Stanford Department of Medicine

The keynote address at the 2022 Gastric Cancer Summit focused on redefining the direction of research, treatment, and patient care. It highlighted current global challenges in early detection and disparities in access to therapy. Speakers emphasized collaboration among clinicians, researchers, policymakers, and patient advocates. Innovations in precision medicine, immunotherapy, and genomic profiling were discussed. The session also underscored the importance of awareness, screening programs, and patient support systems. Overall, the address aimed to inspire a unified strategy to reduce the global burden of gastric cancer.

Asian Americans have a much higher gastric cancer incidence than non-Hispanic Whites in the U.S., with Koreans showing about 13 times, Vietnamese 7 times, and Japanese/Chinese 5 times greater risk. High prevalence of Helicobacter pylori infection in many Asian immigrant populations is a major contributing factor to this elevated risk. Because screening is not routine, many Asian Americans are diagnosed at later stages, leading to poorer survival compared to countries like Japan and Korea where screening is standard. Despite being a high-risk group, there is no U.S. national screening strategy focused on Asian Americans, and awareness among both providers and communities remains low. Aggregating all Asians together masks large differences among subgroups, so disaggregated data by ethnicity are essential for accurate risk assessment. Experts at the Summit emphasized early H. pylori testing, culturally tailored education, and targeted screening guidelines as critical steps to reduce disparities.

The Summit emphasized the need for risk-stratification models that combine demographic, clinical, and biomarker data to identify people at higher risk, so that screening resources can be focused more efficiently. Variables such as age, sex, Helicobacter pylori infection status, family history, lifestyle factors (e.g. smoking, alcohol), body mass index, and serum biomarker panels (e.g. pepsinogen I/II ratio) were proposed as inputs in predictive models. Some models developed (outside the U.S., e.g. in Korea) achieved moderate to good discriminative ability (Area Under Curve ~0.8), meaning they could meaningfully separate low vs. high gastric neoplasm risk cohorts. Pilot studies and trial designs highlighted during the Summit also addressed how to validate these tools in real-world settings, including internal validation (bootstrapping) and external/clinical validation in diverse populations. The tools are seen not just for selecting who should get endoscopy, but also for implementing sequential screening strategies—using less invasive or cheaper prescreen tests followed by more invasive ones only in selected high-risk people. A particular challenge noted is ensuring that predictive tools are equitable, i.e. calibrated across racial, ethnic, and immigrant populations, so that high-risk minority groups are not under-identified. Also, tools must be feasible in terms of implementation, cost, patient acceptability, and access.

Gastric cancer incidence in the U.S. is disproportionately higher among non-White populations — especially Asian Americans, Hispanic/Latino, Black, and Indigenous groups — compared to non-Hispanic Whites. Among subtypes, non-cardia gastric cancer shows more marked disparities, with Asian and Hispanic groups exhibiting relatively higher rates of non-cardia disease. Differences in Helicobacter pylori prevalence contribute: Black and Hispanic populations tend to have higher H. pylori infection rates than Whites, which can drive elevated gastric cancer risk. Immigrant status and country of origin also play roles: people born in high-incidence regions may carry sustained risk even after migration. Socioeconomic, access-to-care, environmental, dietary, and genetic factors further modify these disparities across groups. The result is not only higher incidence but also later stage at diagnosis and worse survival among some minority groups, pointing to inequities in early detection and care.

The 2022 Gastric Cancer Summit highlighted that gastric cancer remains a major global health burden, especially in East Asia and parts of Latin America. Screening methods such as endoscopy and H. pylori testing were found to be cost-effective in high-risk populations. Early detection significantly reduces treatment costs and improves survival outcomes compared to late-stage interventions. H. pylori eradication was emphasized as a preventive strategy, lowering long-term cancer incidence at relatively low expense. Cost-effectiveness varies by region, depending on cancer prevalence, healthcare infrastructure, and resource availability. Overall, integrating screening with prevention programs offers the best balance of economic efficiency and patient benefit.