Epidemiological transition of urogenital system-related tumors in children and adolescents from the perspective of the global burden of disease.

BACKGROUND

Breast and urogenital tumors are relatively rare in children and adolescents, with sparse and fragmented data on their global disease burden, lacking comprehensive epidemiological assessment.

METHODS

Using Global Burden of Disease (GBD) 2021 data, we analyzed incidence, mortality, prevalence, and disability-adjusted life years (DALYs) of breast and urogenital tumors in individuals aged 0-24, stratified by age, sex, and region. The effects of modifiable risk factors were evaluated using attributable risk analysis, as well as univariable and multivariable Mendelian randomization (MR) approaches. Future trends were projected using a Bayesian age-period-cohort model.

RESULTS

In 2021, 59,378 new cases and 11,653 deaths from breast and urogenital tumors occurred globally among those aged 0-24. Kidney cancer (predominantly Wilms tumor) dominated in 0-14-year-olds, with an incidence of approx. 0.476/100,000, similar between sexes. After age 15, females exhibited sharp rises in breast, cervical, and ovarian cancers; males showed a testicular cancer incidence peak of 0.588/100,000 around age 20. Male pediatric kidney cancer incidence slightly increased from 2000 to 2021, with select Asian and African countries showing annual percentage change (AAPC) > 4. Testicular cancer incidence remained high in high SDI regions, shifting toward middle-high SDI areas; cervical and ovarian cancers continued to impose high burdens in low SDI regions. Alcohol consumption, body mass index (BMI), and unsafe sexual behavior may be modifiable risk factors contributing to disease-specific DALYs. Although BMI-related DALYs are more pronounced in high SDI regions, MR analysis did not establish a clear genetic causal relationship between childhood BMI and tumor risk.

CONCLUSIONS

The global spectrum of breast and urogenital tumors exhibits pronounced transitions across age, sex, and geographic regions. There is an urgent need to strengthen HPV vaccination and sexual health education in low SDI regions, enhance adolescent awareness of testicular health in high SDI regions, promote healthy lifestyle interventions, and advance pediatric cancer registry systems and standardized care pathways across all settings.