In a groundbreaking global study published in BMC Cancer, researchers have illuminated the shifting landscape of early-onset gastric cancer (EOGC), an insidious form of stomach cancer primarily affecting individuals between the ages of 15 and 49. Despite an overall worldwide decline in gastric cancer cases over recent decades, this investigation reveals complex dynamics, with notable geographical disparities and evolving risk factors that challenge conventional wisdom. By evaluating data from 1990 through 2021 and projecting trends through 2035, the study provides a sobering yet critical glimpse into the burden of EOGC on public health.
Gastric cancer has long been recognized as a major cause of cancer mortality globally, yet early-onset cases—those occurring before the age of 50—have distinct clinical and pathological characteristics. Unlike traditional gastric cancer, which tends to afflict older populations and is often linked to long-term Helicobacter pylori infection and chronic gastritis, EOGC appears to follow a divergent etiological pathway. As such, this study sought to dissect the epidemiology of EOGC utilizing extensive datasets from the Global Burden of Disease (GBD) 2021 study, employing advanced statistical frameworks to uncover trends and forecast future patterns.
To meticulously quantify the burden of EOGC, researchers analyzed age-standardized incidence rates (ASIR), mortality rates (ASMR), and disability-adjusted life years (DALYs) per 100,000 population. These metrics provide an age-adjusted lens crucial for meaningful comparisons across regions with diverse demographic structures. Employing estimated annual percentage change (EAPC) to gauge temporal trends allowed for a nuanced understanding of whether these burdens are rising or falling over time. Complementing this, a Bayesian age-period-cohort model facilitated robust projections extending to 2035, integrating historical data with statistically informed predictions about future disease trajectories.
The global results paint a cautiously optimistic picture: the ASIR of EOGC declined from 5.40 per 100,000 in 1990 to 3.17 per 100,000 in 2021, with a statistically significant negative EAPC of -1.8. Mortality and disability measures displayed similar downward trajectories, with ASMR dropping from 2.00 to 1.31 and ASDR from 97.73 to 63.98 over the same period. These decreases reflect advances in public health, diagnostics, and treatment modalities. Nonetheless, the absolute burden remains high, emphasizing the ongoing public health challenge presented by EOGC.
A striking aspect of the research is the pronounced geographical heterogeneity in EOGC burden. East Asia, in particular, exhibits the highest age-standardized rates across incidence, mortality, and disability metrics. This disproportionate concentration suggests region-specific risk factors, genetic predispositions, or environmental exposures that merit deeper investigation. Conversely, regions with higher Socio-demographic Index (SDI) values—essentially proxies for economic and social development—have experienced more marked declines in EOGC burden, suggesting that improvements in healthcare infrastructure and lifestyle changes may play a protective role.
Notably, this study sheds light on lifestyle factors that significantly influence EOGC risk. High intake of sodium and tobacco smoking emerge as critical modifiable risks. High-sodium diets, often linked to processed and preserved foods prevalent in certain cultures, can induce chronic gastric inflammation, potentiating carcinogenesis. Smoking is well-documented as a carcinogen for multiple cancers, including gastric cancer, due to its role in promoting DNA damage and impairing immune surveillance. Targeting these risk behaviors presents an actionable pathway for reducing EOGC incidence, especially in vulnerable populations.
While global trends offer promise, projections paint a complex future. The Bayesian modeling anticipates a continued decline in ASIR, ASMR, and ASDR related to EOGC through 2035 on a global scale. Yet, this optimistic forecast must be interpreted with caution given the persistence of high burden in certain geographic areas and socioeconomic strata. The interplay between ongoing demographic transitions, urbanization, dietary changes, and healthcare access will determine the ultimate trajectory, underscoring the need for region-tailored strategies.
The study’s robust methodological approach leverages comprehensive, population-based data, reinforcing the credibility of its conclusions. By dissecting temporal patterns, the analysis distinguishes age-related, cohort-specific, and period-specific effects, illuminating how exposure to risk factors and healthcare improvements evolve across generations. This multifaceted statistical analysis enhances the granularity of insights into EOGC trends and aids policymakers in prioritizing interventions.
Despite notable advances, the research highlights gaps requiring urgent attention. The persistent high burden in low- and middle-income countries points to disparities in screening, early detection, and access to effective therapies. Enhanced surveillance systems, capacity building in oncology care, and public health campaigns tailored to local cultural contexts are essential to mitigate these disparities. Moreover, understanding genetic susceptibilities unique to EOGC may unlock avenues for precision medicine and targeted prevention.
The investigators advocate for future research emphasizing identification of additional risk factors beyond sodium consumption and smoking. Emerging evidence suggests a complex interplay involving Helicobacter pylori strains, microbiome composition, autoimmune gastritis, and potential environmental carcinogens. Large, prospective cohort studies and molecular epidemiology investigations will be pivotal in unraveling these multifactorial determinants. Integrating genomics with population health data promises to transform our understanding of EOGC pathogenesis.
Importantly, prevention strategies must extend beyond individual behavior modification to encompass structural interventions. Policies promoting healthy diets, reducing sodium content in processed foods, and controlling tobacco use through taxation and public awareness have profound implications. Investments in healthcare equity, including neighborhood-level access to screening and treatment, are critical for altering the course of EOGC burden globally.
This comprehensive study also underscores the value of international collaborations and standardized data collection in cancer epidemiology. The Global Burden of Disease framework exemplifies how harmonized metrics enable comparisons and benchmarking of cancer trends worldwide. Such evidence-based insights guide resource allocation and inspire concerted global health initiatives, including those aligned with the World Health Organization’s cancer control targets.
The nuanced depiction of the complex and evolving landscape of EOGC burden provided by this study challenges complacency. Although gradual declines in incidence and mortality kindle hope, the continued high absolute numbers and marked regional disparities demand sustained vigilance. Tailored clinical protocols and culturally sensitive public health measures are indispensable. By directing attention to this younger demographic affected by a traditionally older-onset malignancy, the research galvanizes a critical recalibration of gastric cancer control efforts.
In conclusion, this seminal investigation navigates the intricate epidemiology of early-onset gastric cancer through sophisticated methodologies and a global lens. It elevates awareness of EOGC’s distinct features and future challenges, paving the way for enhanced surveillance, preventive measures, and therapeutic innovation. As the world advances toward 2035, addressing the multifaceted burden of EOGC will be essential to reduce morbidity and mortality effectively, particularly within vulnerable populations bearing disproportionate risk.
Subject of Research: Epidemiology and burden of early-onset gastric cancer (EOGC) in individuals aged 15–49 years, including incidence, mortality, and disability trends from 1990 to 2021, with projections to 2035.
Article Title: Global, regional, and national burdens of early onset gastric cancer aged 15–49 years from 1990 to 2021 with projections to 2035: a population-based study
Article References:
Lu, Y., Wu, J., Yang, T. et al. Global, regional, and national burdens of early onset gastric cancer aged 15–49 years from 1990 to 2021 with projections to 2035: a population-based study. BMC Cancer 25, 1533 (2025). https://doi.org/10.1186/s12885-025-15056-1
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