New Study Highlights Need for Coordinated Approach to Stomach Cancer Screening and Prevention

Stomach cancer, or gastric cancer, is the third leading cause of cancer deaths worldwide, largely because most individuals are not diagnosed until after the cancer has progressed to a late stage.

A new study led by researchers at Yale School of Medicine sheds new light on the incidence rates, stage of diagnosis, and racial and geographic differences in survival outcomes for individuals with gastric cancer in the United States. The study was published in JCO Oncology Advances.

The researchers analyzed a National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) dataset of more than 110,000 cases of gastric cancer from patients in seven states with high incidences of the disease: California, New York, New Jersey, Texas, Connecticut, Georgia, and New Mexico. The study found significant racial and geographic differences in five-year survival rates of gastric cancer across seven states. For example, the five-year relative survival rates were as high as 33.16% in New York, compared to just 19.11% in New Mexico.

The authors note that these differences were most pronounced in early-stage gastric cancer, where effective treatments could have the most significant impact on survival. Across all racial and ethnic groups, advanced-stage diagnosis remains the norm, with only a small subset of patients receiving a diagnosis in the early stages of the disease.

“The findings highlight persistent disparities in stage distribution and survival, underscoring the urgent need for tailored, community-centered prevention strategies to reduce these gaps,” says Chul S. Hyun, MD, PhD, associate professor of medicine (digestive diseases) and the first author of the paper.

Hyun, who joined Yale in 2024 after decades in community-based clinical practice, is the director of the Yale Gastric Cancer Prevention and Screening Program. The multidisciplinary research group is focused on improving early detection and prevention of gastric cancer. It is the first program of its kind at a U.S. academic medical center.

Currently, medical societies do not recommend universal screening for stomach cancer in the U.S., as incidence rates are low across the general population. However, certain groups—including Asian and Hispanic populations—have significantly higher incidence rates. People who have a prior Helicobacter pylori (H. pylori) infection, a stomach infection that spreads primarily through contaminated food or water, are also at higher risk for gastric cancer.

“There is a need for more robust identification and screening of individuals to determine not only who should be screened for stomach cancer, but who should receive screening for H. pylori and other risk factors associated with gastric cancer,” says Hyun.

Hyun and his colleagues are working on new initiatives to increase screening for patients at higher risk of developing gastric cancer. In partnership with local organizations, they are piloting community-based H. pylori screening pilots in high-risk populations. Preliminary results from more than 250 Asian Americans in New York and Connecticut have already shown a lifetime prevalence of roughly 60% for H. pylori infection—evidence of a substantial hidden burden that translates into significant long-term cancer risk.

The lab is also developing tools to help educate physicians about gastric cancer, including the link between prior H. pylori infections and stomach cancer. Additionally, Hyun and his colleagues are creating point-of-care tools and referral pathways to help improve testing for H. pylori, ongoing surveillance, and access to specialists. Hyun is also planning additional research to better understand gaps in clinical awareness across the U.S. and is working with policymakers to advance legislation to support public education, screening guidelines, and early detection of the disease.

“This is a cancer that, if found early, before the cancer has spread, has survival rates of more than 70%,” says Hyun, pointing to countries like Japan and South Korea that have high incidence rates of gastric cancer but better outcomes compared to the United States for most patients. “With coordinated prevention and screening, better tools for clinicians, and improved patient access to ongoing surveillance, I am optimistic that we can diagnose patients earlier, leading to more timely treatment and better outcomes.”

Additional study authors include: Rong Wang, PhD, MPH; Jae Il Shin, MD, PhD; Raghav Sundar, MD, PhD; and Pamela Kunz, MD from Yale, and Yun Seo Kim and Sung Hwi Hong, MD, from Yonsei University in Seoul, Korea.