South Korea’s High Stomach Cancer Rates Persist, but Early Detection Boosts Survival

[medi K / HEALTH IN NEWS] In South Korea, stomach cancer continues to be a significant public health challenge, driven by a combination of dietary habits, bacterial infections, and genetic predispositions. The country’s prevalence of salty, preserved foods, alongside high rates of Helicobacter pylori infection and hereditary factors, contributes to a higher incidence compared to Western nations. Yet, advancements in early screening and treatment have steadily improved survival rates, offering hope amid persistent challenges.

Survival Rates Climb, but Late-Stage Diagnoses Persist

According to the 2024 National Cancer Registry, South Korea’s five-year relative survival rate for stomach cancer has reached 78.4%, a remarkable increase of over 20 percentage points compared to two decades ago. This progress reflects the impact of widespread early screening programs and cutting-edge treatment technologies. However, a sobering reality remains: approximately 10% of patients are diagnosed with stage IV stomach cancer, where surgery is no longer viable. For these patients, survival rates plummet significantly. The disease’s lack of early symptoms makes timely detection difficult, and delayed diagnosis often leads to a grim prognosis.

A Silent Disease with Subtle Warning Signs

Early-stage stomach cancer is notoriously asymptomatic, with many patients experiencing no noticeable signs. Mild indigestion or heartburn is frequently mistaken for common conditions like gastritis or peptic ulcers, complicating early diagnosis. As the cancer progresses to stage III or IV, symptoms such as vomiting, weight loss, abdominal bloating, and loss of appetite emerge. In cases of internal bleeding, patients may experience black stools, vomiting blood, or anemia, signaling advanced disease.

Risk Factors: Diet, Infection, and Complacency

Stomach cancer is heavily influenced by environmental factors. Infection with Helicobacter pylori, a bacterium prevalent in South Korea, increases the risk of developing the disease by two to three times. The nation’s culinary tradition, which often includes salty and charred foods, further elevates risk. South Korea’s food culture, characterized by dishes like kimchi, fermented soy products, and grilled meats, is deeply rooted but often high in sodium—a known contributor to gastric cancer risk. Carcinogens such as benzopyrene and heterocyclic amines, produced in charred foods, also play a role. Smoking and excessive alcohol consumption are additional culprits, particularly for those with a family history of the disease.

Men in South Korea face roughly twice the risk of stomach cancer compared to women. However, certain types of gastric cancer are more common in women, potentially linked to hormonal factors, though research is ongoing.

Early Detection Offers Non-Surgical Options

When caught early, stomach cancer confined to the mucosal layer can often be treated without invasive surgery. Endoscopic submucosal dissection (ESD), a minimally invasive procedure, can effectively remove small, localized tumors. However, about 80% of patients are diagnosed at a stage requiring more extensive interventions, such as gastrectomy (stomach removal) and lymph node dissection.

Laparoscopic surgery, which offers faster recovery and less pain, is increasingly common, even for some advanced cases. Robotic surgery, with its enhanced precision, is also gaining traction.

Peritoneal Metastasis: A Dire Complication

Peritoneal metastasis, where cancer spreads to the abdominal cavity, occurs in about 40% of stage IV stomach cancer patients. For these individuals, median survival ranges from just two to nine months, as the cancer triggers severe complications. Traditional systemic chemotherapy struggles to deliver sufficient drug concentrations to the peritoneal cavity. To address this, intraperitoneal chemotherapy—delivering anticancer drugs directly into the abdominal cavity—has emerged as a promising approach.

Dr. Won-Joon Seo, a leading researcher at Korea University Guro Hospital, emphasizes the limitations of systemic chemotherapy alone for peritoneal metastasis. “Intraperitoneal administration offers a complementary strategy to overcome these challenges,” he says. Recent studies from his team show that combining intraperitoneal and systemic chemotherapy achieved a six-month progression-free survival rate of 82.6%, a 2.7-fold improvement over conventional treatments. This approach is currently under evaluation in a nationwide phase III clinical trial in South Korea.

Younger Patients at Risk, Family History a Key Factor

Stomach cancer is increasingly diagnosed in South Koreans under 40, yet the national cancer screening program begins at age 40, leaving younger individuals vulnerable to missed diagnoses. Dr. Seo notes that younger patients often dismiss symptoms like mild abdominal pain or weight loss, delaying critical intervention. Those with a family history of stomach cancer are urged to consider screening before age 40, as early detection dramatically improves outcomes and may eliminate the need for aggressive treatments.

Prevention: Diet and Screening Are Key

No single solution prevents stomach cancer, but lifestyle changes can reduce risk. Limiting salty and charred foods, increasing intake of fresh vegetables and fruits, and avoiding smoking and excessive alcohol are critical steps. Testing for and treating Helicobacter pylori infection is also essential. Above all, regular endoscopic screening remains the cornerstone of prevention. For high-risk groups, including those with a family history, routine screenings—regardless of age—are vital for catching the disease early, when cure rates are highest.

South Korea’s high incidence of stomach cancer underscores the need for vigilance, but its improving survival rates highlight the power of early detection and advanced care. By combining better screening, innovative treatments, and public awareness, the country is making strides against this persistent threat.

Lim Hye Jung / press@themedik.kr

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