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In 2012, cancer of the stomach had an expected incidence in the United States of 21,320 cases and an expected number of 10,540 deaths.1 Age-adjusted gastric cancer death rates have decreased markedly in the United States since 1930 from approximately 28 to 2.3 in 100,000 women and from 38 to 5.2 in 100,000 men. Of the 45 countries in which age-adjusted death rates for gastric cancer were compared for 2000 (E-Fig. 75-1), the United States ranked 45th for both men and women.2 Kyrgyzstan ranked first for both men (47.0 in 100,000) and women (18.9 in 100,000).
The causes of the decline in the U.S. rates are incompletely understood, but environmental factors, chiefly dietary, are suspected. Within the United States the lowest incidence is in whites, Chinese, and Filipinos, with a higher incidence in U.S. Japanese. However, epidemiologists have noted a significant decrease in incidence among migrants from high-incidence countries (such as Japan and Chile) to low-incidence countries. Although there is an overall reduction in gastric cancer incidence, there has been a steady rapid increase in the incidence of gastroesophageal junction (GEJ) and proximal gastric cancers.