{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:31:49Z","timestamp":1780338709272,"version":"3.54.1"},"reference-count":83,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: This population-based study examined epidemiological trends of primary cancers in adolescents and young adults (AYAs) to enhance the understanding of the specific spectrum of cancers impacting AYAs in Belgium. Methods: Data on incidence, prevalence, mortality, and survival were obtained from the Belgian Cancer Registry (2004\u20132020, N = 43,535). (A)APC statistics were compared with children (5\u201314 years) and adults (40\u201349 years). Results: Cancer incidence increased by 0.4% annually from 66 to 80 per 100,000 person-years (ESR2013) but stabilised after 2015, except for Hodgkin lymphoma, chronic myeloid neoplasms, and testicular and breast cancer, which continued to rise. Mortality decreased by 1% annually, from 10 to 7 per 100,000 person-years (2004\u20132019). Five-year relative survival (RS) was 87% but remained low for certain cancers, including ovary (78%), central nervous system (67%), precursor haematopoietic neoplasms (64%), gastrointestinal (excl. colorectal) (49%), and lung-bronchus-trachea cancers (42%). Conclusions: From 2004\u20132020, the cancer burden among AYAs in Belgium increased due to improved survival, while incidence stabilised after 2015. Five-year RS exceeds 80% overall but remains lower for some cancers compared to children (e.g., precursor haematopoietic neoplasms) or older adults (e.g., breast cancer, sarcoma). The Belgian epidemiological trends align with those in neighbouring countries (Netherlands, France, Germany).<\/jats:p>","DOI":"10.3390\/cancers17091543","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T05:10:32Z","timestamp":1746076232000},"page":"1543","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cancer Burden in Adolescents and Young Adults in Belgium: Trends to Incidence Stabilisation in Recent Years with Improved Survival"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5182-6463","authenticated-orcid":false,"given":"Fabienne","family":"Van Aelst","sequence":"first","affiliation":[{"name":"Cancer Center, Sciensano, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8604-8097","authenticated-orcid":false,"given":"Bart","family":"Van Gool","sequence":"additional","affiliation":[{"name":"Belgian Cancer Registry, 1210 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Van Damme","sequence":"additional","affiliation":[{"name":"Belgian Cancer Registry, 1210 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne A.","family":"Poirel","sequence":"additional","affiliation":[{"name":"Cancer Center, Sciensano, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"key":"ref_1","unstructured":"(2025, February 02). Belgian Cancer Registry. Available online: https:\/\/kankerregister.org\/default.aspx?lang=EN."},{"key":"ref_2","unstructured":"(2025, February 02). StatBel. Structure of the Population Based on the National Register. Available online: https:\/\/statbel.fgov.be\/."},{"key":"ref_3","unstructured":"GBD 2019 Adolescent Young Adult Cancer Collaborators (2022). The Global Burden of Adolescent and Young Adult Cancer in 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. Lancet Oncol., 23, 27\u201352."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100744","DOI":"10.1016\/j.esmoop.2022.100744","article-title":"Cancer Burden in Adolescents and Young Adults in Europe","volume":"8","author":"Trama","year":"2023","journal-title":"ESMO Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1093\/jnci\/djaa007","article-title":"International Trends in the Incidence of Cancer Among Adolescents and Young Adults","volume":"112","author":"Gupta","year":"2020","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_6","unstructured":"International Agency for Research on Cancer (IARC), WHO (2025, February 02). Cancer Incidence in Five Continents (CI5). Available online: https:\/\/ci5.iarc.fr\/ci5plus\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100255","DOI":"10.1016\/j.esmoop.2021.100255","article-title":"Worldwide Cancer Statistics of Adolescents and Young Adults in 2019: A Systematic Analysis of the Global Burden of Disease Study 2019","volume":"6","author":"You","year":"2021","journal-title":"ESMO Open"},{"key":"ref_8","unstructured":"(2025, February 02). Global Burden of Disease (GBD) 2021; Institute for Health Metrics and Evaluation (IHME). Available online: http:\/\/www.healthdata.org\/results\/data-visualizations."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"113558","DOI":"10.1016\/j.ejca.2024.113558","article-title":"Survival of European Adolescents and Young Adults Diagnosed with Cancer in 2010\u20132014","volume":"202","author":"Trama","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"443","DOI":"10.3322\/caac.21637","article-title":"Cancer Statistics for Adolescents and Young Adults, 2020","volume":"70","author":"Miller","year":"2020","journal-title":"CA Cancer J. Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"881","DOI":"10.6004\/jnccn.2023.7056","article-title":"Understanding Causes of Inferior Outcomes in Adolescents and Young Adults with Cancer","volume":"21","author":"Wolfson","year":"2023","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100096","DOI":"10.1016\/j.esmoop.2021.100096","article-title":"Adolescents and Young Adults (AYA) with Cancer: A Position Paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE)","volume":"6","author":"Ferrari","year":"2021","journal-title":"ESMO Open"},{"key":"ref_13","unstructured":"US Department of Health And Human Services, US National Institutes of Health, US National Cancer Institute, and Adolescent and Young Adult Oncology Progress Report Group (2025, February 02). Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancers, Available online: https:\/\/www.cancer.gov\/types\/aya\/research\/ayao-august-2006.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e000252","DOI":"10.1136\/esmoopen-2017-000252","article-title":"The Care of Adolescents and Young Adults with Cancer: Results of the ESMO\/SIOPE Survey","volume":"2","author":"Saloustros","year":"2017","journal-title":"ESMO Open"},{"key":"ref_15","unstructured":"(2024, August 22). Convention Entre Le Comit\u00e9 de l\u2019assurance Du Service Des Soins de Sant\u00e9 de l\u2019INAMI et Les \u00c9tablissements Hospitaliers Pour Le Financement Des \u00c9quipes de R\u00e9f\u00e9rence AJA Visant \u00e0 Soutenir Des Soins Sur Mesure Aux AJA Atteints d\u2019un Cancer. Note CSS 2023\/321 (8 November 2023). Available online: https:\/\/www.inami.fgov.be\/fr\/actualites\/cancer-une-prise-en-charge-sur-mesure-pour-les-adolescents-et-jeunes-adultes-grace-a-notre-financement-d-equipes-de-reference-aja."},{"key":"ref_16","unstructured":"(2024, August 22). Overeenkomst Tussen Het Verzekeringscomit\u00e9 van de Gezondheidszorgdienst van Het RIZIV En de Ziekenhuizen Voor de Financiering van AJA-Referentieteams Met Als Doel Op Maat Gemaakte Zorg Te Ondersteunen Voor AYA\u2019s (Adolescenten En Jongvolwassenen) Die Getroffen Zijn Door Kanker. Nota CSS 2023\/321 (8 November 2023). Available online: https:\/\/www.riziv.fgov.be\/nl\/nieuws\/zorg-op-maat-voor-adolescenten-en-jongvolwassenen-met-kanker-dankzij-onze-vergoeding-van-aya-referentieteams."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4634","DOI":"10.1002\/cncr.33041","article-title":"A System for Classifying Cancers Diagnosed in Adolescents and Young Adults","volume":"126","author":"Barr","year":"2020","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1002\/cncr.20910","article-title":"International Classification of Childhood Cancer, Third Edition","volume":"103","author":"Stiller","year":"2005","journal-title":"Cancer"},{"key":"ref_19","unstructured":"National Cancer Institute (2025, February 02). Surveillance, Epidemiology, and End Results Program. AYA Site Recode 2020 Revision, Available online: https:\/\/seer.cancer.gov\/ayarecode\/aya-2020.html."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/MOP.0000000000001200","article-title":"Adolescent and Young Adult Cancers: Unmet Needs and Closing the Gaps","volume":"35","author":"Berkman","year":"2023","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1200\/JCO.23.01465","article-title":"Psychological Outcomes in Adolescent and Young Adult Cancer Survivors","volume":"42","author":"McGrady","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_22","unstructured":"(2025, February 02). Cancer in Children and Adolescents in Belgium, 2004\u20132016; D\/2019\/11.846\/1; Belgian Cancer Registry. Available online: https:\/\/kankerregister.org\/en\/publicaties\/cancer-children-and-adolescents-belgium-2004-2016."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"(2025, February 02). Cancer in Children and Adolescents in Belgium, 2004\u20132020; D\/2023\/11.846\/1; Belgian Cancer Registry. Available online: https:\/\/kankerregister.org\/en\/publicaties\/cancer-children-and-adolescents-belgium-2004-2020.","DOI":"10.1093\/med\/9780198797210.003.0001"},{"key":"ref_24","unstructured":"(2025). Cancer in Adolescents and Young Adults, Belgium 2004\u20132022; D\/2025\/11.846\/1; Belgian Cancer Registry: Brussels. Available online: https:\/\/kankerregister.org\/en\/publicaties\/cancer-adolescents-and-young-adults-belgium-2004-2022."},{"key":"ref_25","unstructured":"(2025, February 02). Federale Overheidsdienst Volksgezondheid, Veiligheid van de Voedselketen En Leefmilieu\/Service Public Federal Sante Publique, Securite de La Chaine Alimentaire et Environnement. Wet Houdende Diverse Bepalingen Betreffende Gezondheid\/Loi Portant Dispositions Diverses En Mati\u00e8re de Sant\u00e9. Available online: https:\/\/etaamb.openjustice.be\/nl\/wet-van-13-december-2006_n2006023386.html."},{"key":"ref_26","unstructured":"(2025, February 02). Service Public Federal Sante Publique, Securite de La Chaine Alimentaire et Environnement. Loi Portant Dispositions Diverses En Mati\u00e8re deSant\u00e9. Available online: https:\/\/etaamb.openjustice.be\/fr\/loi-du-13-decembre-2006_n2006023386."},{"key":"ref_27","unstructured":"Statbel (2025, February 02). Mortality, Life Expectancy and Causes of Death.; 2023. Available online: https:\/\/statbel.fgov.be\/en\/themes\/population\/mortality-life-expectancy-and-causes-death."},{"key":"ref_28","unstructured":"(2025, February 02). ESMO\/SIOPE Adolescents and Young Adults Working Group. Available online: https:\/\/www.esmo.org\/about-esmo\/organisational-structure\/educational-committee\/adolescents-and-young-adults-working-group."},{"key":"ref_29","unstructured":"(2025, January 27). Centraal Bureau voor de Statistiek (CBS). Available online: https:\/\/www.cbs.nl\/nl-nl."},{"key":"ref_30","unstructured":"(2025, January 27). Integraal Kankercentrum Nederlands (IKNL). Available online: https:\/\/nkr-cijfers.iknl.nl\/."},{"key":"ref_31","unstructured":"(2025, January 27). Institut National de la Statistique et des Etudes Economiques (Insee). Available online: https:\/\/www.insee.fr\/."},{"key":"ref_32","unstructured":"(2025, January 27). Institut National du Cancer. Available online: https:\/\/www.e-cancer.fr\/."},{"key":"ref_33","unstructured":"(2025, January 27). DeStatis Statistisches Bundesamt. Available online: https:\/\/www.destatis.de\/EN\/Themes\/Society-Environment\/Population\/."},{"key":"ref_34","unstructured":"(2025, January 27). Zentrum F\u00fcr Krebsregisterdaten, Robert Koch Institut. Available online: https:\/\/www.krebsdaten.de\/Krebs\/."},{"key":"ref_35","unstructured":"(2025, January 27). Eurostat\u2019s Task Force, M. and W. Papers. Revision of the European Standard Population. Available online: https:\/\/ec.europa.eu\/eurostat\/documents\/3859598\/5926869\/KS-RA-13-028-EN.PDF.pdf\/e713fa79-1add-44e8-b23d-5e8fa09b3f8f?t=1414782757000."},{"key":"ref_36","unstructured":"Ahmad, O.B., Boschi Pinto, C., Lopez, A.D., Murray, C.J., Lozano, R., and Inoue, M. (2001). Age Standardization of Rates: A New WHO Standard, World Health Organization."},{"key":"ref_37","first-page":"101","article-title":"The Relative Survival Rate: A Statistical Methodology","volume":"6","author":"Ederer","year":"1961","journal-title":"Natl. Cancer Inst. Monogr."},{"key":"ref_38","unstructured":"(2025, February 02). Joinpoint Regression Program, Version 5.0.2, Available online: https:\/\/surveillance.cancer.gov\/joinpoint\/."},{"key":"ref_39","unstructured":"(2024, January 02). National Cancer Institute\u2014Surveillance Research Program. Number of Joinpoints\u2014Joinpoint Help System, Available online: https:\/\/surveillance.cancer.gov\/help\/joinpoint\/setting-parameters\/advanced-tab\/number-of-joinpoints."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13045-024-01623-9","article-title":"Global Cancer Statistics for Adolescents and Young Adults: Population Based Study","volume":"17","author":"Li","year":"2024","journal-title":"J. Hematol. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e000049","DOI":"10.1136\/bmjonc-2023-000049","article-title":"Global Trends in Incidence, Death, Burden and Risk Factors of Early-Onset Cancer from 1990 to 2019","volume":"2","author":"Zhao","year":"2023","journal-title":"BMJ Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1038\/s41571-022-00672-8","article-title":"Is Early-Onset Cancer an Emerging Global Epidemic? Current Evidence and Future Implications","volume":"19","author":"Ugai","year":"2022","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s11912-022-01213-3","article-title":"Cancer Predisposition Genes in Adolescents and Young Adults (AYAs): A Review Paper from the Italian AYA Working Group","volume":"24","author":"Toss","year":"2022","journal-title":"Curr. Oncol. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1093\/jnci\/djac091","article-title":"Subsequent Primary Cancer Risk Among 5-Year Survivors of Adolescent and Young Adult Cancers","volume":"114","author":"Sung","year":"2022","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Macq, G., Silversmit, G., Verdoodt, F., and Van Eycken, E. (2023). The Epidemiology of Multiple Primary Cancers in Belgium (2004\u20132017): Incidence, Proportion, Risk, Stage and Impact on Relative Survival Estimates. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-10777-7"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zhang, L., Muscat, J.E., Chinchilli, V.M., and Behura, C.G. (2024). Trends in Cancer Incidence and Mortality in US Adolescents and Young Adults, 2016\u20132021. Cancers, 16.","DOI":"10.3390\/cancers16183153"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s10654-024-01134-4","article-title":"Trends in Incidence and Mortality of Early-Onset Cancer in Germany between 1999 and 2019","volume":"39","author":"Voeltz","year":"2024","journal-title":"Eur. J. Epidemiol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"An, S., Kim, K., Moon, S., Ko, K.-P., Kim, I., Lee, J., and Park, S. (2021). Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis. Cancers, 13.","DOI":"10.3390\/cancers13235940"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/jdv.18195","article-title":"Prevention and Screening of Melanoma in Europe: 20 Years of the Euromelanoma Campaign","volume":"36","year":"2022","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_50","unstructured":"Stichting Tegen Kanker\u2014Fondation Contre le Cancer (2025, February 02). Ondanks preventie neemt huidkanker toe\u2014Malgr\u00e9 la pr\u00e9vention, les cancers de la peau sont en hausse. Available online: https:\/\/kanker.be\/resource\/ondanks-preventie-neemt-huidkanker-toe\/-https:\/\/cancer.be\/ressource\/malgre-la-prevention-les-cancers-de-la-peau-sont-en-hausse\/."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"LeClair, K., Bell, K., Furuya-Kanamori, L., Doi, S., and Francis, D. (2021). Evaluation of Gender Inequity in Thyroid Cancer Diagnosis: Differences by Sex in US Thyroid Cancer Incidence Compared with a Meta-Analysis of Subclinical Thyroid Cancer Rates at Autopsy. JAMA Internal Medicine, 181.","DOI":"10.1001\/jamainternmed.2021.4804"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"van der Meer, D.J., Karim-Kos, H.E., van der Mark, M., Aben, K.K., Bijlsma, R.M., Rijneveld, A.W., van der Graaf, W.T., and Husson, O. (2020). Incidence, Survival, and Mortality Trends of Cancers Diagnosed in Adolescents and Young Adults (15\u201339 Years): A Population-Based Study in The Netherlands 1990\u20132016. Cancers, 12.","DOI":"10.3390\/cancers12113421"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1158\/1055-9965.EPI-21-1440","article-title":"Epidemiology of Thyroid Cancer","volume":"31","author":"Kitahara","year":"2022","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"102014","DOI":"10.1016\/j.canep.2021.102014","article-title":"Thyroid Cancer Overdiagnosis Revisited","volume":"74","author":"Zaridze","year":"2021","journal-title":"Cancer Epidemiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4063","DOI":"10.1210\/jc.2013-1705","article-title":"Regional Variation in Thyroid Cancer Incidence in Belgium Is Associated with Variation in Thyroid Imaging and Thyroid Disease Management","volume":"98","author":"Francart","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"101704","DOI":"10.1016\/j.canep.2020.101704","article-title":"Clinical Characteristics and a Rising Incidence of Early-Onset Colorectal Cancer in a Nationwide Cohort of 521 Patients Aged 18-40 Years","volume":"66","author":"Frostberg","year":"2020","journal-title":"Cancer Epidemiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1136\/gutjnl-2018-317592","article-title":"Increasing Incidence of Colorectal Cancer in Young Adults in Europe over the Last 25 Years","volume":"68","author":"Vuik","year":"2019","journal-title":"Gut"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3582443","DOI":"10.1155\/2022\/3582443","article-title":"Risk Factors of Young-Onset Colorectal Cancer: Analysis of a Large Population-Based Registry","volume":"2022","author":"Danial","year":"2022","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Hua, H., Jiang, Q., Sun, P., and Xu, X. (2023). Risk Factors for Early-Onset Colorectal Cancer: Systematic Review and Meta-Analysis. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1132306"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Lawler, T., Parlato, L., and Warren Andersen, S. (2024). The Histological and Molecular Characteristics of Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1349572"},{"key":"ref_61","unstructured":"(2025, February 02). Cervical Cancer Screening Program. Available online: https:\/\/baarmoederhalskanker.bevolkingsonderzoek.be\/en."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Landero-Huerta, D.A., Vigueras-Villase\u00f1or, R.M., Yokoyama-Rebollar, E., Garc\u00eda-Andrade, F., Rojas-Casta\u00f1eda, J.C., Herrera-Montalvo, L.A., D\u00edaz-Ch\u00e1vez, J., P\u00e9rez-A\u00f1orve, I.X., Ar\u00e9chaga-Ocampo, E., and Ch\u00e1vez-Salda\u00f1a, M.D. (2020). Cryptorchidism and Testicular Tumor: Comprehensive Analysis of Common Clinical Features and Search of SNVs in the KIT and AR Genes. Front. Cell Dev. Biol., 8.","DOI":"10.3389\/fcell.2020.00762"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1038\/s41416-019-0445-2","article-title":"Family History of Cancer and Risk of Paediatric and Young Adult\u2019s Testicular Cancer: A Norwegian Cohort Study","volume":"120","author":"Ruud","year":"2019","journal-title":"Br. J. Cancer"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Garolla, A., Vitagliano, A., Muscianisi, F., Valente, U., Ghezzi, M., Andrisani, A., Ambrosini, G., and Foresta, C. (2019). Role of Viral Infections in Testicular Cancer Etiology: Evidence From a Systematic Review and Meta-Analysis. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00355"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1210\/en.2019-00486","article-title":"Is Testicular Germ Cell Cancer Estrogen Dependent? The Role of Endocrine Disrupting Chemicals","volume":"160","author":"Chevalier","year":"2019","journal-title":"Endocrinology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"102746","DOI":"10.1016\/j.canep.2025.102746","article-title":"Smoking and Testicular Cancer: A Danish Nationwide Cohort Study","volume":"95","author":"Hermansen","year":"2025","journal-title":"Cancer Epidemiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1007\/s00432-022-04171-2","article-title":"Association of Birth Weight with Cancer Risk: A Dose\u2013Response Meta-Analysis and Mendelian Randomization Study","volume":"149","author":"Chen","year":"2023","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_68","unstructured":"Gaddam, S.J., and Chestnut, G.T. (2023). Testicle Cancer, StatPearls Publishing."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s11764-020-00976-7","article-title":"Late Effects in Survivors Treated for Lymphoma as Adolescents and Young Adults: A Population-Based Analysis","volume":"15","author":"Lo","year":"2021","journal-title":"J. Cancer Surviv."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1002\/ajh.24964","article-title":"Excess Mortality among 10-Year Survivors of Classical Hodgkin Lymphoma in Adolescents and Young Adults","volume":"93","author":"Xavier","year":"2018","journal-title":"Am. J. Hematol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13045-022-01281-9","article-title":"Incidence, Mortality, Risk Factors, and Trends for Hodgkin Lymphoma: A Global Data Analysis","volume":"15","author":"Huang","year":"2022","journal-title":"J. Hematol. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3920","DOI":"10.1245\/s10434-019-07653-9","article-title":"Adolescents and Young Adults with Breast Cancer Have More Aggressive Disease and Treatment than Patients in Their Forties","volume":"26","author":"Murphy","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"347","DOI":"10.4103\/ijmr.ijmr_1597_23","article-title":"Year-Round Breast Cancer Awareness: Empowering Young Women in the Fight against Breast Cancer","volume":"158","author":"Kumar","year":"2023","journal-title":"Indian J. Med. Res."},{"key":"ref_74","first-page":"100470","article-title":"Hormonal Contraception and Risk of Breast Cancer and Breast Cancer in Situ among Swedish Women 15\u201334 Years of Age: A Nationwide Register-Based Study","volume":"21","author":"Hultstrand","year":"2022","journal-title":"Lancet Reg. Health\u2014Eur."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"22","DOI":"10.7326\/M18-1323","article-title":"Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies","volume":"170","author":"Nichols","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.ejca.2005.11.032","article-title":"BRCA1, BRCA2 and TP53 Mutations in Very Early-Onset Breast Cancer with Associated Risks to Relatives","volume":"42","author":"Lalloo","year":"2006","journal-title":"Eur. J. Cancer"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1093\/jnci\/djae288","article-title":"Trends in Cancer Mortality under Age 50 in 15 Upper-Middle and High-Income Countries","volume":"117","author":"Santucci","year":"2025","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.annonc.2023.12.003","article-title":"European Cancer Mortality Predictions for the Year 2024 with Focus on Colorectal Cancer","volume":"35","author":"Malvezzi","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_79","unstructured":"OECD Publishing (2023). EU Country Cancer Profile: Belgium 2023, EU Country Cancer Profiles, OECD."},{"key":"ref_80","unstructured":"(2025, April 28). BeBOD\u2014Belgian National Burden of Disease Study; Sciensano. Available online: https:\/\/www.sciensano.be\/en\/projects\/belgian-national-burden-disease-study."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e27407","DOI":"10.1002\/pbc.27407","article-title":"Is the Cancer Survival Improvement in European and American Adolescent and Young Adults Still Lagging behind That in Children?","volume":"66","author":"Trama","year":"2019","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1002\/cncr.29869","article-title":"Comparison of Cancer Survival Trends in the United States of Adolescents and Young Adults with Those in Children and Older Adults","volume":"122","author":"Keegan","year":"2016","journal-title":"Cancer"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"pkz031","DOI":"10.1093\/jncics\/pkz031","article-title":"Emerging Cancer Survival Trends, Disparities, and Priorities in Adolescents and Young Adults: A California Cancer Registry-Based Study","volume":"3","author":"Moke","year":"2019","journal-title":"JNCI Cancer Spectr."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1543\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:25:50Z","timestamp":1760030750000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1543"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":83,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17091543"],"URL":"https:\/\/doi.org\/10.3390\/cancers17091543","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}