Stomach Cancer Risk Factors and Screening

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Stomach cancer is uncommon in the United States, but the risk is not spread evenly. It is several times more common in some communities than in others, and much of that difference traces back to a treatable stomach infection and to where a person or their family grew up. This guide explains who is at higher risk of stomach cancer, which symptoms deserve attention, what the current United States guidelines say about screening, and when it makes sense to ask a gastroenterologist about getting checked.

This article is general education, not medical advice. Having a risk factor described here does not mean a person will develop stomach cancer, and most people with these risk factors never do. It cannot tell you whether you need a test. That is a decision to make with a physician who knows your history.

How common is stomach cancer in the United States

The American Cancer Society estimates about 31,510 new cases of stomach cancer in the United States in 2026 (17,900 in men and 13,610 in women) and about 10,740 deaths. Stomach cancer, also called gastric cancer, accounts for about 1.5% of all new cancers diagnosed in the country each year. The average age at diagnosis is 68, and about 6 of every 10 people diagnosed are 65 or older. The lifetime risk is about 1 in 104 for men and 1 in 153 for women.

The American Cancer Society notes that stomach cancer was the leading cause of cancer death in the United States for much of the early 20th century. It has fallen far down the list since. Two reasons are thought to explain most of the decline: refrigeration, which reduced the use of salted and smoked foods, and fewer people carrying the bacterium Helicobacter pylori.

Those national figures are averages, and they hide a wide range. That range is the main reason this topic matters in Northern Virginia.

Stomach cancer risk is not the same for everyone

The National Cancer Institute's SEER program reports the rate of new stomach cancer cases by race and ethnicity. For 2019 to 2023, the rate among men was 7.6 per 100,000 per year for non-Hispanic White men, 12.1 for Hispanic men, 12.2 for non-Hispanic Asian and Pacific Islander men, 13.2 for non-Hispanic Black men, and 15.9 for non-Hispanic American Indian and Alaska Native men. The pattern among women is similar: 4.1 for non-Hispanic White women, compared with 7.2 to 9.2 in the other groups.

Broad categories still blur the picture. The American College of Gastroenterology, in its 2025 clinical guideline on gastric premalignant conditions, describes incidence rates that are 2 to 13 times higher in specific non-White populations than in non-Hispanic White people. It cites a California cancer registry study in which Korean American adults aged 50 and older had a rate of the most common form of stomach cancer of about 70 per 100,000 per year. The guideline points out that stomach cancer ranks among the top 8 causes of cancer death for Hispanic and Asian American people in the United States, compared with 15th for the population as a whole.

Why country of birth matters

Stomach cancer rates differ sharply around the world. The College's guideline identifies East Asia, Eastern Europe, and Central and South America as the regions with the highest incidence, and it describes the South American high-incidence area as the Andean region from Colombia to Chile. People who move from a high-incidence region to a low-incidence country carry much of their original risk with them. The guideline cites a pooled analysis in which first-generation immigrants from high-incidence areas had roughly 1.7 to 1.8 times the stomach cancer incidence of the population they joined. It also notes that immigrant generation and how long a family has lived here affect risk.

The likely explanation is not ancestry alone. H. pylori infection is usually acquired in childhood, and it is far more common in some parts of the world than in others. Diet in early life and family patterns of infection travel with people as well.

What this means in Northern Virginia

Northern Virginia is one of the most international regions in the country. According to the Census Bureau's American Community Survey for 2020 to 2024:

• In Fairfax County, about 354,000 residents were born outside the United States. About 56,000 were born in Eastern Asia, including roughly 30,000 born in Korea and 23,000 born in China. About 58,000 were born in Central America and about 40,000 in South America, including roughly 13,000 born in Bolivia and 12,000 born in Peru.
• In Arlington County, about 7,000 residents were born in Eastern Asia, about 9,000 in Central America, and about 7,500 in South America.
• In the City of Alexandria, about 10,000 residents were born in Central America and about 3,000 in South America.

Not every country within those regions has a high rate of stomach cancer, and where a person was born says nothing certain about that person's health. What the numbers do say is that many of our neighbors belong to groups the gastroenterology societies describe as being at increased risk, and many have never been asked about it. The same is true of hepatitis B screening, which follows a similar pattern.

Stomach cancer risk factors

The American Cancer Society's list of stomach cancer risk factors opens with a caution that applies to everything below: many people with one or more risk factors never get cancer, and some people who do get cancer have few or no known risk factors.

H. pylori infection

H. pylori is a bacterium that lives in the stomach lining. The American Cancer Society calls it a major cause of stomach cancer, especially cancers in the lower part of the stomach. The American College of Gastroenterology describes it as the dominant risk factor for the most common form of stomach cancer and attributes 75% to 89% of those cancers to it.

Two points keep that in proportion. First, H. pylori is common, and the American Cancer Society states that most people who carry it never develop cancer. Second, it is treatable. The infection is also the leading cause of stomach ulcers, which our guide to peptic ulcers and H. pylori covers in detail.

Family history and inherited syndromes

People with a parent, sibling, or child who has had stomach cancer are more likely to develop it. The College's guideline cites observational studies showing a 2 to 10 times higher risk with a family history, which may reflect shared genes, shared H. pylori strains, shared diet, or all three. About 10% of people with stomach cancer have a family history of it.

A smaller share, roughly 1% to 3%, is tied to an inherited cancer syndrome. These include hereditary diffuse gastric cancer, which is most often caused by changes in the CDH1 gene, as well as Lynch syndrome and familial adenomatous polyposis, which are better known for their link to colon cancer. Our guide to family history and colon cancer screening explains those two syndromes. When a family history suggests an inherited syndrome, the guideline advises referral for genetic counseling.

Tobacco, diet, alcohol, and weight

According to the American Cancer Society:

• Smoking nearly doubles the risk of stomach cancer, particularly for cancers of the upper stomach near the esophagus.
• Foods preserved by salting, such as salted fish and meat and pickled vegetables, raise risk when eaten in large amounts. Regularly eating processed, grilled, or charbroiled meats appears to raise it as well.
• Eating little or no fruit likely raises risk, and eating plenty of fresh fruit appears to lower it.
• Alcohol probably raises risk, with the strongest evidence in people who have three or more drinks per day.
• Excess body weight is linked to cancers of the cardia, the upper part of the stomach next to the esophagus.

Cancers of the cardia behave more like cancers of the lower esophagus and share some of the same background as long-standing reflux. Our guides to GERD and acid reflux and Barrett's esophagus cover that territory.

Stomach conditions and prior surgery

Other risk factors on the American Cancer Society's list include previous surgery that removed part of the stomach, adenomatous stomach polyps, pernicious anemia, and a rare condition called Menetrier disease. Age and sex matter too: stomach cancer is more common in men, and most people diagnosed are in their 60s, 70s, or 80s.

How stomach cancer develops: the slow path from gastritis

The most common type of stomach cancer usually does not appear suddenly. The American College of Gastroenterology describes a sequence of changes in the stomach lining that typically unfolds over many years and causes no symptoms along the way:

• Chronic gastritis. Long-term inflammation of the stomach lining, most often from H. pylori. Our guide to gastritis explains the condition.
• Atrophic gastritis. The lining thins and loses some of its normal glands.
• Intestinal metaplasia. The cells that normally line the stomach are replaced by cells that resemble the lining of the intestine.
• Dysplasia. Cells look abnormal under the microscope. This is the step closest to cancer.

A report that mentions intestinal metaplasia can be alarming to read. The guideline offers perspective: for most people the overall risk of progression is low, similar to other precancerous findings such as Barrett's esophagus or low-risk colon polyps. Risk is higher when the change is more extensive, when it is a subtype called incomplete, or when there is a family history of stomach cancer. The guideline also reports that milder changes sometimes improve after H. pylori is treated.

This slow sequence is the reason prevention and early detection are possible at all. It is also why stomach conditions appear in our guide to digestive conditions that are often silent.

Stomach cancer symptoms and when to get checked

The American Cancer Society states that early stomach cancer often causes no symptoms. When signs and symptoms of stomach cancer do occur, they can include:

• Poor appetite
• Weight loss without trying
• Abdominal pain, or vague discomfort in the abdomen, usually above the navel
• Feeling full after eating only a small meal
• Heartburn or indigestion
• Nausea
• Vomiting, with or without blood
• Swelling or fluid build-up in the abdomen
• Blood in the stool, which may make the stool look dark brown or black
• Feeling tired or weak from anemia, meaning too few red blood cells

The American Cancer Society is direct about the context: most of these symptoms are more likely to be caused by something other than stomach cancer. Indigestion, reflux, ulcers, gastritis, and gallbladder problems are all far more common. The reason to have symptoms checked is that they persist or worsen, not that cancer is the likely answer.

Symptoms that should not wait

Some symptoms call for prompt evaluation whatever the cause turns out to be: unexplained weight loss, difficulty swallowing, persistent vomiting, black or bloody stools, vomiting blood, and iron deficiency anemia. Vomiting blood or passing black, tarry stools with lightheadedness is an emergency, and the right step is to call 911 or go to an emergency department. Our guide to when to see a gastroenterologist sorts symptoms by urgency.

Is there screening for stomach cancer in the United States

Screening means testing people who feel well. For colon cancer, the United States has a clear national screening recommendation. For stomach cancer, it does not, and the two main gastroenterology societies have recently described the situation in slightly different terms. Both documents were published in 2025.

People at average risk

The American College of Gastroenterology suggests against routine screening with upper endoscopy for stomach cancer in the general United States population. The American Cancer Society says the same: no major medical organization recommends routine screening for people who are not at increased risk, because the disease is uncommon here and the benefits would likely not outweigh the risks of extra tests and procedures.

People at increased risk

Here the two societies differ in emphasis, and it is fair to say so.

The American Gastroenterological Association's clinical practice update on screening and surveillance in people at increased risk for gastric cancer states that there are identifiable high-risk groups in the United States who should be considered for screening. It lists first-generation immigrants from regions with high stomach cancer incidence, and possibly other non-White racial and ethnic groups; people with a family history of stomach cancer in a first-degree relative; and people with certain hereditary polyposis or cancer syndromes. It describes endoscopy as the preferred test. The authors note that this document is expert advice drawn from the published literature and does not carry formal evidence ratings.

The American College of Gastroenterology reviewed the same question using a formal grading method and concluded that it could not make a recommendation for or against screening people considered high risk because of immigration history, race, or ethnicity. Its reason was the lack of direct studies in United States populations, not evidence that screening fails. The guideline adds that endoscopic screening and H. pylori treatment are considerations on an individual basis, with shared decision-making, for people at the highest risk. For a person with a parent, sibling, or child who had stomach cancer, it describes screening endoscopy as a consideration starting between ages 45 and 60, or 10 years before the age at which the youngest affected relative was diagnosed.

Screening in this context means endoscopy. The College suggests against using blood tests or other noninvasive markers to screen for stomach cancer in the United States.

What the evidence from other countries shows

Much of the support for screening comes from East Asia, where stomach cancer is common enough that national programs exist. The College's guideline summarizes that evidence. In South Korea's national program, organized screening of adults 40 and older was associated with 47% lower stomach cancer mortality than no screening. A pooled analysis of studies from Asian countries found about 40% lower mortality with endoscopic screening. Screening did not reduce the number of cancers. It found them earlier, when treatment works far better.

Stage at diagnosis is the heart of the matter. SEER data for 2016 to 2022 show that about 32% of stomach cancers in the United States are found while still confined to the stomach, where five-year relative survival is 78.1%. About 35% are found after the cancer has spread to distant parts of the body, where it is 8.1%. Survival figures describe large groups and cannot predict what will happen for any one person.

When screening is not the right choice

The American Gastroenterological Association also says who should not be screened: in general, only people who are fit for endoscopic or surgical treatment should be screened or kept under surveillance. Upper endoscopy is a low-risk procedure, but it does carry some risk, and insurance coverage for an endoscopy done purely for screening is not well defined. Our guide to upper endoscopy cost explains how billing works.

H. pylori testing and stomach cancer prevention

Treating H. pylori is the step with the firmest evidence behind it. The College's guideline cites a pooled analysis of 22 studies in which clearing the infection was associated with a 46% lower incidence of stomach cancer and 39% lower mortality from it, over follow-up periods of 4 to 22 years.

The American Gastroenterological Association advises that testing for H. pylori be considered in people at increased risk for stomach cancer, and in adult household members of anyone who tests positive, because the infection tends to cluster in families. The College recommends treating the infection in everyone found to have precancerous stomach changes and then confirming that the treatment worked.

Testing is simple. A breath test or a stool test can detect an active infection without a procedure, and biopsies can do so during an endoscopy. Our guide to breath testing explains how the H. pylori breath test works. Treatment generally combines acid suppression with two or more antibiotics for 14 days, and a follow-up test confirms the result. Which test fits a given person is a clinical decision, particularly for someone with symptoms or a family history of stomach cancer, where an endoscopy may answer more questions at once.

Other steps that may lower risk

The American Cancer Society says there is no sure way to prevent stomach cancer. Not smoking, limiting alcohol, staying at a healthy weight, being physically active, and eating less salt-preserved food and more fresh fruit are all reasonable steps with other health benefits. Regular aspirin or anti-inflammatory use is not advised for this purpose: the College suggests against it for people with precancerous stomach changes, and these medications can cause serious bleeding.

What an upper endoscopy looks for

An upper endoscopy, also called an EGD, uses a thin flexible camera passed through the mouth to examine the esophagus, the stomach, and the first part of the small intestine. In most cases it is done with sedation, and the exam itself often takes about 15 to 30 minutes.

When the question is stomach cancer risk, both societies stress that the quality of the exam matters. Their recommendations call for a high-definition scope, a stomach that has been cleaned of mucus and gently inflated so the folds flatten, enough time spent looking, and photographs of each region. They also call for biopsies taken in a set pattern, with at least five samples from defined areas of the stomach, with samples from the lower and upper stomach sent separately. That lets the pathologist report not only whether intestinal metaplasia is present, but where it is, how much there is, and which subtype.

If intestinal metaplasia or atrophic gastritis is found

Follow-up depends on the details, and this is where the two 2025 documents line up closely.

• Higher-risk findings. The American College of Gastroenterology suggests a repeat endoscopy every three years for people with intestinal metaplasia who also have a higher-risk feature: the incomplete subtype, involvement of the upper stomach as well as the lower, a first-degree relative with stomach cancer, birth in a high-incidence country, or a higher-risk racial or ethnic background. It suggests the same interval for moderate to severe changes. The American Gastroenterological Association likewise advises considering surveillance every three years.
• Lower-risk findings. For mild changes limited to the lower stomach, of the complete subtype, in a person with none of those risk factors, the College suggests against routine surveillance.
• Dysplasia. Both societies advise that dysplasia be confirmed by a pathologist experienced in gastrointestinal disease and that patients be referred to a center with expertise in diagnosing and removing early stomach tumors. The guideline notes that early cancers that have not grown deep into the stomach wall can be removed through an endoscope at such centers, with five-year survival above 95% in the data it cites.
• H. pylori. In every case, an active infection is treated and the result confirmed.

Both documents describe these intervals as not yet well defined and expect them to be refined as more United States data accumulate. A person with several risk factors may be advised to return sooner.

How to prepare for a conversation about stomach cancer risk

A discussion about stomach cancer risk goes further when a few facts are on hand:

• Family history. Which relatives had stomach cancer and how old they were at diagnosis. Stomach, colon, uterine, and breast cancers in the same family are worth mentioning together.
• Where you and your parents were born, and roughly how long you lived there.
• H. pylori history. Whether you or anyone in your household has tested positive, whether it was treated, and whether a follow-up test confirmed it was gone.
• Prior endoscopy and pathology reports, especially any that mention gastritis, atrophy, or intestinal metaplasia.
• Current symptoms and medications, including acid reducers, aspirin, and anti-inflammatory pain relievers.

Questions that often help: Given my background and family history, am I at higher risk than average? Should I be tested for H. pylori, and by which method? Would an upper endoscopy be reasonable for me, and what would it cost? If I have had an endoscopy before, were biopsies taken, and what did they show? If I am due for a colonoscopy, does it make sense to discuss my stomach at the same visit?

Evaluation for stomach cancer risk in Northern Virginia with GC of NoVA

Gastroenterology Center of Northern Virginia cares for adults across Arlington, Annandale, and the surrounding communities, including many families with roots in parts of the world where stomach cancer is more common. Our physicians evaluate upper digestive symptoms, test for and treat H. pylori, perform upper endoscopy, and review prior pathology reports to help patients understand what a finding such as intestinal metaplasia means for them. When a finding calls for specialized treatment, we coordinate referral to a center with that expertise. We see patients at our Arlington office, next to VHC Health, and our Annandale office, in the Woodburn Medical complex.

If this is your first visit, our guide to your first gastroenterologist visit explains what to bring. To schedule a consultation, contact our Arlington office at (703) 522-7476 or our Annandale office at (703) 560-6106, or learn more at gcofnova.com.

This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.