A study, led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and published in The Lancet Oncology, predicts that new cases of breast cancer will increase by a third worldwide. From 2.3 million in 2023 it will rise to more than 3.5 million in 2050. Annual deaths will grow by 44%, reaching almost 1.4 million, and will disproportionately affect countries with fewer resources.
Breast cancer remains the leading cause of oncological disease and premature death in women. In 2023 it caused about 24 million years of healthy life lost due to illness and early death.
The results indicate that maintaining a healthy lifestyle – not smoking, getting enough physical activity, reducing red meat consumption and maintaining an adequate weight – could prevent more than a quarter of the years of healthy life lost due to this disease in the world.
“Breast cancer continues to have a profound impact on women’s lives and their communities,” said lead author Kayleigh Bhangdia of IHME. “While women in high-income countries often benefit from screening programs, earlier diagnoses, and comprehensive treatment strategies, the growing burden of breast cancer is shifting to low- and lower-middle-income countries, where patients face later-stage diagnoses, more limited access to quality care, and higher mortality rates that threaten to overshadow the gains made in women’s health.”
The study uses data from population-based cancer registries, civil registration systems and interviews with family members or caregivers of women who died from breast cancer. It provides an updated analysis of the global, regional and national burden between 1990 and 2023 in 204 countries and territories, with projections to 2050. In addition, it estimates the years of healthy life lost due to illness, disability and premature death.
More cases in rich countries, more deaths in poor ones
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In 2023, 2.3 million new cases were diagnosed in women, of which 73% (1.67 million) were registered in high- and upper-middle-income countries. That year there were 764,000 deaths, and 39% (300,000) occurred in low- and lower-middle-income countries.
When adjusting for age to compare across countries and over time, the analysis reveals deep inequalities. Age-standardized incidence rates were highest in high-income countries, while they were much lower in several low- and middle-income countries in 2023.
Since 1990, age-adjusted new case rates have increased by 147% on average in low-income countries, while remaining stable in high-income countries. In that same period, age-adjusted mortality rates fell 30% in rich countries, to 16 deaths per 100,000 women, but almost doubled in low-income countries, to 24 per 100,000.
Globally, years of healthy life lost have more than doubled since 1990, from 11.7 million to 24 million in 2023. Although women in low- and lower-middle-income countries account for 27% of new cases, they bear more than 45% of the total burden in terms of poor health and premature death.
“Low- and middle-income countries are hardest hit by the rising burden of breast cancer, as many face changing demographics and lifestyles alongside less-prepared healthcare systems, shortages of radiotherapy equipment, chemotherapy drugs and pathology laboratories, and standard treatments that can be very expensive,” said co-author Olayinka Ilesanmi, a physician and epidemiologist at the Africa CDC. “Although survival continues to improve in high-income countries, reflecting the success of screening, diagnosis and treatment, even within these countries outcomes may depend on where a woman lives.”
Situation in Spain
In Spain, the age-standardized incidence rate went from 68.7 cases per 100,000 women in 1990 to 65.0 in 2023, which represents a decrease of 5.4%. Age-adjusted mortality fell more sharply, from 23.9 to 13.9 deaths per 100,000 women, 41.9% less.
These data place the country in line with the trend observed in other high-income states, where survival improves thanks to screening, early diagnosis and access to treatments.
Increase in young women
In 2023, three times as many new cases were diagnosed in women aged 55 years or older than in those aged 20 to 54 years (161 versus 50 per 100,000). However, since 1990 the rates in the 20 to 54 age group have increased by 29%, while in older women they have barely changed. These differences may reflect changes in age patterns and risk factors, which vary before and after menopause.
Modifiable risk factors
In 2023, 28% of the global burden of breast cancer—6.8 million years of healthy life lost—was linked to six modifiable factors. The main one was high consumption of red meat (almost 11% of the years lost), followed by tobacco (8%), high blood glucose (6%) and excess weight (4%), in addition to alcohol and low physical activity (2% each).
Since 1990, the burden attributable to alcohol and tobacco has decreased significantly, but similar progress is not observed in the other factors.
“Given that more than a quarter of the global burden of breast cancer is linked to modifiable changes in lifestyle, there are enormous opportunities to change the trajectory of risk in the next generation,” highlights Marie Ng, senior co-author of the work and associate professor at IHME. “Acting on known factors through public policies and facilitating healthier choices is crucial to curbing the rise in cases.”
Close the care gap
Even with effective prevention, millions of women will develop the disease. The authors emphasize that guaranteeing equitable access to early diagnosis and treatment in countries with fewer resources, together with reducing the cost of therapies and their inclusion in universal health coverage, is key to improving survival.
“Collaborative efforts are needed to ensure health systems capable of offering early diagnosis and comprehensive treatment in all countries,” says Lisa Force, also from IHME.
The study recognizes limitations due to the lack of quality oncological registries in some countries and the absence of data on tumor stage, molecular subtype or impact of the pandemic and recent conflicts.
In a linked comment, Yeon Hee Park, from the Sungkyunkwan University School of Medicine (South Korea), points out that without information on ethnic or genetic origin it is not possible to determine whether regional differences respond to biological predisposition, environmental factors or inequalities in health care, although he considers that the work provides a solid basis for global health planning.
Global, regional, and national burden of breast cancer among females, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023.The Lancet Oncology2026.
