Chul S. Hyun, MD, PhD, MPH
Gastric Cancer and Prevention Screening Program, Yale School of Medicine, New Haven, CT 

Gastric cancer is the fifth most common cancer worldwide, with around 1.1 million new cases in 2020 and is one of the leading causes of cancer-related deaths (1). A significant portion of gastric cancer cases arises in Asia, followed by regions such as Latin America, Europe, and other areas. Despite the high incidence, the five-year survival rate remains low, only about 20%, which signals an urgent global health concern (2,3,4). Projections suggest a sharp increase in both incidence and mortality by 2040, making screening and prevention critical components of cancer control efforts (5).

Gastric Cancer In the US

The incidence of gastric cancer in the US varies significantly between different ethnicities and races. For instance, the incidence is substantially higher in specific minority populations than in Non-Hispanic Whites (NHW) The highest number of cases of gastric cancer in the US occurs among Asian and Hispanic Americans (6,7). Looking at the subjects aged 50 and older, the incidence of NCGC (Non-Cardia GC- the predominant form of GC) was at least 1.8-fold to 7.3-fold higher in non-white groups than in NHW. Compared to NHW, the incidence of NCGC was as much as 14.5-fold higher in Korean American men and women (8). 

Based on the Surveillance, Epidemiology, and End Results (SEER) data from 2012 to 2018, the five-year survival rate for gastric cancer in the U.S. is a low 33% (9). Mortality rates vary across ethnic groups, with specific Asian and Black populations experiencing the highest death rates, while NHW have the lowest (6). Significant disparities remain, emphasizing the uneven burden of gastric cancer among racial and ethnic groups in the U.S. (10,11).

Despite concerning statistics, there is no established system in the U.S. to screen high-risk populations for gastric cancer. The mechanisms that make these minority populations so vulnerable must be understood to overcome the barriers responsible for these disparities. (6,11).

Cancer Funding Disparity

A significant factor in the disparity is the lack of federal funding for gastric cancer research. While gastric cancer claims many lives, it receives significantly less funding compared to other cancers. A study revealed that gastric cancer only receives $13.2 million annually, compared to breast cancer’s $542.2 million. This funding gap is reflected in the Funding-to-Lethality (FTL) score, which quantifies funding in relation to a cancer’s mortality rate. Gastric cancer’s FTL score is just 1.78, compared to breast cancer’s 179.65, highlighting a 100-fold difference. This funding disparity leaves cancers that predominantly affect minority populations, such as gastric cancer, uterine, and liver cancers, underfunded and under-researched (12,13).

Overcoming the Barriers: Lessons from Hepatitis B

Gastric cancer disparities mirror other health issues among minority populations, like chronic hepatitis B (CHB), a significant cause of liver cancer and cirrhosis. The prevalence of CHB varies across ethnic groups: 5–10% of Asian Americans are affected, compared to only 0.2% of NHW (14,15). CHB has been both underdiagnosed and undertreated (16). Barriers to care include a lack of awareness, language and cultural differences, and financial constraints (17,18). U.S. public health systems are often unprepared to serve diverse populations (19,20). Despite extensive documentation of CHB in immigrant populations, the U.S. Preventive Services Task Force (USPSTF) did not issue a grade B recommendation for screening high-risk individuals until 2014 (21).

Stomach Cancer Task Force (SCTF)

Addressing health disparities in minority populations requires a multifaceted approach. Socioeconomic, cultural, and linguistic barriers complicate access to care, making it essential to understand these obstacles before offering solutions. Beyond education and raising awareness among the public and healthcare professionals, other strategies are needed to tackle these disparities.

The Stomach Cancer Task Force (SCTF) exemplifies this grassroots approach, concentrating on high-risk populations. By working at the intersection of community outreach, healthcare education, and policy advocacy, SCTF is uniquely positioned to address these disparities. A recent milestone, the introduction of the “Stomach Cancer Prevention and Early Detection Act” in collaboration with Congresswoman Caraveo, exemplifies the power of advocacy in influencing healthcare policies.

To further its mission, SCTF collaborates with communities, academic institutions, and organizations like Yale’s Gastric Cancer Prevention and Screening Program, Hope for Stomach Cancer, and Debbie’s Dream Foundation. These partnerships amplify SCTF’s impact through research, policy advocacy, and community outreach. By pushing for policy changes, expanding outreach, and engaging with healthcare professionals, SCTF is building a future where gastric cancer prevention and early detection are accessible to at-risk populations, particularly the most vulnerable.