Stomach cancer epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahad Hasan, M.D.[2] Omer Kamal, M.D.[3], Rim Halaby, M.D. [4], Mohammed Abdelwahed M.D[5]
Overview
Gastric cancer is the fifth most commonly diagnosed cancer and the fifth leading cause of cancer death worldwide. GLOBOCAN estimated 968,350 new cases and 659,853 deaths in 2022.[1][2] Age-standardized incidence and mortality have declined for more than half a century, mainly because Helicobacter pylori prevalence has fallen and food refrigeration and preservation have improved. Absolute case numbers keep rising because of population growth and aging.[3] Incidence is highest in East Asia, Eastern Europe, and parts of Central and South America. In the United States, about 30,300 new cases are diagnosed each year, the median age at diagnosis is 68 years, and incidence in men is nearly twice that in women.[2] Cardia and non-cardia gastric cancer are epidemiologically distinct diseases. The incidence of early-onset disease (diagnosis before age 50) is rising in several low-incidence countries, including the United States.[4][2]
Epidemiology and Demographics
Global Burden
- GLOBOCAN 2022 ranked gastric cancer fifth worldwide in both incidence and mortality, with 968,350 new cases and 659,853 deaths.[1][2]
- In the Global Burden of Disease (GBD) 2021 analysis, the global age-standardized incidence rate (ASIR) was 14.33 per 100,000, down from 24.76 per 100,000 in 1990. The age-standardized mortality rate (ASMR) was 11.20 per 100,000.[5]
- Over the same period, absolute incident cases rose from about 981,000 (1990) to about 1.23 million (2021).[5]
- Different modeling frameworks give different absolute counts, so figures should always be cited with their source and year rather than averaged:[1][5]
| Source (estimate year) | New cases | Deaths | Comment |
|---|---|---|---|
| GLOBOCAN 2020 | ~1.09 million | ~769,000 | Registry-based IARC estimates[3] |
| GLOBOCAN 2022 | 968,350 | 659,853 | Current IARC estimate[1] |
| GBD 2021 | ~1.23 million | — | ASIR 14.33 and ASMR 11.20 per 100,000[5] |
| GBD 2023 forecast (2050) | — | ~1.16 million | Deaths +22.5%, although ASMR is forecast to fall ~36%[6] |
Geographic Distribution
- Incidence is highest in East Asia (China, Japan, South Korea), Eastern Europe, and parts of Central and South America. It is lowest in North America and most of Africa.[3]
- In 2020, incidence was about 22.4 per 100,000 in Eastern Asia, compared with about 4.2 per 100,000 in North America and 3–4 per 100,000 in Africa.[3]
- Asia accounts for about 75% of global cases and deaths. In GBD 2021, China alone accounted for about 612,000 cases.[7][8]
- Development gradient: Incidence tracks H. pylori prevalence. Mortality is proportionally higher in medium- and low-HDI regions because of late diagnosis and limited access to treatment.[3]
- Migration: First-generation immigrants from high-incidence countries keep up to ~5-fold higher incidence and ~2-fold higher mortality than the low-incidence host population. The excess shrinks in later generations.[9] Classic studies of Japanese migrants to the United States first showed that early-life environmental exposures, rather than genetics, drive most of this risk.[10]
Secular Trends
- Age-standardized incidence and mortality have fallen worldwide. The global ASIR dropped by roughly 30–40% between 1990 and 2021.[5]
- In the United States, age-standardized incidence fell by about 1.46% per year from 1975 to 2019 (11.6 to 6.1 per 100,000).[3] The decline was about 0.94% per year between 2001 and 2015.[11]
- Rates are falling while counts are rising, because aging and population growth outweigh the falling rates. This has direct implications for service planning.[3]
United States
- Estimates for 2025 are about 30,300 new cases and 10,780 deaths.[2]
- Five-year relative survival across all stages rose from 15% in 1977 to about 36% by 2020.[2]
- Survival depends strongly on stage: about 70% for localized, 31% for regional, and 6% for distant disease. About 60% of patients present with regional or distant disease.[12] Early-stage disease amenable to endoscopic or surgical resection has a 5-year relative survival of about 75%.[2]
- Mortality fell substantially across all racial and ethnic groups from 2000 to 2019. It was lowest in the White population every year, and minoritized populations had higher mortality in almost all counties.[12]
- Gastric cancer mortality is 43% higher in U.S. counties with persistent poverty.[9]
Age
- Incidence rises sharply after age 50. Globally, the 70–74-year age group has the most incident cases and deaths.[8]
- In the United States, the median age at diagnosis is 68 years.[2] About 70% of patients are diagnosed between ages 55 and 84.[13]
- Early-onset disease (before age 50) has a distinct epidemiology and is described below.
Sex
- Gastric cancer is about 2- to 3-fold more common in men than in women, both worldwide and in the United States.[3] U.S. incidence is 8.4 per 100,000 per year in men and 4.8 per 100,000 per year in women.[2]
- Most of the male excess comes from cardia cancer, where the male-to-female incidence rate ratio is about 4.2. For non-cardia cancer the ratio is about 1.6.[3]
- Incidence in women resembles that in men but lags by roughly 10–15 years after menopause. A protective effect of estrogen has been proposed, but this remains a hypothesis.[13]
- Early-onset disease runs counter to the overall male predominance: it is relatively more common in women.[14][4]
Race and Ethnicity (United States)
- Gastric cancer is one of the few malignancies for which non-Hispanic White Americans have the lowest incidence and mortality.[12]
- Non-cardia gastric cancer incidence is 1.7- to 3.9-fold higher in Black, Hispanic, Asian/Pacific Islander, American Indian, and Alaska Native individuals than in non-Hispanic White individuals.[15]
- Korean American men and women aged 50 years or older have the highest risk: up to 12- to 14.5-fold higher non-cardia incidence than non-Hispanic White peers. Korean American men in this age group had a non-cardia incidence of about 70 per 100,000.[16][9]
- Cardia gastric cancer, by contrast, is more common in White patients.[14]
- Minoritized groups more often present with regional or distant non-cardia disease.[17]
- Race and ethnicity are surrogates for underlying drivers: H. pylori prevalence, country of origin, and social determinants of health. Aggregate categories such as "Asian" hide markedly different risk across origin groups, so risk should be assessed by country or region of birth.[9] Implications for targeted screening are covered in Stomach cancer screening.
Anatomic Subsite: Cardia vs Non-Cardia
Gastric cancer is best understood as two epidemiologically distinct diseases.[3][1]
| Feature | Non-cardia (body/antrum) | Cardia / gastroesophageal junction |
|---|---|---|
| Share of cases | ~85% of cases globally[2] | 30–40% of gastric cancers in North America and Western Europe[1] |
| Principal drivers | Chronic H. pylori infection (~90% attributable), high-salt or salt-preserved diet, smoking, low socioeconomic status[2][1] | Obesity, gastroesophageal reflux disease, Barrett's esophagus; profile overlaps esophageal adenocarcinoma. Only ~1 in 5 cases is H. pylori-attributable globally[18][1] |
| Male:female incidence rate ratio | ~1.6 | ~4.2[3] |
| U.S. race/ethnicity pattern | Higher in Black, Hispanic, Asian/Pacific Islander, and AI/AN populations than in non-Hispanic White[15] | More common in White patients[14] |
| Secular trend | Declining for decades | U.S./UK incidence rose from the 1960s to the 1980s, then stabilized[1][18] |
Early-Onset Gastric Cancer
- Incidence of gastric cancer diagnosed before age 50 is rising, mainly in low-incidence countries. People born in 1980–1994 have roughly double the rates of those born in the 1950s.[4]
- In the United States, age-adjusted incidence in people under 50 rose from 2013 to 2022:[2]
- Women: 1.2 to 1.8 per 100,000 (average annual percent change [AAPC] 4.0%)
- Men: 1.5 to 1.6 per 100,000 (AAPC 1.7%)
- Hereditary syndromes account for only about 3% of early-onset cases, mainly hereditary diffuse gastric cancer (CDH1) and Lynch syndrome. Most cases are sporadic.[4]
- Early-onset disease has distinct biology and presentation. Compared with later-onset disease, it is:[4][14]
- enriched for diffuse histology and signet-ring cells
- more common in women
- often genomically stable
- frequently diagnosed at an advanced stage
Histologic Distribution
- Adenocarcinoma accounts for more than 90% of gastric cancers.[2] It has two Lauren subtypes:
- Intestinal type: more common in older men; arises through the Correa cascade (chronic gastritis → atrophy → intestinal metaplasia → dysplasia).
- Diffuse / signet-ring type: affects younger patients, is more often seen in women, and has a worse prognosis.[2][4]
- Less common subtypes include:
- gastric neuroendocrine tumors (G-NET)
- neuroendocrine carcinoma / mixed neuroendocrine–non-neuroendocrine neoplasm (MiNEN)
- gastrointestinal stromal tumors
- lymphomas, including MALT lymphoma
- SEER 2000–2022 subtype trends:[19]
- Adenocarcinoma incidence is falling (AAPC −1.74%).
- G-NET (AAPC +4.37%) and G-NEC/MiNEN (AAPC +3.67%) incidence is rising, partly because more endoscopy is being performed and more lesions detected.
- Five-year overall survival is highest for G-NET (~83%) and lowest for gastric carcinoma with a squamous component (~12%).
Projected Burden
- GLOBOCAN-based modeling projects about a 62% increase, to roughly 1.77 million new cases a year, by 2040.[3]
- Lifetime projections for people born in 2008–2017 across 185 countries:[20]
- About 15.6 million gastric cancers are expected, about 76% of them attributable to H. pylori and therefore potentially preventable.
- Two-thirds of these cases are expected in Asia.
- Sub-Saharan Africa could see roughly six times more cases than current estimates suggest.
- GBD 2023 forecasts that stomach cancer deaths will rise about 22.5%, to about 1.16 million, by 2050, even as age-standardized mortality falls about 36%.[6]
Determinants of Population Patterns
Detailed risk factors are covered in Stomach cancer risk factors. The factors that most shape the epidemiologic patterns above are:
- H. pylori: an IARC Group 1 carcinogen since 1994. It accounts for 75–90% of non-cardia gastric cancers, and its falling prevalence explains much of the secular decline in incidence.[3][21]
- Diet and tobacco: The main drivers here are high intake of salt and salt-preserved, smoked, or processed foods, and low fruit and vegetable intake.[21] In GBD analyses, tobacco is the leading attributable risk factor for gastric cancer mortality after diet.[8]
- Obesity and GERD: These principally explain cardia/GEJ disease and its different trends in Western populations.[18]
- Inherited predisposition: About 1–3% of cases (CDH1, Lynch syndrome, BRCA1/BRCA2). In carriers of homologous-recombination gene variants, H. pylori infection markedly amplifies risk.[4][22]
Data Interpretation and Areas of Uncertainty
- Incidence vs prevalence: Older references, including earlier versions of this page, often reported incidence rates as "prevalence." Incidence, mortality, and survival should be reported as distinct metrics.
- Early-onset drivers are unresolved: Candidate contributors include autoimmune gastritis, gastric microbiome dysbiosis, antibiotic and acid-suppressant use, obesity, and residual hereditary predisposition. Whether the rise is concentrated in cardia disease, non-cardia disease, or both is still debated.[1]
- Cardia etiology varies by population: The H. pylori-attributable fraction of cardia cancer is about 20% globally, but much higher in some high-incidence populations. A single etiologic model may therefore not apply everywhere.[1]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024). "Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries". CA Cancer J Clin. 74 (3): 229–263. doi:10.3322/caac.21834. PMID 38572751 Check
|pmid=value (help). - ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Patel AK, Sethi NS, Park H (2026). "Gastric Cancer: A Review". JAMA. doi:10.1001/jama.2025.20034.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Thrift AP, Wenker TN, El-Serag HB (2023). "Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention". Nat Rev Clin Oncol. 20 (5): 338–349. doi:10.1038/s41571-023-00747-0.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Sundar R, Nakayama I, Markar SR, Shitara K, van Laarhoven HWM; et al. (2025). "Gastric cancer". Lancet. doi:10.1016/S0140-6736(25)00052-2.
- ↑ 5.0 5.1 5.2 5.3 5.4 Zhou L, Han B, Yuan Y, Dong Z, Shi Y, Zheng R (2025). "The global burden of stomach cancer and its risk factors from 1990 to 2021: findings from the Global Burden of Disease Study 2021". BMC Public Health. doi:10.1186/s12889-025-23901-y. PMC PMC12326841 Check
|pmc=value (help). - ↑ 6.0 6.1 GBD 2023 Cancer Collaborators (2025). "The global, regional, and national burden of cancer, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023". Lancet. 406 (10512): 1565–1586. doi:10.1016/S0140-6736(25)01635-6. PMID 41015051 Check
|pmid=value (help). - ↑ Mousavi SE, Ilaghi M, Elahi Vahed I, Nejadghaderi SA. Epidemiology and socioeconomic correlates of gastric cancer in Asia: results from the GLOBOCAN 2020 data and projections from 2020 to 2040. Sci Rep. 2025.
- ↑ 8.0 8.1 8.2 Cui X, Chen Y, Jiao Z, et al. Global burden of gastric cancer from 1990 to 2021 (Global Burden of Disease Study 2021). Chin Med J. 2026.
- ↑ 9.0 9.1 9.2 9.3 Shah SC, Wang AY, Wallace MB, Hwang JH (2025). "AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review". Gastroenterology. doi:10.1053/j.gastro.2024.11.001.
- ↑ Haenszel W, Kurihara M (1968). "Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States". J Natl Cancer Inst. 40 (1): 43–68. PMID 5635018.
- ↑ Thrift AP, El-Serag HB (2020). "Burden of Gastric Cancer". Clin Gastroenterol Hepatol. 18 (3): 534–542. doi:10.1016/j.cgh.2019.07.045. PMC PMC8859863 Check
|pmc=value (help). PMID 31362118. - ↑ 12.0 12.1 12.2 GBD US Health Disparities Collaborators (2023). "The burden of stomach cancer mortality by county, race, and ethnicity in the USA, 2000–2019: a systematic analysis of health disparities". Lancet Reg Health Am. 24: 100547. doi:10.1016/j.lana.2023.100547. PMC PMC10435837 Check
|pmc=value (help). - ↑ 13.0 13.1 Nawawi KNM, El-Omar EM, Ali RAR. Screening, surveillance, and prevention of esophageal and gastric cancers. In: Gastrointestinal Oncology – A Critical Multidisciplinary Team Approach. 2nd ed. 2024.
- ↑ 14.0 14.1 14.2 14.3 Castillo DR, Shah P, Tai D, et al. Early-onset gastric cancer as a high-risk disease entity in the United States: clinicopathologic features, regional variation, and outcomes. Cancer Med. 2026.
- ↑ 15.0 15.1 Li D, Jiang SF, Lei NY, Shah SC, Corley DA (2023). "Effect of Helicobacter pylori eradication therapy on the incidence of noncardia gastric adenocarcinoma in a large diverse population in the United States". Gastroenterology. 165 (2): 391–401. doi:10.1053/j.gastro.2023.04.026.
- ↑ Shah SC, McKinley M, Gupta S, Peek RM, Martinez ME, Gomez SL (2020). "Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Age 50 Years and Older". Gastroenterology. 159 (5): 1705–1714.e2. doi:10.1053/j.gastro.2020.07.049. PMID 32771406 Check
|pmid=value (help). - ↑ Urujeni C, Epplein M, Li CI, Pete D. Racial and ethnic differences in gastric cancer by stage of diagnosis, 2009–2019. Cancer Epidemiol Biomarkers Prev. 2026.
- ↑ 18.0 18.1 18.2 Alsina M, Arrazubi V, Diez M, Tabernero J (2023). "Current developments in gastric cancer: from molecular profiling to treatment strategy". Nat Rev Gastroenterol Hepatol. 20 (3): 155–170. doi:10.1038/s41575-022-00703-w.
- ↑ Yin K, Wang S, Wang Y, et al. Trends in gastric cancer incidence, mortality, and survival by histologic subtype in the United States, 2000–2022. Cancer Epidemiol Biomarkers Prev. 2026.
- ↑ Park JY, Georges D, Alberts CJ, Bray F, Clifford G, Baussano I (2025). "Global lifetime estimates of expected and preventable gastric cancers across 185 countries". Nat Med. doi:10.1038/s41591-025-03793-6.
- ↑ 21.0 21.1 Huang RJ, Laszkowska M, In H, Hwang JH, Epplein M (2023). "Controlling Gastric Cancer in a World of Heterogeneous Risk". Gastroenterology. 164 (5): 736–751. doi:10.1053/j.gastro.2023.01.018. PMID 36706842 Check
|pmid=value (help). - ↑ Usui Y, Taniyama Y, Endo M, Koyanagi YN, Kasugai Y, Oze I; et al. (2023). "Helicobacter pylori, Homologous-Recombination Genes, and Gastric Cancer". N Engl J Med. 388 (13): 1181–1190. doi:10.1056/NEJMoa2211807. PMID 36988593 Check
|pmid=value (help).