柳叶刀-肿瘤学 | 乳腺癌仍是全球女性过早死亡的主要原因，预计2050年新发病例数将超过350万

乳腺癌仍是全球女性癌症相关疾病和过早死亡的主要原因。2023年，全球约有230万例乳腺癌新发病例和76.4万例乳腺癌死亡病例，因疾病和过早死亡损失的健康寿命年达2400万年。

超四分之一的乳腺癌健康寿命损失年可归因于六项可控风险因素，包括大量摄入红肉、吸烟、高血糖及高BMI，这一发现为疾病预防提供重要契机。

2023-2050年，全球乳腺癌年新发病例数预计将从230万例增加至350万例，增幅达三分之一；年死亡病例数预计将从76.4万例增加至近140万例，增幅达44%。

作者指出，只有通过积极的预防策略、建立能够实现早期诊断和综合治疗的健全卫生系统，并让所有人都能够获得且负担得起癌症服务，才能确保所有女性都有平等机会从乳腺癌中幸存下来。

《柳叶刀-肿瘤学》（The Lancet Oncology）发表一项由全球疾病负担研究乳腺癌协作组（GBD 2023 Breast Cancer Collaborators）新完成的大型分析。研究显示，尽管近年来乳腺癌治疗取得进展，但2023-2050年，全球女性乳腺癌年新发病例数将从230万例增加至350万例以上，增幅达三分之一。与此同时，年死亡病例数预计将从76.4万例增加至140万例，增幅达44%，其中资源有限国家受到的影响将尤为严重。值得注意的是，研究结果表明，保持健康的生活方式，包括不吸烟、进行充足体育锻炼、减少红肉摄入以及保持健康体重，可能有助于预防全球四分之一因乳腺癌相关疾病和过早死亡导致的健康寿命损失年。

1990-2023年全球、地区和国家的女性乳腺癌负担以及至2050年的预测：一项关于2023年全球疾病负担研究的系统分析

背景

乳腺癌是全球女性死亡和发病的主要原因。作为全球疾病负担、伤害与风险因素研究（GBD）2023的一部分，本研究旨在提供关于1990-2023年全球、地区和国家的乳腺癌流行病学趋势、疾病负担和风险因素的最新全面评估。

方法

本研究按年龄和性别估算1990-2023年204个国家和地区的乳腺癌发病率、死亡率、患病率、伤残损失寿命年（YLDs）、早死损失寿命年（YLLs）及伤残调整寿命年（DALYs）。死亡率主要通过GBD死亡原因集成模型（Cause of Death Ensemble models）估计，数据来源包括人群癌症登记系统、生命登记系统和口头尸检。计算死亡发病比，并估算出死亡率和发病率。患病率通过结合发病率和模拟生存估计得出。YLLs通过将年龄别死亡数与死亡年龄对应的GBD标准化预期寿命相乘得出。YLDs基于伤残权重与患病数计算得出。YLLs和YLDs相加得到DALYs。通过比较风险评估框架分析乳腺癌疾病负担的七种可归因风险因素，并采用GBD预测框架对2024-2050年乳腺癌的发病率和死亡率进行预测。所有指标的年龄标准化率均基于GBD 2023全球标准化人数计算。

结果

据估算，2023年，全球新增230万例女性乳腺癌病例（95%不确定性区间[UI]：201-261），76.4万例乳腺癌死亡病例（67.2-85.4），因乳腺癌损失的DALYs达2410万（2130-2750）。在世界银行划分的低收入国家组中，虽然年龄标化发病率（ASIR）较低（每10万人年44.2例[31.2-58.4]），但年龄标化死亡率（ASMR）最高（每10万人年24.1例[16.8-31.9]）。此外，高收入国家组的ASIR最高（每10万人年75.7例[67.1-84.0]），中等偏上收入国家组的ASMR最低（每10万人年11.2例[10.2-12.3]）。1990-2023年，低收入国家组的ASIR增幅达147.2%（38.1%-271.7%），而高收入国家组的增幅仅为1.2%（-11.5%至17.2%）。高收入国家组的ASMR下降29.9%（25.9%-33.6%），而低收入国家组则上升99.3%（12.5%-202.9%）。年龄标准化DALY率的增长趋势与ASMR一致。2023年，归因于不健康膳食、吸烟及高空腹血糖等风险因素的DALYs占比达28.3%（16.6%-38.9%）。1990-2023年，归因于过量饮酒和吸烟的DALYs有所下降。据估算，至2050年，全球女性乳腺癌新发病例将达356万例（229-483），死亡病例将达137万例（84.1-202）。

解释

高收入国家女性乳腺癌发病率稳定，死亡率下降，反映出这些国家在筛查、诊断和治疗方面的成效。与之相对，其他地区发病率和死亡率的同步上升则提示着其卫生体系存在的短板。若缺乏有效的干预措施，许多国家将无法实现WHO全球乳腺癌倡议提出的“截至2040年ASMR每年降低2.5%”这一宏伟目标。随着乳腺癌负担的加重，全球易感人群将受到不成比例的影响，若不立即采取果断行动，必将进一步加剧全球范围内的健康不公平性。

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Funding

Gates Foundation, St Jude Children's Research Hospital.

Declaration of interests

C Agostinis Sobrinho reports support for the present manuscript from Fundação para a Ciência e a Tecnologia (FCT; Portugal; CEECINST/00093/2021/CP2815/CT0001) and by FCT within the framework of the Sport, Physical Activity and Health Research & Innovation Center (UID/6185/2023). R Ancuceanu reports consulting fees from Abbvie and Merck Romania; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Laropharm, Reckitt, and Merck Romania; and support for attending meetings and travel from Merck Romania and Reckitt; all outside the submitted work. M S Aslam reports grants or contracts outside the submitted work from Xiamen University Malaysia Research Fund (XMUMRF; grant number MUMRF/2025-C15/ITCM/0006; project title: therapeutic and toxicity evaluation of selected medicinal herbs for nafld: exploring the inter-organelle contact sites modulation theory; role: co-investigator; dates: January, 2025, to December, 2027 [ongoing], internal XMUMRF research grant administered by Xiamen University Malaysia; funds disbursed to institutional research account only; no salary, honoraria, or personal payments to author; and grant number XMUMRF/2023-C11/ISEM/0041; project title: children's rights education in the early years of divorce: an exploration of adolescents’ perspectives; role: co-investigator; dates: January, 2023 to December, 2025 [ongoing]; internal XMUMRF research grant administered by Xiamen University Malaysia; funds disbursed to institutional research account only; no salary, honoraria, or personal payments to author). A K M Azad reports support for the present manuscript from Imam Mohammad Ibn Saud Islamic University (IMSIU; Riyadh 13318, Saudi Arabia) and other financial or non-financial interests outside the submitted work from the Deanship of Scientific Research, (IMSIU, Riyadh 13318, Saudi Arabia). E C Dee reports support for the present manuscript from the Prostate Cancer Foundation Young Investigator Award and through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748). L M Force reports support for the present manuscript from Gates Foundation and St Jude Children's Research Hospital; grants or contracts from St. Baldrick's Foundation, Conquer Cancer Foundation, and NIH Loan Repayment Program, outside the submitted work; leadership or fiduciary roles in board, society, committee, or advocacy groups, unpaid with the Lancet Oncology International Advisory Board, outside the submitted work. A Guha reports grants or contracts from the American Heart Association and the US Department of Defense; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the ZERO Prostate Cancer Health Equity Task Force; all outside the submitted work. C Herteliu reports grants or contracts from the project “Analysis of the impact of COVID-19 on the main demographic indicators in Romania and the Republic of Moldova by using econometric modeling” code PN-IV-P8-8.3-ROMD-2023-0208 funded by the Romanian Ministry of Research, Innovation and Digitalization through UEFISCDI, grant of the European Commission Horizon 4P-CAN (Personalised Cancer Primary Prevention Research through Citizen Participation and Digitally Enabled Social Innovation), the project “Societal and Economic Resilience within multi-hazards environment in Romania” funded by EU NextgenerationEU, and the Romanian Government, under the National Recovery and Resilience Plan for Romania (contract number 760050/ 23.05.2023, cod PNRR-C9-I8-CF 267/ 29.11.2022), through the Romanian Ministry of Research, Innovation, and Digitalization, within Component 9, Investment I8, and the project “A better understanding of socio-economic systems using quantitative methods from Physics” funded by EU NextgenerationEU and the Romanian Government, under National Recovery and Resilience Plan for Romania (contract number 760034/ 23.05.2023, cod PNRR-C9-I8-CF 255/ 29.11.2022), through the Romanian Ministry of Research, Innovation, and Digitalization, within Component 9, Investment I8, all outside the submitted work. I M Ilic reports support for the present manuscript from the Ministry of Science, Technological Development, and Innovation of the Republic of Serbia (number 451-03-137/2025-03/200110). M D Ilic reports support for the present manuscript from the Ministry of Science, Technological Development and Innovation of the Republic of Serbia (number 451-03-47/2023-01/200111). T Joo reports support for the present manuscript from the National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security). J J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, Adamed, Amgen, Boehringer Ingelheim, and Servier, all outside the submitted work. M K Kashyap reports grants or contracts from the Indian Council of Medical Research (ICMR), New Delhi (# 5/13/55/2020/NCD-III; patents 2023-1100-3940 [Indian Patent-Pending] and 2023-1105-8515 [Indian Patent-Pending]); all outside the submitted work. J M Kocarnik reports support for the present manuscript from the Institute for Health Metrics and Evaluation as an employee, the Gates Foundation (paid to his institution), and American Lebanese Syrian Association Charities (paid to his institution). M-C Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 113-2314-B-003-002) and the “Higher Education Sprout Project” of National Taiwan Normal University; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Journal of the American Heart Association as Technical Editor; all outside the submitted work. K S-K Ma reports a research grant from the International Team for Implantology outside the submitted work. H R Marateb reports grants or contracts from Universitat Politècnica de Catalunya (UPC) via salary, outside the submitted work. S A Meo reports grants or contracts from the Ongoing Research Funding Program (ORF-2025-47), King Saud University, Riyadh, Saudi Arabia outside the submitted work. S Nomura reports support for the present manuscript from Ministry of Education, Culture, Sports, Science and Technology of Japan (24H00663), Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (JPMJPR22R8), and National Cancer Center Research and Development Fund (2024-A-14), all outside the submitted work. B Oancea reports support for the present manuscript from the MRID, project PNRR-I8 number 842027778, contract number 760096. S K Panda reports support for the present manuscript from Siksha ‘O’ Anusandhan (deemed to be University) via salary; grants or contracts outside the submitted work (from file number 17-59/2023-24/CCRH/Tech./Coll./ICMR-Diabetes/960) as co-investigator. R Passera reports participation on a Data Safety Monitoring Board or Advisory Board as Member of the Data Safety Monitoring Board dello studio “Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKi-treated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patients” – Fondazione Italiana Linfomi, Alessandria (Italy), unpaid; leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid, as Member of the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris (France), and as past Member 2020-2023 (biostatistician) of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC (Italy); all outside the submitted work. R G Pestell reports support for the present manuscript from research grants W81XWH-22-BCRP and RGH_L_2024, from CytoDyn as a consultant, via travel support, as owner of stock and warrants and sponsored research, from StromaGenesis, EcoGenome, and LightSeed as CEO and owner of company and patents, from Shenandoah Pharmaceuticals; and ioROC Therapeutics as CEO and owner of company; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events outside the submitted work from HUN_REN National Advisory Board (Hungary) and National Cancer Institute NCI Cancer Center Reviewer – subcommittee A. Y L Samodra reports grants or contracts from School of Public Health, TMU, Taiwan; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Benang Merah Research Center (benangmerah.net) as Co-Founder; other financial or non-financial interest with Jago Beasiswa (idebeasiswa.com) as Scholarship Mentor; all outside the submitted work. M Šekerija reports consulting fees from Roche; payment of honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astellas; all outside the submitted work. V Sharma reports other financial or non-financial support from DFSS (MHA)‘s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, and RUSA grant to Panjab University by Ministry of Education, Government of India, outside the submitted work. V Shivarov reports a patent with the Bulgarian Patent Office; other financial or non-financial interests from ICON plc via a salary; all outside the submitted work. M Sikdar reports other financial or non-financial interests outside the submitted work with the Anthropological Survey of India; all opinions expressed by the author are entirely personal and do not reflect the views or official position of the Anthropological Survey of India. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, Yale, Hulio, Horizon Pharmaceuticals/DINORA, ANI/Exeltis, USA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, the National Institutes of Health, and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the speaker's bureau of Simply Speaking; support for attending meetings and travel as a past steering committee member of OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies; participation on a Data Safety Monitoring Board or Advisory Board, unpaid, with FDA Arthritis Advisory Committee; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with OMERACT as past steering committee member; stock or stock options in Atyr Pharmaceuticals, Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding, Aebona Pharmaceuticals, and Charlotte's Web Holdings; and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals; all outside the submitted work. Sa Singh reports support for the present manuscript from the Indian Council of Medical Research (project ID: 2021-6329). R Tabares-Seisdedos reports grants or contracts from Valencian Regional Government's Ministry of Education (PROMETEO/CIPROM/2022/58) and the Spanish Ministry of Science, Innovation and Universities (PID2021-129099OB-I00) outside the submitted work; the funders were not involved in the design of the manuscript or decision to submit the manuscript for publication, nor will they be involved in any aspect of the study's conduct. J H V Ticoalu reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Benang Merah Research Center (benangmerah.net) as co-founder outside the submitted work. M Zielińska reports other financial or non-financial interests as an Alexion, AstraZeneca Rare Disease employee, outside the submitted work.

中文翻译仅供参考，所有内容以英文原文为准。

DOI: 10.1016/S1470-2045(25)00730-2

题图Attribution: Getty Image