Gastric cancer (GC) is the fifth most common form of cancer worldwide. In 2020, there were approximately 1.1 million new cases reported, making it a significant cause of cancer-related deaths. The prevalence of GC is high in Asia, followed by Latin America, Central and Eastern Europe, and other countries. GC is often fatal but can be cured if caught early. Unfortunately, it is frequently undetected until it has spread to other organs or lymph nodes. GC’s global five-year survival rate is only 20%, while in the US, it’s slightly better at 33%.
Although the incidence of GC, including cardia GC (CGC) and non-cardia GC (NCGC), is low in the United States, it varies significantly among different ethnicities and races. For example, the incidence is significantly higher in specific minority populations than in non-Hispanic white (NHW) populations. The highest number of cases of GC in the US is reported among Asian and Hispanic Americans. In subjects aged 50 and above, the incidence of NCGC adenocarcinoma was at least 1.8 to 7.3 times higher in non-white groups than in NHW. Compared to NHW, the incidence of NCGC was up to 14.5 times higher in Korean American men and women. Additionally, there are notable differences in mortality rates between different racial and ethnic groups. For example, between 2000 and 2019, age-standardized mortality rates linked to GC were the highest among specific Asian and Black communities, while NHW had the lowest rates.
Despite the persistently high incidence and mortality from GC among these minority groups, the federal funding allocated to GC research is significantly lower than funding for other types of cancers found more commonly in NHW. These disparities in incidence, mortality, and funding may increase with the expected rise in the minority population due to immigration in the US.
It is concerning that high-risk populations in the United States lack an organized screening system for GC. To address this issue, it is essential to understand why these minority groups are more susceptible to GC. This may involve addressing social and political barriers and improving infrastructure to reduce disparities and risk of GC in specific populations.
Developing a strategy to facilitate research, screen for GC, and increase primary prevention accessibility in high-risk populations is crucial. It is essential to allocate more funds for basic and clinical research and studies to assess the cost-effectiveness of regular screening for GC in high-risk populations. In addition, we need a multidimensional grassroots campaign involving the community, healthcare professionals, and policymakers to encourage local and national governments to implement strategies for GC screening in these minority populations.
Stomach Cancer Task Force (SCTF)
The SCTF is a US 501c3 Not-for-profit organization, established to engage the community to battle the GC disparities in the US. Its mission is to bring together communities and physicians to work towards creating innovative approaches for stomach cancer awareness campaigns.
The specific objectives of SCTF are (A) to effectively campaign to raise public and healthcare provider awareness of stomach cancer and its disparities in the United States; (B) to provide patients afflicted with stomach cancer with support and to link them with clinical care, especially for those that are economically disadvantaged; (C) to support stomach cancer research and provide patients access to the fruits of such research; and (D) to reduce the impact of stomach cancer by making stomach cancer screening and early detection more accessible to high-risk populations, focusing on equity.
A successful GC campaign should have the following three specific objectives. First, it should increase public awareness of GC and its disparities. We need a multi-faceted grassroots approach involving communities, physicians and other healthcare providers (HCPs), and policymakers to achieve these goals. The primary community component would be education, increasing awareness of GC and its risk in specific populations. It is crucial to spread information to the affected ethnic minority populations, where language, culture, and financial barriers may preclude them from accessing appropriate care.
Second, it is essential to reach out to HCPs in the community. They need to know the level of risk their communities have in developing GC. This could be through seminars and forums for physicians with the most frequent contact with at-risk communities, including Asian and Hispanic Americans. In addition to updating HCPs on GC disparities, screening, treatments, and monitoring, these educational activities can help motivate providers to participate in community outreach.
Finally, there exists a significant knowledge gap among policymakers regarding GC risk in minority populations, like the knowledge gap present in the general public and HCP communities. According to an informal survey conducted by SCTF in 2023, only one of 17 policymakers (including 2 federal senators, 6 federal congressmen, 3 state senators, 4 state assemblymen, and 2 mayors in metropolitan NY) knew about the high incidence of GC among the Asian and Hispanic populations. Six participants were people of color.
Policymakers and government agencies must have a solid understanding of the incidence and mortality rates of GC in specific minority groups and the disparities associated with them. For this to happen, the current epidemiologic facts, disparities in funding, and health and financial burdens caused by GC in affected minority groups must be effectively communicated to policymakers. While this information may be presented in various formats, including academic papers and social media, one of the most impactful methods for the community to communicate its concerns and findings to policymakers is in person.
SCTF aims to identify the gaps between the affected community and policymakers and provide direction that increases the translation of clinical evidence into effective policy and planning, focusing on reducing the burden from GC and potential financial loss. Improving health equity cannot be achieved by the government’s health agencies alone. The key to achieving health equity is to engage communities by seeking their input, listening to their needs, and collaborating with them. In SCTF, it is paramount to consider the community’s viewpoints in all of its endeavors.
January 8, 2024
Chul S. Hyun, MD, PhD
Chairman, New York Health Forum
President, Stomach Cancer Task Force
Chul S. Hyun received his B.A. from Johns Hopkins University, M.D. from the University of Miami School of Medicine and completed his Internal Medicine Internship and Residency at Georgetown University Medical Center. Subsequently, he pursued a Gastroenterology and Liver Fellowship at Yale University School of Medicine. He holds a Ph.D. in Biophysics from the University of Rochester School of Medicine and an MPH from Columbia University. He furthered his research with a postdoctoral fellowship in Physiology at the University of Chicago School of Medicine. He is Board-certified in Gastroenterology and has been a faculty in the Division of Gastroenterology and Hepatology at Weill Cornell Medical College since 1996. Dr. Hyun has served as a Board Member of the New Jersey State Board of Medical Examiners (2017- 2018). He has also served as the president of the Korean American Medical Association (2011-2013) and is the founding President of the World Korean Medical Organization (2012-2015). He has founded several nonprofit health organizations such as the Center for Viral Hepatitis and Asian American Stomach Cancer Task Force, and published articles on ethnic health disparities in the US. He is currently the chair of the New York Health Forum (NYHF).