Migration-Informed Strategies for Gastric Cancer Prevention in the United States: Closing the Equity Gap

Abstract

Gastric cancer remains an overlooked source of inequity in U.S. cancer prevention policy. Immigrant and underserved populations from East Asia, Eastern Europe, Latin America, and other high-incidence regions face markedly elevated rates of non-cardia gastric adenocarcinoma, yet remain outside the scope of national screening and eradication programs. This commentary calls for a migration-informed approach to gastric cancer prevention, emphasizing early-life Helicobacter pylori exposure, structural inequities, and the policy inertia that sustains avoidable disparities. Drawing on lessons from hepatitis B and colorectal cancer prevention, a multisectoral framework—linking academic centers, community organizations, and federal policy—can operationalize targeted testing, awareness, and surveillance. The recently introduced Stomach Cancer Prevention and Early Detection Act represents a historic step toward national recognition of gastric cancer as a preventable disease of equity concern. By reframing gastric cancer through a structural and immigrant health lens, the United States can begin to align research, funding, and prevention infrastructure with the populations most affected.

Plain Language Summary

Stomach cancer is one of the few cancers in the United States that still causes many deaths but receives very little attention. While the overall numbers are lower than in some countries, the burden is not shared equally. People who were born in or whose families come from East Asia, Eastern Europe, Latin America, and other high-risk regions face a much greater chance of developing stomach cancer than most Americans. These differences are linked to early-life exposure to a common infection called Helicobacter pylori (H. pylori), as well as differences in access to care, awareness, and prevention services. Unlike other preventable cancers—such as colon or cervical cancer—the United States does not yet have a national plan for stomach cancer screening or H. pylori testing. As a result, many people are diagnosed too late, when treatment is harder and survival is lower. Countries like Japan and Korea have shown that early detection and H. pylori eradication can dramatically reduce deaths from stomach cancer. This article calls for a fairer, “migration-informed” approach to prevention and early detection in the United States. It highlights the importance of building partnerships between doctors, community organizations, and policymakers to reach high-risk groups with culturally and linguistically appropriate education and screening. It also supports new legislation, the Stomach Cancer Prevention and Early Detection Act, which would help the country take the first steps toward a national strategy. By recognizing stomach cancer as a disease of inequity—and treating prevention as a matter of fairness—the United States can save lives and ensure that every community has access to early detection and treatment.

Gastric cancer, most commonly non-cardia adenocarcinoma, arises through multiple pathways—most frequently chronic Helicobacter pylori infection leading to atrophic gastritis and intestinal metaplasia—and is the fifth most common cancer worldwide and the fourth leading cause of cancer-related death.^1,2 In the United States, an estimated 30 300 new cases and 10 780 deaths are expected in 2025, with a 5-year relative survival rate of 37.9%—still among the lowest of all major cancers. ³ Recent analyses reveal striking geographic and ethnic disparities, with disease burden disproportionately affecting immigrant populations from East Asia, Latin America, and Eastern Europe.^4,5 These inequities reflect not race but early-life H. pylori exposure, migration history, and persistent barriers to timely care.^4,6 Despite being a largely preventable, infection-associated cancer, gastric cancer receives the lowest federal research investment among major malignancies, ⁷ and no national strategy exists for early detection or H. pylori eradication ⁸ —highlighting its neglect as a major public-health equity issue.

The United States has the tools—but not the infrastructure—to treat gastric cancer as a preventable disease. Lessons from hepatitis B elimination efforts and colorectal cancer screening show the power of combining community outreach, policy change, and clinical engagement.^9,10 A similar framework for gastric cancer is long overdue. Recent policy attention, including the bipartisan Stomach Cancer Prevention and Early Detection Act, ¹¹ signals growing recognition of this gap. By aligning public health, academic, advocacy, and policy stakeholders, the U.S. could begin treating gastric cancer not as a niche concern but as an urgent issue of equity.

These disparities are further reflected across age, geography, and ancestry. Certain Asian American groups over age 50 face gastric cancer incidence rates up to 14.5 times higher than NHWs. ¹² Black and Indigenous Americans, underserved NHWs in rural areas, and immigrant communities from high-incidence regions also bear disproportionate risk.^4,5,12,13 Adding urgency, early-onset gastric cancer is rising among younger adults across racial and ethnic groups. ¹⁴ Moreover, survival in the United States remains far lower than in countries such as Japan and Korea, where population-based screening and eradication programs have raised 5-year survival to more than 70%. ¹⁵ This gap underscores the consequences of missed opportunities for early detection in the U.S.

These gaps are reinforced by structural inequities in funding and policy. When examined using the “funding-to-lethality” ratio, cancers common among NHWs, such as breast cancer and leukemia, receive exponentially more investment than cancers disproportionately affecting immigrant and minority groups. ⁷ Even where expert reviews recommend targeted H. pylori testing and treatment in high-risk groups, implementation falters. Insurance coverage is inconsistent, provider awareness is limited, and culturally tailored outreach remains rare. ⁸ Many high-risk individuals remain unaware of their susceptibility, while frontline clinicians often lack migration-informed frameworks for identifying risk.^4,5

Addressing this inequity requires a coordinated prevention agenda. Academic centers can play a central role by generating evidence, shaping guidelines, and training providers in risk-informed care, while community-based organizations bring the cultural and linguistic insight needed to reach immigrant populations. Emerging academic–community partnerships already demonstrate how migration-informed frameworks for prevention and screening can be operationalized in the U.S. context. ¹⁶ Legislative action, such as the Stomach Cancer Prevention and Early Detection Act, ¹¹ offers a path toward national prioritization by mandating federal review of incidence, prevention, and awareness strategies. The symbolism of this bill is as significant as its content: it acknowledges gastric cancer as a preventable disease that disproportionately affects underserved populations and could catalyze new investment in prevention, education, and outreach. Targeted research is also needed, including the development of migration-informed risk models that integrate biological, social, and environmental determinants, and the evaluation of community-based H. pylori testing strategies in high-risk populations. Together, such efforts would generate the evidence base necessary for sustainable policy change.

Ultimately, gastric cancer must be recognized not only as a clinical condition but as a health-equity issue shaped by structural and social determinants. Sustained collaboration across clinical, community, and policy spheres—guided by evidence, equity, and engagement—will be essential to align national priorities with the populations most affected and to translate recognition into action.