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, 28KB) . 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.
Source: Surveillance, Epidemiology, and End Results (SEER) Program

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.
Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992–1993, 1994–1996, 1997–1999, 2000–2002, 2003–2005), and National Hospital Discharge Survey (NHDS)

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.
Source: Vital Statistics of the United States
Share this page
Facebook Twitter Email WhatsApp LinkedIn Reddit Pinterest

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.