Multi-omics Biomarkers in Early Gastric Cancer Screening: Translating Discovery Evidence to Routine Screening Implementation

Early detection of gastric cancer is critical for reducing incidence and mortality, as well as for improving survival outcomes. Although gastroscopy remains the gold standard for gastric cancer screening and diagnosis, its invasiveness, discomfort during the procedure, and limited acceptability restrict population participation and screening coverage. Recently, rapid advances in liquid biopsy technologies have led to the discovery of numerous multi-omics biomarkers spanning genomics, transcriptomics, proteomics, and metabolomics, with promising diagnostic performance. However, their translational value for population-based gastric cancer screening and control remains insufficiently characterized. This review aims to provide a comprehensive overview of multi-omics biomarkers for gastric cancer screening and to evaluate their potential role in advancing population-level gastric cancer control. First, we synthesize multi-omics biomarkers with diagnostic and screening relevance across the continuum of gastric carcinogenesis, from chronic inflammation and atrophy to intestinal metaplasia, dysplasia, and early gastric cancer. Furthermore, we highlight the integrative value of multi-omics biomarkers, current limitations, translational challenges, and future opportunities for moving biomarkers from discovery to implementation in organized screening programs. In conclusion, multi-omics biomarkers have the potential to complement existing screening strategies by providing scalable, non-invasive, and risk-adapted approaches for early gastric cancer detection. Bridging the gap between biomarker discovery and real-world implementation will be essential for realizing their value in future gastric cancer screening programs.