Asian Americans and Their Unique Stomach Cancer Burden

Asian Americans and Their Unique Stomach Cancer Burden

Stomach cancer disproportionately affects Asian Americans. Find out why, and how to reduce your risk.
Asian Americans and Their Unique Stomach Cancer Burden
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Stomach cancer is a disease that disproportionately affects Asian Americans

 — and this is especially true for Korean, Japanese, and Chinese Americans.

“The compiled data [on Asian Americans] that comes out on [the cancer statistics database] SEER [Surveillance, Epidemiology, and End Results] does not do justice to the health inequity that exists,” says Yanghee Woo, MD, a surgical oncologist and the director of the gastroenterology minimally invasive therapy program at City of Hope, a cancer research and treatment organization.

According to the California Cancer Registry, Asians have the highest risk of developing stomach cancer within their lifetime of all racial groups, with a 1.90 percent risk of diagnosis, compared with a 0.78 percent risk for white people.

Dr. Woo says this risk can vary a lot depending on a person's ethnicity. In a study published in 2015 that looked at cancer rates from 1988 to 2011, a team of researchers found that while the number of Filipino American men who were newly diagnosed with stomach cancer was around 6 in 100,000 people, for Korean American men it was around 43 in 100,000 people. In comparison, white American men had a rate of about 7 in 100,000.

“So treating all of us the same in cancer care is not right,” Woo says.

Stomach Cancer Is Usually Caused by Bacteria

Besides being Asian, the biggest risk factor for stomach cancer is exposure to a type of bacteria called Helicobacter pylori, also known as H. pylori, says Robert Huang, MD, a gastroenterologist and an assistant professor of medicine at Stanford Health Care in California.

H. pylori is incredibly common, with researchers estimating that it’s present in about half the world’s population, though its prevalence has declined somewhat over time.

 Many people get H. pylori infection in childhood, and there are often no signs or symptoms of having it, sometimes for years.

It’s often unclear how an H. pylori infection happens, but transmission methods include drinking contaminated water or eating food that hasn’t been prepared properly. It can also be passed through saliva, or on hands that weren’t washed thoroughly after using the bathroom.

H. pylori is sort of endemic in some developing countries,” Woo says. “You can have it when you're a child, and it can stay in your stomach. There are bacteria that hide in the [lining] of the stomach, and it starts to create changes in the stomach over the course of time.”

Woo says H. pylori is easy to detect though, and doctors have several different detection methods. There’s a breath test, which checks for carbon after you drink a special fluid. A stool sample can be sent to a lab and checked for bacteria. An upper endoscopy test, which Woo calls the “gold standard screening tool for gastric cancer,” is when a flexible tube is inserted down the throat and into the stomach. A small tissue sample is then taken and tested for H. pylori.

While H. pylori is very common, Dr. Huang says it’s also simple to deal with once it’s detected.

“We can very easily treat this infection with a course of oral antibiotics taken over a two-week period,” Huang says. “If we could just get Asians tested for this infection, then we could potentially prevent a lot of [stomach] cancers.”

Diet Affects Stomach Cancer Risk

Though H. pylori is the biggest determinant, there are other risk factors that make Asian Americans more susceptible to stomach cancer — and Woo says they often work in combination.

Poor eating habits is one. In particular, a diet that’s low in fruits, vegetables, and fiber, and high in salty, charred, fried, and processed foods puts you at a higher risk. So does eating a lot of kimchi, which has been linked to stomach cancer.

 Woo says this is probably because kimchi is prepared with a lot of salt.
Other risk factors include smoking and drinking in excess. “[These factors] cause stress and inflammation in the stomach lining, which, over the course of a very long time, can turn into stomach cancer,” Woo says. According to a 2022 study, chronic inflammation can act as a “gateway” for cancer because it provides the “perfect environment” for malignant cells to grow.

 Studies show that the highest rates of heavy and risky drinking are in East Asian countries compared with others around the world.

Finally, family history does matter. According to the American Cancer Society, people with first-degree relatives (like parents or siblings) who have had stomach cancer are more likely to develop the disease.

Symptoms of Stomach Cancer

Many people with stomach cancer have no symptoms until it has advanced to a later stage.

 “You can be asymptomatic even with fairly advanced stage stomach cancer,” Woo says. “Or the symptoms may be mild.”
For those who do experience them, early symptoms of stomach cancer may include belly pain, bloating, indigestion, and nausea.

 On their own, these symptoms are usually nothing to worry about, but they become concerning when they last months rather than hours or days.

“I have many patients in their thirties and forties, and some as young as 21, who come in and their symptoms have been completely ignored,” Woo says. “More than 60 percent of our patients will have symptoms that have lasted more than 3 to 12 months.”

In advanced stages of cancer, symptoms can include early satiety (feeling full after eating small amounts of food), weight loss, black stool, loss of appetite, and difficulty swallowing.

Importance of Stomach Cancer Screening for Asian Americans

Because many people experience zero symptoms, Woo says it’s important for Asian Americans to be proactive about screenings.

“I think there's some direct questions [patients] can ask, regardless of whether they have symptoms, when they're going to see their primary care physician or to a wellness check,” says Woo. “I think they should ask about their stomach health.”

Asian countries like Korea have a national cancer screening program that has helped increase early detection rates,

 but no program exists in the United States for stomach cancer. As a result, “A majority of our patients in the United States are diagnosed very late,” Woo says.

That’s why Asian Americans should ask their doctors what their cancer risks are. If you’re experiencing chronic stomach symptoms, Woo says the question should be, “‘Are these symptoms concerning? I seem to be losing weight. I can’t eat as much as I used to.’ No 40-year-old should be losing weight unless they’re on a really strong and successful diet.”

Being proactive is the key to early detection. “Early cancer overall is much easier to treat,” Woo says. “The treatment is much easier to tolerate. When it's very early and small, you don't even need surgery.” Treatment involves an endoscopy every three to six months, depending on the risk of recurrence, and then annual surveillance of the stomach.

“If you treat H. pylori early, [stomach cancer] is preventable. It decreases the risk,” Woo adds. “If you identify it early, you can be cancer free, so do not ignore the symptoms. Don't let the healthcare system tell you otherwise.”

The Takeaway

  • Stomach cancer is more common among Asian Americans, especially Korean, Japanese, and Chinese people.
  • Risk factors include an untreated H. pylori infection, diet, alcohol and tobacco use, and family history.
  • Early detection greatly improves stomach cancer prognosis, but this cancer usually doesn’t cause early symptoms — and if they do, they're mild.
  • Be proactive about screenings, and discuss any chronic stomach symptoms with your doctor to prevent and catch stomach cancer early.
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Walter Tsang, MD

Medical Reviewer
Walter Tsang, MD, is a board-certified medical oncologist, hematologist, and lifestyle medicine specialist. Inspired by the ancient Eastern philosophy of yang sheng ("nourishing life"), Dr. Tsang has developed a unique whole-person oncology approach that tailors cancer care and lifestyle recommendations to each patients’ biopsychosocial-spiritual circumstances. He partners with patients on their cancer journeys, emphasizing empowerment, prevention, holistic wellness, quality of life, supportive care, and realistic goals and expectations. This practice model improves clinical outcomes and reduces costs for both patients and the healthcare system. 

Outside of his busy clinical practice, Tsang has taught various courses at UCLA Center for East West Medicine, Loma Linda University, and California University of Science and Medicine. He is passionate about health education and started an online seminar program to teach cancer survivors about nutrition, exercise, stress management, sleep health, and complementary healing methods. Over the years, he has given many presentations on integrative oncology and lifestyle medicine at community events. In addition, he was the founding co-chair of a lifestyle medicine cancer interest group, which promoted integrative medicine education and collaborations among oncology professionals.

Tsang is an active member of American Society of Clinical Oncology, Society for Integrative Oncology, and American College of Lifestyle Medicine. He currently practices at several locations in Southern California. His goal is to transform cancer care in the community, making it more integrative, person-centered, cost-effective and sustainable for the future.
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Gretchen Smail

Author
Gretchen Smail is a freelance health and science multimedia journalist from the San Francisco Bay Area. Her work focuses on health disparities, poverty, senior communities, and climate change. 

She also has over five years of experience as an arts and culture journalist, and she's written about projects from creators of color for sites like Bustle, Oprah Daily, Vulture, The Guardian, Hollywood Reporter, IGN, and Nerdist.
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Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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