Noncardia gastric cancer risk may reach clinically meaningful levels one to two decades earlier in several Hispanic and Asian populations than in non-Hispanic White populations, according to a population-based study published in Gastro Hep Advances.
The findings suggest that age alone may not adequately capture gastric cancer risk and could support more individualized prevention strategies that account for ancestry, country of birth, migration history and other established risk factors.
“The key takeaway is that gastric cancer risk is not only higher in certain populations; it emerges at younger ages,” corresponding author Chul S. Hyun, MD, PhD, MPH, of the Section of Digestive Diseases at Yale School of Medicine, told GI & Hepatology News. “A middle-aged patient from a higher-risk population may carry a level of risk more comparable to that of a much older patient in the general population.”
The investigators analyzed noncardia gastric cancer incidence in California and New York from 2010 through 2022 using data from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. The analysis included 35,375 cases, including 11,703 among Hispanic individuals and 8,125 among non-Hispanic Asian or Pacific Islander individuals.
Researchers estimated age-specific incidence among non-Hispanic White, Hispanic and non-Hispanic Asian or Pacific Islander populations. Chinese, Japanese, Korean and Vietnamese populations were also analyzed separately to assess differences that may be obscured within broader racial categories.
Incidence increased with age in every group but remained higher among Hispanic and Asian populations than among non-Hispanic White populations. The investigators then identified the age at which each group reached approximately the incidence observed among non-Hispanic White adults aged 60 to 69 years.
Several Hispanic and Asian populations reached or closely approached this benchmark by ages 40 to 59, one to two decades earlier than non-Hispanic White populations. Korean and Vietnamese populations did so by ages 40 to 49.
The analysis also showed marked variation among Asian ancestry groups. Korean individuals had the highest incidence across several age groups, reaching 61.51 cases per 100,000 at ages 60 to 69, compared with 5.11 per 100,000 among non-Hispanic White adults of the same age.
“By examining Chinese, Japanese, Korean and Vietnamese populations separately, we found marked differences in incidence,” Dr. Hyun said. “Broad racial categories may obscure important differences in risk.”
Dr. Hyun said the differences may partly reflect cumulative exposures acquired earlier in life, including Helicobacter pylori infection and the environment in which a person grew up.
“Risk can travel with populations,” Dr. Hyun said. “Individuals who migrate from higher-incidence regions may continue to carry elevated risk decades after arriving in the United States. We routinely consider country of birth and migration history when assessing risk for conditions such as hepatitis B and tuberculosis, and gastric cancer may warrant a similar risk-informed perspective.”
The study does not establish specific screening ages or evaluate whether screening improves outcomes. However, Dr. Hyun said the age-specific patterns have practical implications for prevention nonetheless.
“This includes greater attention to H. pylori detection and eradication in higher-risk populations, as well as a more individualized approach to endoscopic evaluation when patients have additional risk factors, such as a family history of gastric cancer or known premalignant gastric lesions,” he said. “The broader goal is to match prevention and early detection strategies to an individual’s risk profile rather than relying solely on age.”
Several limitations temper the clinical implications. The study was descriptive and evaluated incidence patterns rather than the effectiveness of screening, surveillance or other interventions. It was also limited to California and New York, although both states include large and diverse populations and provided sufficient case numbers for subgroup-specific estimates.
Cancer registry data did not include individual-level information on H. pylori status, country of birth, duration of U.S. residence, migration history, family history or socioeconomic factors. The findings therefore should not be used to guide decisions based on race or ethnicity alone. There are also no U.S. Preventive Services Task Force recommendations for gastric cancer screening and no widely adopted U.S. risk-stratification framework.
“The next step is to move beyond broad population categories and develop more refined risk-stratification models,” Dr. Hyun said. “These models should incorporate individual-level factors such as ancestry, nativity, migration history, prior H. pylori exposure, family history and premalignant gastric findings.”
Such tools could help identify patients who may benefit from targeted prevention without treating race or ethnicity as stand-alone clinical proxies.
The authors reported having no disclosures.