Gastric Adenocarcinoma in the United States: The Toll of Late Diagnosis and Racial and Geographic Disparities

PURPOSE Gastric cancer (GC) in the United States is often diagnosed at a distant stage, resulting in poor survival. Despite this, no systematic early detection programs exist. This study focuses on gastric adenocarcinoma (GA), the most common and aggressive GC subtype, across seven states with large Asian and Hispanic populations—groups at elevated risk. We examined noncardia GA incidence, stage at diagnosis, survival outcomes, and hazard ratios (HRs) to identify geographic and racial disparities and inform targeted prevention strategies. METHODS Using SEER 22 data, we analyzed GA cases diagnosed from 2010 to 2019 in seven states: California, New York, New Jersey, Texas, Connecticut, Georgia, and New Mexico. Cases were categorized by tumor location, stage, and race/ethnicity. Median survival, 5-year survival rates, and adjusted HRs were estimated. RESULTS GA was predominantly diagnosed at the distant stage (cardia: 37.9%, noncardia: 39.1%), with consistently poor survival. For noncardia GA, 5-year survival at the localized and regional stages ranged from 46.2% to 73.9% and 23.7% to 40.3%, respectively; distant-stage survival ranged from 2.2% to 5.9%, with a median survival of 4.6 to 7.1 months. Compared with California, New York and New Jersey showed better survival at earlier stages, while Texas and New Mexico fared worse. Racial disparities were evident: non-Hispanic Black patients had the poorest survival, and non-Hispanic Asians had the best. CONCLUSION This study highlights striking racial and geographic disparities in GA outcomes. The 5-year survival rate for GA was 26%—substantially lower than the 36% rate typically cited for GC overall. These findings underscore the need for risk-informed screening and early detection efforts, particularly in underserved and high-risk populations.