A Migration-Informed, Risk-Based Approach to H. pylori Screening and Gastric Cancer Prevention in the U.S.

Gastric cancer (GC) remains one of the most lethal cancers worldwide.Although its overall incidence in the U.S. appears low, this masks deep disparities in who is affected, when they are diagnosed, and how they fare. 1,2Immigrants from countries with high rates of H. pylori infection and GC-including many Asian and Latin American communities-face disproportionately high risk. [3][4]4][5] Yet despite decades of global evidence identifying H. pylori as the leading modifiable risk factor for non-cardia GC, the U.S. still lacks formal screening guidelines, a national prevention strategy, and widespread public or provider awareness. 6,7hile other countries with centralized healthcare systems have successfully reduced GC through national H. pylori screening and eradication efforts, 8,9 replicating those strategies in the U.S. is not feasible.What is needed instead is a model tailored to the U.S. context-one that reflects its demographic complexity and decentralized healthcare structure.This commentary proposes a new direction for GC prevention in the U.S.: a migrationinformed H. pylori screening strategy that integrates nativity, ancestry, clinical symptoms, family and personal history, dietary patterns, and other sociocultural factors to better identify high-risk individuals.It further integrates community-based outreach with structured behavioral assessment to capture both clinical and contextual determinants of risk.By combining biological screening with insights into knowledge, attitudes, and practices (KAP), this approach supports more targeted and scalable prevention in a fragmented healthcare system.To clarify the framework used in this commentary, we define three central terms at the outset.A migration-informed strategy incorporates factors such as country of origin, duration of residence in the U.S., and other migration-related variables to assess disease risk.A nativity-sensitive approach distinguishes between U.S.-born and foreign-born individuals to better understand patterns of exposure.Meanwhile, community-anchored (based) interventions refer to programs that are designed and implemented in collaboration with trusted local organizations embedded within the communities they aim to serve.