Gastric cancer remains a formidable health issue worldwide, marked by high incidence and mortality rates despite numerous advances in diagnosis and treatment.

This malignancy continues to claim hundreds of thousands of lives annually, posing significant challenges to public health systems globally.

<h3>Global Incidence and Mortality Patterns</h3>

According to recent global cancer statistics, over one million new cases of gastric cancer were reported in 2020, with an estimated 769,000 deaths attributed to this disease. These numbers highlight a substantial mortality rate relative to incidence, reflecting the often late-stage diagnosis and aggressive nature of the disease.

Projections indicate that while some countries have seen a gradual decline in age-standardized incidence and mortality rates over the past decade, the absolute number of cases is expected to rise due to aging and population growth, particularly in regions like sub-Saharan Africa where gastric cancer incidence is predicted to increase sharply.

<h3>Types and Etiology of Gastric Cancer</h3>

Gastric cancer includes various types based on tumor location and histology, notably classified into non-cardia and cardia cancers. Non-cardia gastric cancer, occurring in the distal stomach, associates predominantly with chronic infections by Helicobacter pylori (H. pylori), which is recognized as the leading carcinogenic factor worldwide.

Nearly 90% of distal gastric cancers are linked to this infection, which induces chronic inflammation, leading to precancerous changes in the stomach lining.

In contrast, cardia gastric cancer arises near the junction between the stomach and esophagus and is more frequently associated with obesity and gastroesophageal reflux disease, especially in Western populations. This dichotomy underscores that gastric cancer is not a uniform entity but a spectrum influenced by divergent risk profiles requiring tailored prevention approaches.

<h3>Key Risk Factors Influencing the Disease Burden</h3>

H. pylori infection stands as the dominant modifiable risk factor globally, classified by global health organization as a Class I carcinogen. Beyond infection, lifestyle factors significantly impact risk. These include excessive consumption of salt-preserved and processed foods, low intake of fresh fruits and vegetables.

Dietary improvements, particularly through better food storage and refrigeration, have contributed to declining cancer rates in some countries.

<h3>Advances in Prevention and Control</h3>

Effectively combating gastric cancer demands comprehensive strategies targeting its root causes. Eradication of H. pylori infection through antibiotic treatment is recognized as a potent preventive intervention, particularly in high-risk populations. Screening programs using endoscopy have shown promise in early detection, significantly improving prognosis when pre-cancerous or early-stage lesions are identified.

Dr. Josep Tabernero, a leading expert in gastrointestinal (GI) cancers, states "Complete surgical resection is the cornerstone of treatment for localized gastric or gastroesophageal junction cancer. In most Western countries, the FLOT three-drug chemotherapy regimen is the standard-of-care for this patient population, given before and after surgery."

Gastric cancer continues to be a significant global health burden characterized by complex epidemiology and diverse etiologies. The interplay of chronic H. pylori infection, lifestyle factors, and demographic changes shapes the persistent challenge this disease presents.

Although progress in understanding risk factors and preventive measures has led to declines in some regions, the overall incidence remains high, with projections indicating growing numbers in several parts of the world.

Addressing this disease's burden requires coordinated global efforts prioritizing prevention, early diagnosis, and equitable access to effective treatment. With the majority of cases linked to potentially preventable causes, gastric cancer stands as a critical target for impactful cancer control interventions in global health.