{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:32:07Z","timestamp":1786977127171,"version":"build-2736575974"},"reference-count":52,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Innovation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To report the global, regional, and national burden of breast cancer (BC) and its attributable risk factors between 1990 and 2021, by age, sex, and sociodemographic index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the Global Burden of Disease Study 2021, we analyzed BC prevalence, deaths, disability\u2010adjusted life years (DALYs), and attributable risk factors across 204 countries and territories from 1990 to 2021. Age\u2010standardized prevalence, deaths, and DALYs rates were estimated, and temporal trends were assessed using the estimated annual percentage change. Geographical and sociodemographic inequalities were further evaluated using decomposition analysis, concentration curves, and sociodemographic index (SDI)\u2010based modeling. Attributable risk factors for deaths and DALYs were quantified using the comparative risk assessment framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, BC presents a starkly diverging landscape. While the age\u2010standardized prevalence has climbed to 239 per 100,000 (a 9.3% increase since 1990), the death and DALYs rates have actually declined by 13.7% and 9.8%, respectively. This global trend, however, masks a critical geographical shift. High\u2010income regions maintain the highest prevalence, yet the most rapid increases in burden are now concentrated in resource\u2010limited areas such as North Africa and the Middle East. The \u201ctriple threat\u201d in low\u2010SDI regions defines this transition. Decomposition analysis revealed that while population growth and aging lead to absolute mortality everywhere, high\u2010SDI regions successfully offset this pressure through favorable epidemiological changes and advancements in screening and treatment. In contrast, low\u2010SDI regions face a deteriorating epidemiological profile that actively contributes to rising deaths. Our inequality analysis further underscores this systemic shift; concentration curves confirm that BC mortality is becoming disproportionately concentrated in lower\u2010SDI countries over time. Additionally, the disease follows a nonlinear, inverted U\u2010shaped relationship with socioeconomic development, peaking at an SDI of 0.75. Finally, we identified a distinct sex\u2010based etiological divide: while female risk patterns are multifaceted, male BC is almost singularly driven by metabolic dysregulation, with high body mass index emerging as the leading global driver of the disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite progress in reducing the BC burden, it remains a global public health challenge. The prevalence is high in developed countries, while the burden is rapidly increasing in low\u2010 and middle\u2010income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cai2.70055","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:47:05Z","timestamp":1775807225000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Burden of Breast Cancer and its Attributable Risk Factors in 204 Countries and Territories, 1990\u20132021: Results From the Global Burden of Disease Study 2021"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7568-4701","authenticated-orcid":false,"given":"Jiahui","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical 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