Gastric cancer is the world’s fifth most common cause of cancer-related deaths globally, which occurs due to Helicobacter pylori (H. pylori) infection. It is typically treated with proton pump inhibitors and antibiotic medicines. A recent global study projected the future burden of gastric cancer across 185 countries, focusing on individuals born during the period from 2008 to 2017. These birth cohorts are expected to account for approximately 15.6 million lifetime cases of gastric cancer, with H. pylori infection present in 76% of these cases.
In 2013, the International Agency for Research on Cancer (IARC) under the World Health Organization (WHO) conducted a campaign examining national efforts to implement population-based H. pylori screening and treatment programs. The United Nations (UN) Development Programme is classified into four tiers based on the Human Development Index (HDI) into four levels: low, middle, high, and very high levels.
Researchers used pre-diagnostic samples with long-term follow-up to determine the relative risk of gastric cancer associated with H. pylori. They applied estimates from previous studies to detect infections occurring at least 10 years before the diagnosis of cancer. This allowed for an accurate calculation of the proportion of gastric cancer cases attributable to chronic infection.
Age group-specific contributions were added to determine the cumulative incidence between the age groups of 5 to 14 years in 2022 till they complete their 84 years of age, which assumes age group-specific incidence rates were constant across birth cohorts. The project disease burden in Asia and Latin America is estimated to be two to six times higher than the current levels. In contrast, the future burden in an average single birth cohort is six times higher than in most of sub-Saharan Africa, where incidence remains low.
The projected number of cases was estimated to be 38.2% lower or 66.5% higher under the scenarios of −3% or 3% annual increases or declines in noncardiac gastric cancer (NCGC) incidence rates over the next 20-year period. In Africa and Oceania countries, life expectancy significantly influences the expected number of stomach cancer cases as compared to other regions, due to the large impact of using the lower or higher 95% confidence interval in UN mortality predictions.
Under the Health Flagship Project, Bhutan successfully completed time-bound national programs for the prevention of gastric cancer in 2023. These programs included a population-based H. pylori screen-and-treat program for individuals aged between 18 and 75 years and a population-based endoscopic screening for precancerous lesions for those aged between 40 and 75 years. In Africa, despite the high prevalence of H. pylori infection, there are no recognized population-based strategies available for preventing stomach cancer.
Countries with very low incidence rates are supposed to keep more than one-fourth of the future global burden. A large-scale community-based H. pylori elimination trial in China shows promise as an effective public health strategy for stomach cancer prevention. Researchers observed the burden of H. pylori infection to evaluate the regional and national burden of gastric cancer. Finally, the study highlights the urgent need for increased funding and greater attention to prevention, particularly targeting youth. It stresses the importance of early intervention, lifestyle education, and proactive screening, regardless of access to current therapies.
Reference: Park JY, Georges D, Alberts CJ, et al. Global lifetime estimates of expected and preventable gastric cancers across 185 countries. Nat Med. 2025. doi:10.1038/s41591-025-03793-6
