Stomach Cancer

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Causes, Risk Factors, and Prevention TOPICS

What are the risk factors for stomach cancer?

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But risk factors don’t tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.

Scientists have found several risk factors that make a person more likely to get stomach cancer. Some of these can be controlled, but others cannot.

Gender

Stomach cancer is more common in men than in women.

Age

There is a sharp increase in stomach cancer rates in people over the age of 50. Most people diagnosed with stomach cancer are between their late 60s and 80s.

Ethnicity

In the United States, stomach cancer is more common in Hispanic Americans, African Americans, and Asian/Pacific Islanders than it is in non-Hispanic whites.

Geography

Worldwide, stomach cancer is more common in Japan, China, Southern and Eastern Europe, and South and Central America. This disease is less common in Northern and Western Africa, South Central Asia, and North America.

Helicobacter pylori infection

Infection with Helicobacter pylori (H pylori) bacteria seems to be a major cause of stomach cancer, especially cancers in the lower (distal) part of the stomach. Long-term infection of the stomach with this germ may lead to inflammation (chronic atrophic gastritis) and pre-cancerous changes of the inner lining of the stomach (see “Do we know what causes stomach cancer?”).

Patients with stomach cancer have a higher rate of H pylori infection than people without this cancer. H pylori infection is also linked to some types of lymphoma of the stomach. Even so, most people who carry this germ in their stomach never develop cancer.

Stomach lymphoma

People who have had a certain type of lymphoma of the stomach known as mucosa-associated lymphoid tissue (MALT) lymphoma have an increased risk of getting adenocarcinoma of the stomach. This is probably because MALT lymphoma of the stomach is caused by infection with H pylori bacteria.

Diet

An increased risk of stomach cancer is seen in people with diets that have large amounts of smoked foods, salted fish and meat, and pickled vegetables. Nitrates and nitrites are substances commonly found in cured meats. They can be converted by certain bacteria, such as H pylori, into compounds that have been shown to cause stomach cancer in lab animals.

On the other hand, eating lots of fresh fruits and vegetables appears to lower the risk of stomach cancer (see “Can stomach cancer be prevented?”).

Tobacco use

Smoking increases stomach cancer risk, particularly for cancers of the upper portion of the stomach near the esophagus. The rate of stomach cancer is about doubled in smokers.

Being overweight or obese

Being overweight or obese is a possible cause of cancers of the cardia (the upper part of the stomach nearest the esophagus), but the strength of this link is not yet clear.

Previous stomach surgery

Stomach cancers are more likely to develop in people who have had part of their stomach removed to treat non-cancerous diseases such as ulcers. This might be because the stomach makes less acid, which allows more nitrite-producing bacteria to be present. Reflux (backup) of bile from the small intestine into the stomach after surgery might also add to the increased risk. These cancers typically develop many years after the surgery.

Pernicious anemia

Certain cells in the stomach lining normally make a substance called intrinsic factor (IF) that we need to absorb vitamin B12 from foods. People without enough IF may end up with a vitamin B12 deficiency, which affects the body’s ability to make new red blood cells. This condition is called pernicious anemia. Along with anemia (too few red blood cells), people with this disease have an increased risk of stomach cancer.

Menetrier disease (hypertrophic gastropathy)

In this condition, excess growth of the stomach lining causes large folds in the lining and leads to low levels of stomach acid. Because this disease is very rare, it is not known exactly how much this increases the risk of stomach cancer.

Type A blood

Blood type groups refer to certain substances that are normally present on the surface of red blood cells and some other types of cells. These groups are important in matching blood for transfusions. For unknown reasons, people with type A blood have a higher risk of getting stomach cancer.

Inherited cancer syndromes

Some inherited conditions may raise a person’s risk of stomach cancer.

Hereditary diffuse gastric cancer

This inherited syndrome greatly increases the risk of developing stomach cancer. This condition is rare, but the lifetime stomach cancer risk among affected people is about 70% to 80%. Women with this syndrome also have an increased risk of getting a certain type of breast cancer. This condition is caused by mutations (defects) in the CDH1 gene. Some cancer centers can test for these gene mutations.

Hereditary non-polyposis colorectal cancer (HNPCC)

HNPCC, also known as Lynch syndrome, is an inherited genetic disorder that increases the risk of colorectal cancer. People with this syndrome also have an increased risk of getting stomach cancer (as well as some other cancers). In most cases, this disorder is caused by a defect in either the MLH1 or MSH2 gene, but other genes can cause HNPCC, including MLH3, MSH6, TGFBR2, PMS1, and PMS2.

Familial adenomatous polyposis (FAP)

In FAP syndrome, people get many polyps in the colon, and sometimes in the stomach and intestines as well. People with this syndrome are at greatly increased risk of getting colorectal cancer and have a slightly increased risk of getting stomach cancer. It is caused by mutations in the APC gene.

BRCA1 and BRCA2

People who carry mutations of the inherited breast cancer genes BRCA1 or BRCA2 may also have a higher rate of stomach cancer.

Li-Fraumeni syndrome

People with this syndrome have an increased risk of several types of cancer, including developing stomach cancer at a relatively young age. Li-Fraumeni syndrome is caused by a mutation in the TP53 gene.

Peutz-Jeghers syndrome (PJS)

People with this condition develop polyps in the stomach and intestines, as well as in other areas including the nose, the airways of the lungs, and the bladder. The polyps in the stomach and intestines are a special type called hamartomas. They can cause problems like bleeding or blockage of the intestines. PJS can also cause dark freckle-like spots on the lips, inner cheeks and other areas. People with PJS have an increased risk of cancers of the breast, colon, pancreas, stomach, and several other organs. This syndrome is caused by mutations in the gene STK1.

Most cancers are caused by gene changes that happen during a person’s lifetime, but a person’s cancer risk can be higher if they have one of these rare inherited mutations. Doctors can test for certain kinds of gene changes that make a person more likely to get cancer. You can read more in our document, Genetic Testing: What You Need to Know.

A family history of stomach cancer

People with first-degree relatives (parents, siblings, or children) who have had stomach cancer are more likely to develop this disease.

Some types of stomach polyps

Polyps are non-cancerous growths on the lining of the stomach. Most types of polyps (such as hyperplastic polyps or inflammatory polyps) do not seem to increase a person’s risk of stomach cancer, but adenomatous polyps – also called adenomas – can sometimes develop into cancer.

Epstein-Barr virus (EBV) infection

Epstein-Barr virus causes infectious mononucleosis (also called mono). Almost all adults have been infected with this virus at some time in their lives, usually as children or teens.

EBV has been linked to some forms of lymphoma. It is also found in the cancer cells of about 5% to 10% of people with stomach cancer. These people tend to have a slower growing, less aggressive cancer with a lower tendency to spread. EBV has been found in some stomach cancer cells, but it isn’t yet clear if this virus actually causes stomach cancer.

Certain occupations

Workers in the coal, metal, and rubber industries seem to have a higher risk of getting stomach cancer.

Common variable immune deficiency (CVID)

People with CVID have an increased risk of stomach cancer. The immune system of someone with CVID can’t make enough antibodies in response to germs. People with CVID have frequent infections as well as other problems, including atrophic gastritis and pernicious anemia. They are also more likely to get gastric lymphoma and stomach cancer.


Last Medical Review: 02/15/2013
Last Revised: 04/22/2014