Global study reveals disparities in early-onset gastric cancer

Gastric cancer remains the fifth leading cause of cancer-related deaths worldwide. Although its overall incidence has declined, early-onset cases—diagnosed before age 50—display unique biological and clinical patterns. These include diffuse histologic features, signet ring cell predominance, and poor prognosis. Environmental and lifestyle exposures, such as Helicobacter pylori infection, smoking, and high-salt diets, are known contributors. However, previous global studies have rarely focused exclusively on early-onset gastric cancer(EOGC). Due to these challenges, it is necessary to conduct in-depth research on the global distribution, risk factors, and future trends of EOGC to inform effective prevention

A research team from Chongqing Medical University, China, published (DOI: 10.20892/j.issn.2095-3941.2025.0320) their findings in Cancer Biology & Medicine, presenting the first comprehensive global analysis of EOGC from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data. The study revealed that, despite a 2.9% annual decline in global mortality, inequalities between high- and low-income regions are widening. Smoking and high-salt diets were identified as the main risk factors, accounting for 7.1% and 7.7% of disability-adjusted life years (DALYs), respectively.

The study analyzed 371 diseases across 204 countries to assess the global burden of EOGC using Bayesian age-period-cohort modeling and joinpoint regression. In 2021, approximately 125,000 new EOGC cases, 78,000 deaths, and 3.86 million DALYs were recorded worldwide. The incidence peaked in individuals aged 45-49 years, with males showing higher prevalence, while females under 30 exhibited greater mortality risk. The age-standardized incidence and mortality rates both declined globally between 1990 and 2021, especially in East Asia and Europe. However, several sub-Saharan African countries experienced rising rates.

Smoking accounted for more than 10% of DALYs in East Asia and Central Europe, while high-salt diets showed consistent impact worldwide. Disparities were strongly linked to socioeconomic development: high-income regions achieved steady reductions through screening and health education, while low-income regions faced growing burdens due to limited healthcare access and population growth. Projections suggest a continued global decline through 2040.

EOGC poses a complex challenge because it affects individuals during their most productive years. Our findings show that preventive measures such as smoking control, salt reduction, and H. pylori eradication can significantly lower the disease burden. However, these strategies must be tailored to local conditions. In low-resource settings, strengthening healthcare infrastructure and expanding screening access are critical steps toward reducing disparities."

Wei Wang, corresponding author, Chongqing Medical University

The study underscores the importance of integrating lifestyle modification, early detection, and public health policy to address EOGC globally. High-risk regions such as East Asia should promote dietary interventions and early endoscopic screening, while low-income areas require investment in healthcare systems and public awareness programs. Tobacco taxation, food labeling, and salt reduction campaigns could further reduce exposure to key risk factors. Future research combining epidemiological data with genomic and environmental monitoring will help identify susceptible populations and optimize precision prevention strategies against EOGC.