Temporal trends, future projections, and burden of early-onset genitourinary cancers in Asia from 1990 to 2023: an analysis of the Global Burden of Disease Study 2023.

BACKGROUND: Early-onset cancers, often referred to as cancers that occur in those who are less than 50 years old, are indicated to be more prevalent over past decades. Significantly, early-onset genitourinary cancers could cause more burden for individuals. Asia, home to 60% of the world's population, is undergoing a unique epidemiological transition that makes it a critical model for non-communicable disease (NCD) research. We aimed to demonstrate the incidence, burden, prediction, and risk factors of early-onset bladder cancers (EOBCa), kidney cancers (EOKCa), and prostate cancers (EOPCa) to cast light on early-onset genitourinary tumor prevention and management.

METHODS: We analyzed data from the Global Burden of Disease Study 2023, sourced from the Global Health Data Exchange (GHDx), covering 48 Asian countries (1990-2023). Age-standardized incidence, mortality, and disability-adjusted life-year (DALY) rates were calculated using population denominators from the United Nations. Temporal trends were quantified using the Estimated Annual Percentage Change (EAPC), with 95% uncertainty intervals (UIs) and P values derived from log-linear regression. Bayesian age-period-cohort (BAPC) modeling projected 2024-2035 incidence. Socio-demographic index (SDI) stratification and sex- and age-specific analyses were performed.

RESULTS: We found that (I) in Asia, the incidence of EOBCa [EAPC =-0.96 (95% UI: -1.15 to -0.76)] decreased from 1990 to 2023, while EOKCa [EAPC =1.40 (95% UI: 1.22-1.58)] and EOPCa [EAPC =1.50 (95% UI: 1.31-1.68)] rates increased, with EOPCa projected to continue rising; (II) the spectrum of early-onset genitourinary cancers varied across different SDI levels and countries, while EOKCa had the highest burden among the three cancer types in most regions; (III) males suffered higher risks of incidence and mortality, as well as the increasing trends for early-onset genitourinary cancers than females; (IV) tobacco was the common risk factor for these three early-onset cancers and had shown a continued upward trend between 1990 and 2023.

CONCLUSIONS: (I) The declining incidence of EOBCa may reflect improved drinking water quality, whereas rising EOKCa and EOPCa incidence is likely driven by greater screening awareness, advances in imaging and biomarker-based detection, and possible overdiagnosis; (II) the increase in EOKCa may also be linked to dietary westernization; (III) the faster decline in disease burden in high-SDI regions likely results from better access to advanced treatments; (IV) early-onset genitourinary cancers exhibit substantial heterogeneity within Asia, and public health strategies should therefore be tailored to the specific epidemiologic profiles of individual countries; (V) sex differences remain evident and may involve hormone-related modulation of carcinogen metabolism; (VI) although early-onset patients are generally healthier, they still face psychological stress, fertility concerns, treatment-related sequelae, and recurrence risk. Notably, cause-specific mortality appears higher in early-onset than late-onset cases, underscoring the need for tailored public health strategies, early screening, and timely intervention.