Gastric cancer remains a major cause of cancer-related mortality worldwide. The temporal trends for this malignancy, however, are dynamic, and reports from the past decade indicate important declines in some regions and demographic groups, as well as a few notable exceptions in which gastric cancer rates are either stable or increasing. Two main anatomical subtypes of gastric cancer exist, non-cardia and cardia, with different temporal trends and risk factors (such as obesity and reflux for cardia gastric cancer and Helicobacter pylori infection for non-cardia gastric cancer). Shifts in the distribution of anatomical locations have been detected in several high-incidence regions. H. pylori is an important aetiological factor for gastric cancer; importantly, the anticipated long-term findings from studies examining the effect of H. pylori eradication on the risk of (re)developing gastric cancer have emerged in the past few years. In this Review, we highlight the latest trends in incidence and mortality using an evidence-based approach. We make the best possible inferences, including clinical and public health inference, on the basis of the quality of the evidence available, and highlight burning questions as well as gaps in knowledge and public health practice that need to be addressed to reduce gastric cancer burden worldwide.
Globally, gastric cancer remains the fifth most common malignant cancer and the fourth leading cause of cancer-related mortality. Despite declining incidence rates, the global burden of this malignancy is expected to have a 62% increase by 2040.
Overall, gastric cancer incidence rates have been decreasing over the past 5 decades in the USA, although the incidence of non-cardia gastric cancer among adults aged <50 years and that of advanced-stage gastric cancer in Hispanic individuals are both increasing.
Worldwide, Helicobacter pylori infection accounts for almost 90% of distal gastric cancers; other well-established risk factors include excess body fat, cigarette smoking and diets high in salt and processed meats.
Other possible risk factors for gastric cancer include Epstein–Barr virus infection, autoimmune gastritis and Ménétrier disease, and possible protective factors include high vegetable intake and treatment with nonsteroidal anti-inflammatory drugs and statins.
A small proportion of all gastric cancers are diagnosed in patients not infected with H. pylori; other components of the gastric microbiome might have a role in the development of these cancers.
Population-based screening and surveillance programmes and H. pylori eradication hold promise for reducing gastric cancer-related mortality.
The knowledge on risk factors needs to be translated into actionable diagnostic algorithms for public health and clinical use.
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Thrift, A.P., Wenker, T.N. & El-Serag, H.B. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol 20, 338–349 (2023). https://doi.org/10.1038/s41571-023-00747-0