Published January 26, 2024
More than a decade ago, Shria Kumar, a gastroenterologist and researcher at the University of Miami, began noticing something unsettling. Some of the stomach cancer patients coming to her were much younger than is typical and many of them were women. It’s a trend that continues to this day.
Scientists are busy trying to figure out why this is happening, but last spring they got confirmation that the phenomenon is real in the United States. By examining comprehensive cancer registries in multiple states across the country, researchers concluded that stomach cancer has been increasing at a greater rate in younger women. Over nearly two decades, rates for women under 55 rose 3 percent, which is twice that for younger men. This is occurring as rates for older people were dropping. The increase in young women is happening primarily in non-Hispanic whites, a group traditionally less likely to develop the disease than Blacks, Hispanics, and Asians.
In the U.S., men over 55 still make up the bulk of stomach cancer patients, but the growth in younger women has been especially worrisome because their disease tends to be more virulent.
“These tumors are more advanced at diagnosis and they’re more aggressive,” leading to worse prognoses, Kumar says.
The overall five-year survival rate for stomach cancer in the U.S. is 36 percent. This figure has been dropping in recent years, especially in Asian and Black Americans. But for people diagnosed after the cancer has spread—a likely scenario for the younger people with more aggressive tumors—the survival rate is just 6.6 percent.
The increase in stomach cancers mimics a similar jump in other gastrointestinal cancers in younger people including pancreatic and colorectal cancer, a reason federal recommendations for colonoscopy screenings were lowered a few years ago to age 45 from 50.
Why is this happening?
There are several theories on what is causing the spike but no definitive understanding on why this is happening. “That is the question nobody has a good answer for,” says Michael Cecchini, a medical oncologist at the Center for Gastrointestinal Cancers at Yale Cancer Center.
Srinivas Gaddam, a gastroenterologist at Cedars-Sinai Medical Center in Los Angeles and the senior author of the tracking study believes the lifestyle and environmental changes in recent decades may be impacting young women.
“The environment your stomach sees is everything you take into your body,” Gaddam says. Young women are drinking and smoking more, which may play a role. Or perhaps novel chemicals have entered the food system. Even toxins we breathe can land in the stomach if the lungs cough it up and you swallow it, he notes.
Younger women who are diagnosed with stomach cancer are often shocked by the news. Camilla Row, who was a 39-year-old mother of two young children in Los Angeles at the time remembers thinking, “I didn’t even know you could get cancer of the stomach.”
But Row wasn’t the only one who didn’t consider this possibility. Her physicians overlooked the symptoms too. During the prior two years as she experienced recurring burning and stabbing sensations in her stomach, three physicians diagnosed gastrointestinal reflux disease and prescribed antacids. Every time Row tried to stop taking the drugs, intense pain followed. Only after she called her primary care physician in tears was she finally referred for an endoscopy that led to her cancer diagnosis.
In addition to heartburn and abdominal pain, other symptoms of stomach cancer include nausea, weight loss, and vomiting blood. But since the early stage is generally silent, symptoms like this likely indicate advanced disease.
Germs, genes, and diet
In much of the world, stomach cancer is pervasive and is the fourth leading cancer killer globally. In the U.S., rates are significantly lower, comprising just over 1 percent of cancer diagnoses.
A prime reason is that the leading cause of most stomach cancers is the bacterium Helicobacter pylori, the same germ that causes many stomach ulcers. H. pylori is endemic in many parts of the world due to poor sanitation systems. Other known risk factors for the disease include a diet of smoked, salty, or prepared foods; obesity; and a history of smoking, Cecchini says.
Genetics also play a role, especially for cancers in younger people. This includes those with Lynch syndrome, a disease in which mutations in genes involved in DNA repair increase the risk of numerous cancers including colorectal, small bowel, stomach, ovarian, pancreatic, and brain.
A mutation in a different gene called CDH1 was behind the stomach cancer of Courtney Zentz, a 42-year-old woman from West Chester, Pennsylvania. Her mother died at age 54 in 2006, four months after being diagnosed with a sudden, aggressive stomach cancer. Four years ago, Zentz decided to undergo genetic testing and found she had inherited this rare mutation.
The only way to avoid the same fate as her mother was to prophylactically remove Zentz’s stomach—along with her gallbladder and both breasts, also at high risk of cancer. Zentz followed this advice, leading surgeons to connect her esophagus directly to her small intestine so she could still eat, albeit in smaller portions. Cells taken and analyzed after the operation revealed that she already had stage 1 stomach cancer.
“My mother dying saved my life,” Zentz says. It also saved her brother who had inherited the mutation and undergone stomach-removal surgery.
Treatments keep improving
Treatments for stomach cancer generally involve surgery, chemotherapy, radiation, and/or immunotherapy.
Camilla Row’s cancer was discovered after it had spread only to a few nearby lymph nodes. She initially had good results after stomach removal surgery followed by chemotherapy. But three years later the disease came roaring back, spreading to the membrane in her abdomen known as the peritoneum.
Row had her ovaries removed and had more intravenous chemotherapy. This has been followed by an experimental treatment known as hyperthermic intraperitoneal chemoperfusion, in which chemo drugs are pumped directly inside the abdomen at a concentration 40 times greater than IV chemo. The results documenting the effectiveness of this technique have been mixed.
So far, it’s working. Row, now 45, has had seven treatments at Los Angeles City of Hope cancer center and currently has no signs of cancer. She knows the odds are against her but is determined to maintain a positive mindset.
“I could be one of the six percent who survives long-term,” she says. “That’s what I’m praying for.”
No good screening tools
Unlike mammography for breast cancer or colonoscopy for colorectal, no screening protocols are currently recommended for early detection of stomach cancer.
Widespread screening, which would involve an endoscopy and biopsy of any lesions, doesn’t make sense for all people over a certain age in the U.S. because the cancer is not common enough, Kumar says.
She hopes future research can pinpoint the subgroups of people at highest risk who may one day be referred for annual screens, just as certain former smokers are urged to get annual lung cancer tests.
[Readaboutthe[Readaboutthe New guidance on lung cancer screening. Here’s who is affected.]
So far, Kumar and her colleagues have identified several groups who are more prone, including people born in Eastern Europe, certain Asian countries including Japan (but not Korea or China), Ecuador, Honduras, or Peru, along with those who have H. pylori and smoke.
In the meantime, with incidence rising in younger people, those with a family history of GI cancers or who are experiencing persistent symptoms should discuss the matter with their physician.
“The rising incidence in younger people means we need to have a heightened awareness and take symptoms seriously—patients as well as physicians,” Cecchini says. “They could indicate more than just a nuisance.”