Chapter 6: Cancer of the Stomach

The Burden of Digestive Diseases in the United States

James E. Everhart, M.D., M.P.H.

SEER includes cancers of the gastroesophageal junction and gastric cardia with gastric cancer. Over the period 1979 to 2004, the incidence of cancers of the gastroesophageal junction and cardia approximately doubled, resulting in an increase in the proportion of gastric cancer at these sites from 14.9% in 1979 to 30.4% in 2004. However, for medical care and vital statistics, these sites were included with esophageal cancer.

In 2004, the stomach was the third most common anatomical site for digestive system cancer, after the colon/rectum and the pancreas. Cancer of the stomach, gastric cancer, had an older age distribution than did other GI cancers, with 68 percent of cases having occurred at age 65 years or older (Table 1). Median age of diagnosis was 71 years (PDF, 28 KB) . Asians and Hispanics had the highest age-adjusted incidence rates; non-Hispanic whites had the lowest rate. The incidence of gastric cancer, as reflected by mortality rates, has been declining for more than 70 years in the United States. Between 1979 and 2004, the incidence declined more than one-third (Figure 1).

During that period, 5-year survival following diagnosis increased by 50 percent.

Ambulatory care visits and hospital discharges with gastric cancer were relatively insubstantial (Table 2). Hospitalization rates declined more rapidly than the incidence rate (Figure 2). Because gastric cancer now has somewhat better survival than other digestive system cancers, it was only the fourth leading cause of death among these cancers. Seventy percent of deaths with gastric cancer as the underlying cause occurred at age 65 years or older (Table 3). The large majority of deaths listed gastric cancer as the underlying cause. Age-adjusted mortality rates were more than twice as high among blacks as whites and nearly twice as high among men as women. If cancer of the gastroesophageal junction were included among gastric cancer, the number of deaths would have increased 5.6 percent to 11,883 in 2004. Reflecting the declining incidence rate and longer survival, the age-adjusted mortality rate of gastric cancer declined by 49 percent between 1979 and 2004 (Figure 3), the most rapid decline for any major digestive system cancer.

Table 1. Gastric Cancer: Number of Cases and Incidence Rates by Age, Race/Ethnicity, and Sex, 2004

Source: Surveillance, Epidemiology, and End Results (SEER) Program
Demographic Characteristics	Number of Cases	Incidence per 100,000 Unadjusted	Incidence per 100,000 Age-Adjusted
AGE (Years) Under 15	—	—	—
AGE (Years) 15–44	1,292	1.1	—
AGE (Years) 45–64	6,610	9.4	—
AGE (Years) 65+	14,617	42.7	—
RACE/ETHNICITY Non-Hispanic White	14,224	7.4	6.2
RACE/ETHNICITY Non-Hispanic Black	2,727	8.0	11.4
RACE/ETHNICITY Hispanic	2,425	6.0	12.3
RACE/ETHNICITY Asian/Pacific Islander	1,419	11.5	13.8
RACE/ETHNICITY American Indian/Alaska Native	123	6.6	9.1
Sex Female	8,579	5.9	5.5
Sex Male	12,888	9.2	11.1
Total	21,519	7.5	—

Figure 1. Gastric Cancer: Age-Adjusted Incidence Rates and 5-Year Survival Rates, 1979–2004

Incidence per 100,000 declined from 12.0 in 1979 to 7.64 in 2004. Five-year survival increased from 12.5 percent in 1979 to 18.1 percent in 1999, the last year for which it could be calculated.

Table 2. Gastric Cancer: Number and Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With First-Listed and All-Listed Diagnoses by Age, Race, and Sex in the United States, 2004

Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (3-year average, 2003–2005), and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS)
Demographic Characteristics	Ambulatory Care Visits First-Listed Diagnosis Number in Thousands	Ambulatory Care Visits First-Listed Diagnosis Rate per 100,000	Ambulatory Care Visits All-Listed Diagnosis Number in Thousands	Ambulatory Care Visits All-Listed Diagnosis Rate per 100,000	Hospital Discharges First-Listed Diagnosis Number in Thousands	Hospital Discharges First-Listed Diagnosis Rate per 100,000	Hospital Discharges All-Listed Diagnosis Number in Thousands	Hospital Discharges All-Listed Diagnosis Rate per 100,000
AGE (Years) Under 15	—	—	—	—	—	—	—	—
AGE (Years) 15–44	—	—	—	—	1	1	3	2
AGE (Years) 45–64	—	—	—	—	5	7	10	14
AGE (Years) 65+	—	—	107	295	10	29	19	52
Race White	—	—	99	40	11	4	21	8
Race Black	—	—	—	—	3	11	6	21
Sex Female	—	—	—	—	7	4	14	8
Sex Male	—	—	59	44	9	7	17	13
Total	137	47	141	48	17	6	31	11

Figure 2. Gastric Cancer: Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With All–Listed Diagnoses in the United States, 1979–2004

The rate of ambulatory care visits over time (age-adjusted to the 2000 U.S. population) is shown by 3-year periods (except for the first period which is 2 years), between 1992 and 2005 (beginning with 1992–1993 and ending with 2003–2005). Ambulatory care visits per 100,000 declined from 66.8 in 1992-1993 to 48.2 in 2003-2005. Hospitalizations per 100,000 declined from 20.1 in 1979 to 9.28 in 2004.

Table 3. Gastric Cancer: Number and Age-Adjusted Rates of Deaths and Years of Potential Life Lost (to Age 75) by Age, Race, and Sex in the United States, 2004

Source: Vital Statistics of the United States
Demographic Characteristics	Underlying Cause Number of Deaths	Underlying Cause Rate per 100,000	Underlying Cause Years of Potential Life Lost in Thousands	Underlying or Other Cause Number of Deaths	Underlying or Other Cause Rate per 100,000
AGE (Years) Under 15	—	—	—	—	—
AGE (Years) 15–44	573	0.5	20.7	585	0.5
AGE (Years) 45–64	2,809	4.0	51.8	2,942	4.2
AGE (Years) 65+	7,871	21.7	11.7	8,734	24.0
Race White	8,494	3.3	58.0	9,271	3.6
Race Black	2,008	7.5	18.7	2,177	8.1
Sex Female	4,791	2.8	32.9	5,197	3.0
Sex Male	6,462	5.2	51.3	7,064	5.7
Total	11,253	3.8	84.2	12,261	4.2

Figure 3. Gastric Cancer: Age-Adjusted Rates of Death in the United States, 1979–2004

The mortality rate declined rapidly between 1979 and 2004. Underlying-cause mortality per 100,000 decreased from 7.27 in 1979 to 3.72 in 2004. All-cause mortality per 100,000 decreased from 8.10 in 1979 to 4.05 in 2004.

Last Reviewed January 2008

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