Evaluation of the breast cancer disease burden in China from 1990 to 2021: based on the Global Burden of Disease Study 2021

Objective This study aims to assess the disease burden of breast cancer (BC) in China from 1990 to 2021, identifying key population groups at increased risk and provide reference data for improving breast cancer prevention and treatment strategies. Methods Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed, focusing on six key indicators: mortality, prevalence, incidence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends were characterized via the Joinpoint regression model and Age-Period-Cohort (APC) model, with age-standardized rates calculated using the global age structure as a reference. Results From 1990 to 2021, the incidence of BC in China increased by 364.5%, increaseing from 86,709 cases (95% UI: 70,225 − 105,273) to 402,794 cases (95% UI: 312,117–505,644). Among females, incidence increased by 355% (from 84,793 to 385,838 cases), while male incidence saw a striking 785.2% rise (from 1,916 to 16,956 cases), highlighting a significant gender disparity. The age-standardized incidence rate (ASIR) grew by 113.3%, from 9.1 per 100,000 (95% UI: 7.4–11.0) in 1990 to 19.4 per 100,000 (95% UI: 15.0–24.3) in 2021. Mortality rose by 122%, from 41,218 deaths (95% UI: 33,621 − 50,194) to 91,484 deaths (95% UI: 71,739 − 113,710), with female mortality increasing by 118.3% and male mortality surging by 292.3%. However, the age-standardized mortality rate (ASMR) declined slightly by 6.3%, driven by an 8.2% decrease in females, while male ASMR increased by 62.3%, underscoring divergent survival trends. Disability-adjusted life years (DALYs) rose by 102.5%, from 1.5 million (95% UI: 1.2–1.8 million) to 3 million (95% UI: 2.36–3.84 million), with a 99.2% increase in females and a 270.5% rise in males. Age-Period-Cohort (APC) analysis revealed a net annual incidence drift of 2.13% and a mortality decline of -0.80% in females, with the heaviest burden in middle-aged and older groups: incidence peaked at 124.34 per 100,000 in females aged 60–64, and mortality reached 27.35 per 100,000 in the 55–60 age group. Male incidence peaked at 9.76 per 100,000 in the 70–74 age group, reflecting an escalating burden with age, particularly among the elderly. Conclusion From 1990 to 2021, China’s BC burden surged, with rising incidence, prevalence, and DALYs. Female survival improved slightly, with a modest decline in ASMR, while male mortality increased sharply, highlighting a gender gap. Middle-aged and older women face the highest incidence, alongside a notable rise in male cases. Trends show increasing incidence and worsening mortality in the elderly, driven by aging and lifestyle factors. Screening and treatment advances aid women, but male cases reveal awareness gaps. Enhanced prevention, early detection, and tailored interventions, especially for the elderly and men, are critical to ease this growing public health challenge.