gradually declined since then. These observed increases in burden of cancers may be associated with rising obesity rates, hormonal exposure, poor dietary habits, and environmental pollution among WCBA globally [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Advancements in early cancer screening techniques have significantly enhanced detection rates, while timely interventions have contributed to the reduction in DALYs rates [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, it is crucial to note that overdiagnosis and overtreatment continue to pose challenges, particularly concerning slowly growing and stable tumors, such as certain types of thyroid, lung, and breast cancer [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, the burden of some major cancers have decreased from 1990 to 2021. The incidence, prevalence and DALYs rate of stomach cancer have decreased significantly globally, which was generally believed to be related to low salt diet, fruit and vegetable intake, and reduced smoking [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The incidence and DALYs rates of leukemia have decreased significantly globally, and the prevalence rate reached its peak around 2010 then began to decline, which was related to the reduction of smoking, benzene and formaldehyde exposure [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The DALYs rate of melanoma has been slowly declining from 1990 to 2021, and the incidence and prevalence rates reached their peak around 2009 then began to slowly decline, which was related to the early detection and treatment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The incidence, prevalence and DALYs rates of non-Hodgkin lymphoma showed declines from 1997 to 2007, but began to slowly increase after 2007, which may be related to specific virus infection, Helicobacter pylori infection, or environmental caused chromosome rearrangement and gene mutation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study confirmed the existence of significant health disparities associated with regional development in cancer burden among WCBA. In 2021, the incidence rates of many cancers in high SDI regions were markedly higher than those in low SDI regions, i.e. malignant skin melanoma (22 times), tracheal/bronchus/lung (seven times), colon/rectum (seven times), brain/CNS (five times), non-Hodgkin lymphoma (three times), and thyroid (2.5 times). The incidence and prevalence rates of major cancers were elevated in high and high-middle SDI regions, while the DALYs rates exhibited varying trends. For instance, the incidence, prevalence, and DALYs rates of malignant skin melanoma, tracheal/bronchus/lung, colon/rectum, and brain/CNS were higher in high and high-middle SDI regions; the incidence and prevalence rates of leukemia, non-Hodgkin lymphoma, thyroid, and stomach were higher in high and high-middle SDI regions, while their DALYs rates were lower in high SDI regions. In 2021, the incidence and prevalence rates of major cancers across the 21 GBD regions were positively correlated with SDI. The incidence rates of tracheal/bronchus/lung and brain/CNS increased steadily with rising SDI, as did the incidence and prevalence rates of leukemia and non-Hodgkin lymphoma, the incidence and prevalence rates of malignant skin melanoma remained relatively low until an SDI of 0.65 after which they rose consistently between SDI of 0.65 to 0.8, the burdens of these cancers peaked at an SDI of about 0.8 and all eventually began to decline. Similarly, the DALYs rates of colon/rectum, tracheal/bronchus/lung, brain/CNS, and malignant skin melanoma initially increased with SDI but began to decline when SDI reached 0.7 to 0.8. While the DALYs rates of leukemia, non-Hodgkin lymphoma, thyroid, and stomach showed weak or no correlation with SDI. Despite genetic and environmental factors, high SDI regions benefit from superior disease screening and early diagnosis systems, as well as enhanced data collection capabilities [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A previous study indicated that the incidence rate of thyroid cancer was over ten times higher in high-income Western countries compared to East Asia over the past decades [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. It is not unexpected that the DALYs rates of certain cancers were lower in high SDI regions. It has been proven that advanced healthcare systems in high SDI regions could substantially decrease mortality rates for specific cancers, including breast, gynecological, hematologic malignancies, and stomach cancer [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study revealed that the burden of major cancers among WCBA increased with age groups in 2021, except for the incidence case of brain/CNS cancer which was highest in the 30 to 35 years, and the DALYs cases of leukemia which was highest in the 15 to 19 years. From 1990 to 2021, the percentage change in the burden of cancers also increased roughly with age, except for malignant skin melanoma. The early onset malignancies in adolescents significantly affects their physical development, mental health, and academic performance, and those cancers occurring in young adults have a profound impact on marital prospects, fertility, and career development [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Studies have shown that female patients with cancer experience a higher frequency of adverse events during treatment compared to their male counterparts [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, the lack of care for the WCBA was common, strengthening disease screening and early diagnosis in low and middle SDI regions is imperative, and clinical trials should aim to include more participants from this demographic [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has an important limitation. There are various age intervals in the GBD 2021, with the five year age group being the most frequently utilized. The primary objective of age-standardized rates is to eliminate the confounding effects of differing population structures when comparing incidence, prevalence, and mortality across different populations. Age standardization is employed in epidemiological studies because age-related differences influence the risk factors for numerous diseases, leading to variations in their burdens across different age groups. Age-standardized rates typically apply mean weighting by age category to mitigate the impact of population composition on comparative metrics. However, these standardized rates are artificial constructs, similar to DALYs, designed solely for comparability; their numerical values lose intrinsic significance [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In those studies examining secular trends, age-standardized rates may not always be appropriate and serve as a valid comparison method only when they exhibit temporal stability across all age groups [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. We observed minimal discrepancy in the global crude versus age-standardized rates of the female cancer burdens among WCBA, with the incidence rates (crude versus age-standardized) of breast (28.81 versus 28.1 per 100000 population), cervical (15.77 versus 15.4), ovarian (4.4 versus 4.3), uterine (3.02 versus 2.9), and the DALYs rates of breast (341.7 versus 333.1), cervical (214.7 versus 209.8), ovarian (66.4 versus 65.1), uterine (19.1 versus 18.7) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our study utilized crude rates to more accurately reflect real-world conditions, rather than age-standardized rates.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined the global cancer burden among WCBA to elucidate the disease burden of various cancer types across different regions and age groups, as well as the relationship between cancer burden and SDI. The findings of this study are crucial for formulating global and regional cancer prevention and control strategies tailored to WCBA. Future research should delve deeper into the factors influencing cancer burden and explore how to develop more effective prevention and control measures that account for regional characteristics.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCNS \u0026nbsp;central nervous system\u003c/p\u003e\n\u003cp\u003eDALYs \u0026nbsp;disability adjusted life-years\u003c/p\u003e\n\u003cp\u003eEAPC \u0026nbsp;estimated annual percentage changes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGBD \u0026nbsp;Global Burden of Disease Study\u003c/p\u003e\n\u003cp\u003eHDI \u0026nbsp;Human Development Index\u003c/p\u003e\n\u003cp\u003eSDI \u0026nbsp;socio-demographic index\u003c/p\u003e\n\u003cp\u003eUIs \u0026nbsp; uncertainty intervals\u003c/p\u003e\n\u003cp\u003eWCBA \u0026nbsp;women of child-bearing age\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate the works of the GBD Study 2021 collaborators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYunhai Chuai and Xia Zhang were involved in study design/planning. Yunhai Chuai, Xiaoli Zhang, Wen Jiang, and Xia Zhang performed data collection/entry. Yunhai Chuai and Xia Zhang performed data analysis/statistics. Yunhai Chuai and Xia Zhang interpreted the data. Yunhai Chuai prepared the draft manuscript. Xia Zhang revised this manuscript. Yunhai Chuai, Xiaoli Zhang, Wen Jiang, and Xia Zhang performed literature analysis/search.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is primarily supported by personal resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used for the analyses are publicly available from the Institute of Health Metrics and Evaluation (http://www.healthdata.org/; http://ghdx.healthdata.org/gbd-results-tool).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe use of Global Burden of Disease data did not require institutional review board approval or patient informed consent. The Institutional Review Board of the University of Washington reviewed and approved a waiver of informed consent (https://www.healthdata.org/research-analysis/gbd).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021. J Hematol Oncol. 2024 Nov 29;17(1):119.\u003c/li\u003e\n\u003cli\u003eMahase E. Cancer overtakes CVD to become leading cause of death in high income countries. BMJ. 2019 Sep 3;366:l5368.\u003c/li\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263.\u003c/li\u003e\n\u003cli\u003eBizuayehu HM, Dadi AF, Hassen TA, Ketema DB, Ahmed KY, Kassa ZY, Amsalu E, Kibret GD, Alemu AA, Alebel A, Shifa JE, Assefa Y, Tessema GA, Sarich P, Gebremedhin AF, Bore MG. Global burden of 34 cancers among women in 2020 and projections to 2040: Population-based data from 185 countries/territories. Int J Cancer. 2024 Apr 15;154(8):1377-1393.\u003c/li\u003e\n\u003cli\u003eSiegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025 Jan-Feb;75(1):10-45.\u003c/li\u003e\n\u003cli\u003eLi W, Liang H, Wang W, Liu J, Liu X, Lao S, Liang W, He J. Global cancer statistics for adolescents and young adults: population based study. J Hematol Oncol. 2024 Oct 21;17(1):99.\u003c/li\u003e\n\u003cli\u003eLi Z, Zhang X, Sun C, Li Z, Fei H, Zhao D. Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of Disease Study 2019: a cross-sectional study. Int J Surg. 2024 Apr 1;110(4):1929-1940.\u003c/li\u003e\n\u003cli\u003eAnderson RA, Kelsey TW, Morrison DS, Wallace WHB. Family size and duration of fertility in female cancer survivors: a population-based analysis. Fertil Steril. 2022 Feb;117(2):387-395.\u003c/li\u003e\n\u003cli\u003eBenitez Fuentes JD, Morgan E, de Luna Aguilar A, Mafra A, Shah R, Giusti F, Vignat J, Znaor A, Musetti C, Yip CH, Van Eycken L, Jedy-Agba E, Pi\u0026ntilde;eros M, Soerjomataram I. Global Stage Distribution of Breast Cancer at Diagnosis: A Systematic Review and Meta-Analysis. JAMA Oncol. 2024 Jan 1;10(1):71-78.\u003c/li\u003e\n\u003cli\u003eSun P, Yu C, Yin L, Chen Y, Sun Z, Zhang T, Shuai P, Zeng K, Yao X, Chen J, Liu Y, Wan Z. Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021. EClinicalMedicine. 2024 Jul 2;74:102713.\u003c/li\u003e\n\u003cli\u003eKuang Z, Wang J, Liu K, Wu J, Ge Y, Zhu G, Cao L, Ma X, Li J. Global, regional, and national burden of tracheal, bronchus, and lung cancer and its risk factors from 1990 to 2021: findings from the global burden of disease study 2021. EClinicalMedicine. 2024 Sep 5;75:102804.\u003c/li\u003e\n\u003cli\u003ePicon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, Friedman ER, Slingerland JM. Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention. CA Cancer J Clin. 2017 Sep;67(5):378-397.\u003c/li\u003e\n\u003cli\u003eGlobal Burden of Disease 2019 Cancer Collaboration. Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2022 Mar 1;8(3):420-444.\u003c/li\u003e\n\u003cli\u003eVaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med. 2016 Aug 18;375(7):614-7.\u003c/li\u003e\n\u003cli\u003ePatz EF Jr, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammem\u0026auml;gi MC, Chiles C, Black WC, Aberle DR; NLST Overdiagnosis Manuscript Writing Team. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med. 2014 Feb 1;174(2):269-74.\u003c/li\u003e\n\u003cli\u003eQin N, Fan Y, Yang T, Yang Z, Fan D. The burden of Gastric Cancer and possible risk factors from 1990 to 2021, and projections until 2035: findings from the Global Burden of Disease Study 2021. Biomark Res. 2025 Jan 7;13(1):5.\u003c/li\u003e\n\u003cli\u003eZhou Y, Huang G, Cai X, Liu Y, Qian B, Li D. Global, regional, and national burden of acute myeloid leukemia, 1990-2021: a systematic analysis for the global burden of disease study 2021. Biomark Res. 2024 Sep 11;12(1):101.\u003c/li\u003e\n\u003cli\u003eYi M, Li A, Zhou L, Chu Q, Song Y, Wu K. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. J Hematol Oncol. 2020 Jun 8;13(1):72.\u003c/li\u003e\n\u003cli\u003eSun Y, Shen Y, Liu Q, Zhang H, Jia L, Chai Y, Jiang H, Wu M, Li Y. Global trends in melanoma burden: A comprehensive analysis from the Global Burden of Disease Study, 1990-2021. J Am Acad Dermatol. 2025 Jan;92(1):100-107.\u003c/li\u003e\n\u003cli\u003eSun H, Xue L, Guo Y, Du J, Nan K, Li M. Global, regional and national burden of non-Hodgkin lymphoma from 1990 to 2017: estimates from global burden of disease study in 2017. Ann Med. 2022 Dec;54(1):633-645.\u003c/li\u003e\n\u003cli\u003eFidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. Lancet Oncol. 2017 Dec;18(12):1579-1589.\u003c/li\u003e\n\u003cli\u003eGBD 2019 Adolescent Young Adult Cancer Collaborators. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Oncol. 2022 Jan;23(1):27-52.\u003c/li\u003e\n\u003cli\u003eTeng H, Yan O, Xiao C, Wang X, Liu Z, Xu J. Trends, age shifts, and potential delayed peaks post-pandemic of early-onset brain and central nervous system cancers in individuals aged 20-49: a cross-sectional study. Int J Surg. 2024 Dec 24.\u003c/li\u003e\n\u003cli\u003eZhang J, Ou D, Xie A, Chen D, Li X. Global burden and cross-country health inequalities of early-onset colorectal cancer and its risk factors from 1990 to 2021 and its projection until 2036. BMC Public Health. 2024 Nov 12;24(1):3124.\u003c/li\u003e\n\u003cli\u003eMa J, Song YD, Bai XM. Global, regional, and national burden and trends of early-onset tracheal, bronchus, and lung cancer from 1990 to 2019. Thorac Cancer. 2024 Mar;15(8):601-613.\u003c/li\u003e\n\u003cli\u003eUnger JM, Vaidya R, Albain KS, LeBlanc M, Minasian LM, Gotay CC, Henry NL, Fisch MJ, Lee SM, Blanke CD, Hershman DL. Sex Differences in Risk of Severe Adverse Events in Patients Receiving Immunotherapy, Targeted Therapy, or Chemotherapy in Cancer Clinical Trials. J Clin Oncol. 2022 May 1;40(13):1474-1486.\u003c/li\u003e\n\u003cli\u003eMattsson E, Ljungman L, Einhorn K, Sundstr\u0026ouml;m Poromaa I, St\u0026aring;lberg K, Wikman A. Perceptions of care after end-of-treatment among younger women with different gynecologic cancer diagnoses - a qualitative analysis of written responses submitted via a survey. BMC Womens Health. 2020 Dec 22;20(1):276.\u003c/li\u003e\n\u003cli\u003eZhu JIM. Availability for age-standardized rate in long period trend study [Article in Chinese]. Journal of Disease Control and Prevention. 2003;7(3):247-249.\u003c/li\u003e\n\u003cli\u003eChoi BC, de Guia NA, Walsh P. Look before you leap: stratify before you standardize. Am J Epidemiol. 1999 Jun 15;149(12):1087-96.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"global burden of disease study, women of child-bearing age, cancer","lastPublishedDoi":"10.21203/rs.3.rs-6089535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6089535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground：\u003c/strong\u003eMalignant neoplasm is one of the leading durden of diseases worldwide, particularly among women of child-bearing age (WCBA) with a significant higher incidence rate than their male counterparts. This study aimed to assess the burden and trend of cancers among WCBA from 1990 to 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study retrieved 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. Estimated annual percentage changes (EAPC) and percentage change, by age and socio-demographic index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the correlation between burdens and SDI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOur\u003cstrong\u003e \u003c/strong\u003eresults showed that breast, cervical, ovarian, colon/rectum, thyroid,\u003cstrong\u003e \u003c/strong\u003euterine, tracheal/bronchus/lung, brain/central nervous system (CNS), stomach, non-Hodgkin lymphoma, leukemia, and malignant skin melanoma had the highest global incidence rates respectively among WCBA in 2021. From 1990 to 2021, the incidence and prevalence rates of colon/rectum, thyroid, and brain/CNS cancers showed an upward trend, while the burdens of stomach cancer and leukemia significantly declined. In terms of SDI regions, the high and high-middle SDI regions had higher DALYs rstes of colon/rectum, brain/CNS, tracheal/bronchus/lung, and melanoma, the middle SDI regions had higher DALYs rstes of stomach cancer and leukemia, and the low SDI regions had higher DALYs rstes of thyroid cancers and non-Hodgkin lymphoma. Age distribution analysis indicated that the burden of major cancers increased with age, peaking in the 45 to 49 age group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study reveals the global and regional distribution characteristics of cancer burden among WCBA and highlights the important impact of socio-economic factors on cancer burden. The findings provide a scientific basis for developing cancer prevention and control strategies, especially in high burden regions and specific age groups.\u003c/p\u003e","manuscriptTitle":"Global burden of cancer among women of child-bearing age from 1990 to 2021: insights from the Global Burden of Disease Study 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-03 15:04:31","doi":"10.21203/rs.3.rs-6089535/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ecb53f86-658e-4fd1-a9fb-35ca5f60b530","owner":[],"postedDate":"March 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-08T09:09:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-03 15:04:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6089535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6089535","identity":"rs-6089535","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}