Gastric cancer burden, risk factors, and early detection strategies in Latin America and Colombia

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Despite global declines, incidence and mortality remain high in several countries in the region, including Colombia. Comprehensive, population-based descriptions integrating epidemiological trends, risk factors, and early detection strategies are limited. Methods A sequential exploratory mixed-methods study was conducted. A structured literature review was performed to identify key risk factors and early detection strategies relevant to Latin America and Colombia. These findings informed us of a descriptive and comparative analysis of population-based epidemiological data. Regional estimates for Latin America were obtained from international cancer surveillance sources, and national and subnational data for Colombia (2020–2024) were derived from administrative records. Incidence, prevalence, and mortality were analyzed as age-standardized rates per 100,000 inhabitants. Temporal trends and geographic variation were described without inferential statistical testing. Results Across Latin America, gastric cancer incidence and mortality showed marked geographic heterogeneity, with higher rates concentrated in countries along the Pacific rim, including Chile, Costa Rica, Peru, and Colombia. In Colombia, national incidence remained relatively stable between 2020 and 2024, while prevalence and mortality increased over time, with persistent high-burden departments identified. The literature review highlighted Helicobacter pylori infection as the predominant risk factor, along with dietary, lifestyle, and genetic determinants. No country in Latin America has implemented population-based gastric cancer screening; reported strategies focus on risk-based prevention, opportunistic detection, and surveillance of premalignant gastric lesions. Conclusions Gastric cancer continues to impose a substantial and uneven burden across Latin America and within Colombia. The integration of population-based epidemiological data with contextual evidence on risk factors and early detection strategies underscores the relevance of risk-adapted approaches to gastric cancer control. These findings provide a regional evidence base to inform surveillance, research priorities, and the development of targeted prevention and early detection strategies in high-risk populations. Gastric cancer Epidemiology Risk factors Helicobacter pylori Early detection Latin America Figures Figure 1 Figure 2 Figure 3 Introduction According to the 2022 Global Cancer Observatory estimates, gastric cancer represents 4.9% of all new cancer cases worldwide, with an estimated 660,000 deaths (ranking as the fifth leading cause of cancer death and equating to one in every 15 deaths globally) [ 1 , 2 ]. In Latin America and the Caribbean, stomach cancer ranks fifth in both incidence and mortality, with around 74,379 incident cases and 57,895 deaths [ 3 ]. Gastric cancer is a multi-stage progressive disease in which normal gastric mucosa undergoes chronic inflammation, leading to chronic atrophic gastritis, intestinal metaplasia, dysplasia, and culminating in cancer [ 4 ]. Several risk factors have been associated with gastric cancer and precancerous lesions, making this entity a multifactorial disease since genetic and environmental factors participate in its development [ 5 – 7 ]. Importantly chronic inflammation caused by infection with Helicobacter pylori plays a critical role in the onset of cancer [ 6 ]. Given the considerable burden of stomach cancer in Latin America, the present study aims to describe the epidemiological behavior of gastric cancer in this region and its distribution in Colombia to identify geographic areas with a high burden of the disease and the risk factors associated with gastric cancer in high-risk populations, which would require further research on screening strategies to improve early detection of this public health condition. Materials and Methods Study design The study employed a sequential exploratory mixed-methods design. An initial structured review of the literature was conducted to identify and classify both risk factors and screening or early detection strategies for gastric cancer relevant to Latin America and Colombia. This qualitative phase informed the definition of analytical domains, which were subsequently used to guide a quantitative analysis of population-based epidemiological data. The quantitative component described temporal and geographic patterns of gastric cancer incidence, prevalence, and mortality, and contextualized these findings in relation to the reported screening and early detection approaches. Study procedures We searched the databases PubMed, LILACS, and SciELO using combinations of the following terms: "risk factors", "gastric cancer", "stomach cancer", "Latin America", "Colombia", "early detection", "screening", and "primary care". The searches were not restricted by year or type of study, but articles not mentioning risk factors or early detection were excluded. In addition, we conducted a descriptive analysis of the gastric cancer situation in Latin America and Colombia using epidemiological data from secondary sources, covering the period 2020 to 2024. The variables reviewed included surveillance indicators such as incidence, prevalence, and mortality. We extracted global and Latin American data from the World Health Organization's Global Cancer Observatory 2022 database. We obtained national data from the 2020–2024 administrative records of the High-Cost Account (CAC in Spanish), a non-governmental organization responsible for managing the data obtained from mandatory reports submitted by health insurers in Colombia concerning high-cost diseases such as cancer. The target population included adult patients with a histopathological or clinical diagnosis of gastric cancer. According to the High-Cost Account, incidence was specified as the proportion of newly reported cases during the period analyzed. Prevalence was labeled as the total number of people diagnosed with gastric cancer, regardless of vital status. Mortality was reported by entities and validated using the Unique Affiliate Database (BDUA in Spanish). Statistical Analysis A descriptive and comparative statistical analysis was conducted to characterize the temporal and territorial distribution of gastric cancer in Latin America and Colombia between 2020 and 2024. For the regional context, incidence and mortality estimates were obtained from international population-based sources, while national and subnational estimates for Colombia were derived from administrative surveillance records. All indicators, including incidence, prevalence, and mortality, were expressed as age-standardized rates per 100,000 inhabitants according to the population structures used by the original data sources. National estimates were calculated for each year and compared with subnational estimates at the departmental level to describe geographic variation within Colombia. To support interpretation of the quantitative findings, evidence from a structured literature review was used to contextualize risk factors and screening or early detection strategies relevant to Latin America and Colombia. For the Colombian analysis, the three territorial entities with the highest rates for each indicator were identified annually and contrasted with national values. Temporal changes in national incidence, prevalence, and mortality were assessed using percentage variation across the study period. Given the descriptive objective of the study and the use of population-based data, no inferential statistical testing was performed. Data management and analyses were conducted using Stata version 18 (StataCorp LLC, College Station, TX, USA), and results were summarized in tables and figures following international standards for population-based cancer epidemiology studies. Results Epidemiology of Gastric Cancer in Latin America and Colombia According to the distribution of gastric cancer mortality in the Americas, the burden of disease is concentrated in countries located along the Pacific rim, following the geographical alignment of Central America and the Andean mountain ranges. Data from the 2022 Global Cancer Observatory show a marked gradient in gastric cancer incidence across Latin America and the Caribbean, with higher rates per 100,000 population reported in Chile, Costa Rica, Peru, and Colombia. These countries, together with Guatemala, also presented elevated gastric cancer mortality rates, as illustrated in Fig. 1 . According to the latest information from the High-Cost Account (period January 2023–January 2024), 62,000 new cancer cases were diagnosed in Colombia, of which 2,262 and 10 cases were invasive and in situ gastric carcinoma, respectively (accounting for 3.66% of all new cancer cases in the country). This positioned gastric cancer as the fifth most common cancer among the 11 prioritized cancer types, with 15,704 prevalent cases and 2,988 reported deaths. The median age of diagnosis was 65 years, with 59.1% of cases occurring in men and 49.8% of patients diagnosed with stage IV gastric cancer [ 27 ]. The estimated age-standardized prevalence of gastric cancer in Colombia changed from 25.28 in 2022 to 29.13 in 2024 per 100,000 inhabitants. The age-standardized mortality of gastric cancer also changed from 4.97 in 2022 to 5.66 in 2024 per 100,000 inhabitants [ 27 , 28 ]. When assessing the surveillance indicators by the geographical regions defined by the National Administrative Department of Statistics (DANE in Spanish), Bogotá reported the highest prevalence of gastric cancer in 2024 (38.36 per 100,000 inhabitants), followed by the Central and Pacific regions (30.94 and 25.83 per 100,000 inhabitants, respectively) (Fig. 2 ) [ 27 ]. Bogotá also reported the highest mortality of gastric cancer in the country (6.79 per 100,000 inhabitants), followed by the Pacific and Central regions (5.75 and 5.37 per 100,000 inhabitants, respectively) (Fig. 3 ) [ 27 ]. When assessing the territorial entities, Quindío, Risaralda, Caldas, Bogotá, and Huila reported the highest prevalence of gastric cancer in 2024 (61.09, 59.55, 46.24, 46.03, and 39.03 per 100,000 inhabitants, respectively). Besides, Risaralda, Nariño, Quindío, Caquetá, and Bogotá reported the highest mortality of gastric cancer in the country (10.08, 9.65, 9.41, 8.23, and 8.14 per 100,000 inhabitants, respectively) (Table 1) [ 29 ]. Gastric cancer burden among Latin American populations outside the region Table 2 summarizes reported gastric cancer burden and associated characteristics among Latin American populations residing outside the region. These populations represent a substantial demographic group in low-incidence settings and show higher gastric cancer incidence and mortality compared with reference populations. Reported incidence rates were higher in both men and women, with consistent excess risk observed across sex-specific analyses, and mortality rates showed similar patterns during the evaluated periods. High Helicobacter pylori seroprevalence has been reported in these populations, with variation according to region of origin and age group. Additional characteristics reported in association with higher prevalence included non-native countries of birth, lower educational attainment, smoking, and reduced healthcare utilization. Differences in gastric cancer patterns were also reported according to region of origin and degree of acculturation. Clinical guidance in low-incidence settings describes consideration of gastric cancer screening in first-generation individuals aged ≥ 40 years originating from high-incidence regions, including Latin America, as summarized in Table 2. Main Risk factors reported for Latin-American population Table 3 summarizes the main risk factors associated with gastric cancer reported in Latin America and Colombia. Helicobacter pylori infection showed a high prevalence across the region, with higher estimates among adults than among children and adolescents. The infection was consistently reported as the principal risk factor associated with the intestinal histological subtype of gastric cancer. Differences in gastric cancer risk among infected individuals were described according to bacterial genetic characteristics, with higher-risk profiles reported for CagA-positive strains and vacA s1/m1 genotypes, as well as marked geographic variability in genotype distribution across South American countries. Lifestyle habits and dietary factors were also frequently reported in association with gastric cancer risk in Latin America. Increased risk was observed in relation to tobacco smoking, alcohol consumption, chili pepper intake, frequent consumption of processed or salted meats, high red meat intake, and high salt consumption. In contrast, higher intake of fruits and vegetables was associated with reduced gastric cancer risk. Genetic factors were described at both bacterial and host levels, including regional differences in H. pylori ancestral haplotypes in Colombia and the presence of host genetic variants within the interleukin-1 gene cluster associated with gastric cancer in Latin American populations. Screening and Early Detection Strategies in Primary Care Table 4 summarizes the main gastric cancer screening and early detection strategies reported across different global and Latin American settings. Population-based screening programs in East Asia, notably in Japan and South Korea, have relied on radiographic and endoscopic approaches, with the latter demonstrating a substantial reduction in gastric cancer mortality of up to 47%. In contrast, other countries such as Singapore and Taiwan have adopted targeted screening strategies focused on high-risk populations. Non-invasive approaches, including pepsinogen-based serological testing and volatile organic compound breath analysis, have been evaluated as tools for identifying individuals with premalignant gastric conditions prior to endoscopy, reporting variable diagnostic performance. In Latin America, no country has implemented nationwide population-based gastric cancer screening. Instead, the strategies described include expert consensus–based recommendations, opportunistic endoscopic detection among symptomatic adults, and structured surveillance of premalignant gastric conditions. In Chile, consensus documents and clinical guidelines report risk-based prevention strategies and endoscopic surveillance guided by premalignant lesion staging, while in Colombia, national clinical practice guidelines describe prevention and early detection pathways centered on Helicobacter pylori diagnosis and treatment, targeted endoscopic evaluation, and standardized management of early gastric cancer. Non-invasive approaches, such as pepsinogen-based serology, volatile organic compound breath testing, and combined risk stratification before endoscopy, have been reported as adjunct strategies across settings, with variability in target populations, reported outcomes, and implementation status, as detailed in Table 4. Discussion The present review shows that gastric cancer in Latin America continues to be driven by a confluence of biological, environmental, and structural determinants that remain insufficiently addressed by current health systems. In line with the objective of this study, the analysis of epidemiological trends reveals a clear geographic concentration of the disease along the Pacific rim [ 8 , 40 ] and, in Colombia, in Bogotá and the Central and Pacific regions [ 27 ]. These patterns, consistent across regional surveillance sources, strengthen the hypothesis that gastric cancer in the region is shaped not only by H. pylori prevalence and host susceptibility but also by long-standing socioeconomic inequities that modulate exposure, acquisition age, access to care, and treatment delays [19, 41, 42–45]. The identification of high-risk subpopulations aligns with global evidence, but the Latin American context presents distinctive characteristics. H. pylori infection remains highly prevalent in the region [ 46 ], and particularly virulent genotypes such as CagA + and VacA s1m1 have been repeatedly associated with premalignant lesions and cancer progression [ 47 – 54 ]. This biological vulnerability is further amplified by structural determinants-limited access to safe water, overcrowding, low educational level, high salt intake, and dietary patterns shaped by economic constraints-that foster early infection, persistent inflammation, and accelerated carcinogenic pathways [ 14 , 15 , 55 – 67 ]. Consequently, gastric cancer in Latin America reflects a syndemic interaction between biological risk, environmental exposures, and social inequities. Despite robust evidence, no Latin American country has implemented a population-level gastric cancer screening strategy [ 68 , 69 ]. International experiences, particularly from Japan and South Korea, show that early detection through endoscopy or H. pylori eradication programs can substantially reduce mortality [ 68 , 72 ]. In Colombia, although diagnostic and treatment intervals have improved between 2018 and 2024 [ 27 , 73 ], gaps persist. Gastroenterology services remain concentrated in major cities [ 74 ], and fragmented referral pathways contribute to delayed diagnosis, disproportionately affecting rural and socioeconomically vulnerable communities. This review offers several strengths. It compiles and synthesizes epidemiological indicators from multiple Latin American surveillance systems, providing a consolidated overview of regional burden and geographic hotspots [ 8 , 40 ]. It integrates biological, behavioral, and socioeconomic factors into a comprehensive interpretation of gastric cancer risk, shifting the discussion beyond traditional clinical framings [ 5 – 7 , 14 – 17 ]. It also identifies priority regions within Colombia and Latin America where targeted early detection strategies could deliver the greatest public health benefit. Nevertheless, the review has limitations. Although broad and rigorous, it was not conducted as a systematic review, which may have led to the omission of relevant studies. Additionally, heterogeneity in data availability across countries limits comparability. Critical research gaps persist in areas such as the cost-effectiveness of screening strategies, longitudinal progression of premalignant lesions, and the feasibility of implementing endoscopic programs in resource-limited settings [ 75 – 77 ]. From a public health perspective, the implications are clear. High-risk Latin American populations would benefit from a multi-tiered early detection strategy that includes H. pylori eradication [ 75 ], risk-based endoscopy [ 68 , 76 ], and strengthened diagnostic capacity. For Colombia, where the burden is substantial and rising, further research is needed to assess cost-effectiveness in high-incidence regions [ 78 ], expand endoscopic infrastructure [ 74 ], and establish coordinated pathways to reduce time to diagnosis and treatment [ 27 , 73 ]. Adopting context-specific screening models, similar to those implemented in high-incidence countries [ 72 , 79 ] but adapted to local epidemiology and resource constraints, may meaningfully improve survival and reduce longstanding inequities. Considering the persistently high incidence and late-stage diagnosis of gastric cancer in Latin America, strengthening early detection strategies emerges as an urgent regional priority. Evidence from high-burden countries demonstrates that early detection is the most effective pathway to reduce mortality, while in middle-income settings, targeted approaches such as H. pylori test-and-treat programs, risk-stratified endoscopic surveillance, and prioritization of high-risk geographic areas have been identified as cost-effective interventions [ 75 , 76 ]. Strengthening diagnostic capacity, improving timely access to endoscopy, and implementing coordinated treatment pathways are essential steps to reduce diagnostic delays and improve survival rates in the region. Ultimately, adopting context-specific screening and treatment strategies, aligned with regional epidemiological patterns, represents a critical public health priority to mitigate the growing burden of gastric cancer in Latin America. Conclusion This study provides a comprehensive description of the current burden and distribution of gastric cancer in Latin America, with a detailed focus on Colombia during the period 2020–2024. The findings highlight marked geographic heterogeneity across the region and within Colombia, with persistently elevated incidence and mortality rates in specific territories. Together with evidence from the literature, the results document the continued relevance of established risk factors, including Helicobacter pylori infection, lifestyle and dietary exposures, and population-specific genetic characteristics, as well as the absence of organized population-based screening programs in the region. The integration of population-based epidemiological data with contextual evidence on risk factors and early detection strategies underscores the need for risk-adapted approaches to gastric cancer control in Latin America. While population-wide screening has not been implemented, the findings support the relevance of targeted prevention, early detection, and surveillance strategies tailored to high-risk populations and geographic areas. These results provide an evidence-based foundation to inform future research, surveillance efforts, and policy discussions aimed at improving gastric cancer outcomes in Colombia and the broader Latin American region. Abbreviations AG, atrophic gastritis; ASGE, American Society for Gastrointestinal Endoscopy; BDUA, Unique Affiliate Database (Base de Datos Única de Afiliados); CAC, High-Cost Account (Cuenta de Alto Costo); CI, confidence interval; GC, gastric cancer; GCO, Global Cancer Observatory; GIM, gastric intestinal metaplasia; IARC, International Agency for Research on Cancer; IL-1, interleukin-1; NCGA, non-cardia gastric adenocarcinoma; NCSP, National Cancer Screening Program; OGD, esophagogastroduodenoscopy; OLGA, Operative Link on Gastritis Assessment; OLGIM, Operative Link on Gastric Intestinal Metaplasia; OR, odds ratio; PGI, pepsinogen I; PGII, pepsinogen II; RR, relative risk; SES, socioeconomic status; VOC, volatile organic compounds; WHO, World Health Organization. Declarations Acknowledgments We are grateful for the contributions provided by the Clinical Condition team of gastric cancer and acid peptic disease at Fundación Santa Fe de Bogotá: Sebastián Perico, Catalina Villar, Laura Rodríguez, and Nacxiry Fonseca. We also acknowledge Dr. Darío Londoño, for his guidance and support throughout the study. Author Contribution Conceptualization-OVE, GRM, and GEHA; Collection and assembly of data-MCLM, AMOB, DASZ, LFCO; Data analysis and interpretation-All authors; Manuscript writing-All authors; Final approval of manuscript-All authors; Accountable for all aspects of the work: All authors. Funding The authors received no specific funding for this work. Data availability Data used in this study were obtained from secondary population-based sources, including the Global Cancer Observatory and administrative records from the High-Cost Account of Colombia. Aggregated data are available from the corresponding author upon reasonable request, subject to data use policies of the source institutions. Ethical approval This study was reviewed and approved by the Research Ethics Committee of Fundación Santa Fe de Bogotá (approval code: CCEI-14898-2022). The analysis was conducted using secondary, de-identified population-based data, and no direct contact with patients was involved. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229-63. doi:10.3322/caac.21834. Global Cancer Observatory (GCO). International Agency for Research on Cancer (2022) Cancer Today 2022. Cancer Fact Sheets. Digestive Organs: Stomach [Internet]. 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BMC Gastroenterol. 2023;23:197. doi:10.1186/s12876-023-02838-9 Zamani N, Hajifaraji M, Fazel-tabar Malekshah A, Keshtkar AA, Esmaillzadeh A, Malekzadeh R. Relationship between gastric cancer and meat consumption in Iran. Arch Iran Med. 2013;16:324–329. Gao Y, Hu N, Han XY, Ding T, Giffen C, Goldstein AM, et al. Risk factors for esophageal and gastric cancers in Shanxi Province, China. Cancer Epidemiol. 2011;35:e91–e99. doi:10.1016/j.canep.2011.06.006 Wu Y, Fan Y, Jiang Y, Wang Y, Liu H, Wei M. Risk factors associated with precancerous gastric lesions in eastern China. J Cancer Res Ther. 2013;9:205–209. Fang X, Wei J, He X, An P, Wang H, Jiang L, et al. Dietary factors associated with gastric cancer risk: a systematic review and dose-response meta-analysis. Eur J Cancer. 2015;51:2820–2832. doi:10.1016/j.ejca.2015.09.010 Shikata K, Doi Y, Yonemoto K, Arima H, Ninomiya T, Kubo M, et al. Cigarette smoking and Helicobacter pylori infection on gastric cancer incidence. Am J Epidemiol. 2008;168:1409–1415. Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Alcohol consumption and site-specific cancer risk. Br J Cancer. 2015;112:580–593. Bartsch H, Nair J. Accumulation of lipid peroxidation-derived DNA lesions. Mutat Res. 2005;591:34–44. Key TJ, Appleby PN, Crowe FL, Bradbury KE, Schmidt JA, Travis RC. Cancer in British vegetarians. Am J Clin Nutr. 2014;100(Suppl):378S–385S. Ferguson LR. Meat and cancer. Meat Sci. 2010;84:308–313. Shikata K, Kiyohara Y, Kubo M, Yonemoto K, Ninomiya T, Shirota T, et al. Dietary salt intake and gastric cancer incidence. Int J Cancer. 2006;119:196–201. Parkin DM. Cancers attributable to dietary factors in the UK: salt. Br J Cancer. 2011;105(Suppl):S31–S33. Kim HJ, Lim SY, Lee JS, Park S, Shin A, Choi BY, et al. Fresh and pickled vegetables and gastric cancer risk. Cancer Sci. 2010;101:508–516. Jarosz M. Impact of diet on long-term decline in gastric cancer incidence in Poland. World J Gastroenterol. 2011;17:89–97. Banks M, Graham D, Jansen M, Gotoda T, Coda S, di Pietro M, et al. British Society of Gastroenterology guidelines on gastric adenocarcinoma risk. Gut. 2019;68:1545–1575. Kim B, Cho SJ. Endoscopic screening and surveillance for gastric cancer. Gastrointest Endosc Clin N Am. 2021;31:489–501. Sugano K. Screening of gastric cancer in Asia. Best Pract Res Clin Gastroenterol. 2015;29:895–905. Quach DT, Hiyama T, Gotoda T. Identifying high-risk individuals for gastric cancer surveillance. World J Gastroenterol. 2019;25:3546–3562. Cuenta de Alto Costo (CAC). Situación del cáncer en la población adulta atendida en el SGSSS de Colombia [Internet]. 2018. Registro Especial de Prestadores de Servicios de Salud (REPS). Ministerio de Salud y Protección Social de Colombia. Registro de servicios de gastroenterología [Internet]. 2025. International Agency for Research on Cancer (IARC). Helicobacter pylori eradication as a strategy for preventing gastric cancer [Internet]. Lyon; 2014 Tables Tables 1 to 4 are available in the supplementary files section Additional Declarations No competing interests reported. Supplementary Files Tables.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Feb, 2026 Reviews received at journal 06 Feb, 2026 Reviews received at journal 03 Feb, 2026 Reviews received at journal 27 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers invited by journal 15 Jan, 2026 Editor invited by journal 07 Jan, 2026 Editor assigned by journal 06 Jan, 2026 Submission checks completed at journal 06 Jan, 2026 First submitted to journal 29 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":35797,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence and Mortality of Gastric Cancer. Aged-Standarized Rates per 100, 000, Both Sexes, 2022. Latin America and the Caribbe\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8475256/v1/d1542beefaf5f0c4c8f28f19.png"},{"id":100673751,"identity":"20d9fbba-b3f5-44ac-8ce0-f07dc975659a","added_by":"auto","created_at":"2026-01-20 10:53:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10507,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of gastric cancer by geographical region in Colombia, 2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8475256/v1/1abeea68431e0726cfb32fab.png"},{"id":100674378,"identity":"11c8f7a5-78b0-4760-b306-69fd14c69eda","added_by":"auto","created_at":"2026-01-20 10:59:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":10740,"visible":true,"origin":"","legend":"\u003cp\u003eMortality of gastric cancer by geographical region in Colombia, 2024.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8475256/v1/321413f50e8f7e584779b234.png"},{"id":100679911,"identity":"46d5d938-01db-4da5-87ac-f9c52404a15b","added_by":"auto","created_at":"2026-01-20 11:51:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":674617,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8475256/v1/c804d2a6-458b-4ef2-ae85-b8d5f81b7742.pdf"},{"id":100674199,"identity":"5dbdd009-398b-49fa-8b15-e62baedc9453","added_by":"auto","created_at":"2026-01-20 10:57:29","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18489,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8475256/v1/780995ef5c0a335db9127021.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gastric cancer burden, risk factors, and early detection strategies in Latin America and Colombia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the 2022 Global Cancer Observatory estimates, gastric cancer represents 4.9% of all new cancer cases worldwide, with an estimated 660,000 deaths (ranking as the fifth leading cause of cancer death and equating to one in every 15 deaths globally) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Latin America and the Caribbean, stomach cancer ranks fifth in both incidence and mortality, with around 74,379 incident cases and 57,895 deaths [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Gastric cancer is a multi-stage progressive disease in which normal gastric mucosa undergoes chronic inflammation, leading to chronic atrophic gastritis, intestinal metaplasia, dysplasia, and culminating in cancer [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Several risk factors have been associated with gastric cancer and precancerous lesions, making this entity a multifactorial disease since genetic and environmental factors participate in its development [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Importantly chronic inflammation caused by infection with Helicobacter pylori plays a critical role in the onset of cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Given the considerable burden of stomach cancer in Latin America, the present study aims to describe the epidemiological behavior of gastric cancer in this region and its distribution in Colombia to identify geographic areas with a high burden of the disease and the risk factors associated with gastric cancer in high-risk populations, which would require further research on screening strategies to improve early detection of this public health condition.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe study employed a sequential exploratory mixed-methods design. An initial structured review of the literature was conducted to identify and classify both risk factors and screening or early detection strategies for gastric cancer relevant to Latin America and Colombia. This qualitative phase informed the definition of analytical domains, which were subsequently used to guide a quantitative analysis of population-based epidemiological data. The quantitative component described temporal and geographic patterns of gastric cancer incidence, prevalence, and mortality, and contextualized these findings in relation to the reported screening and early detection approaches.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy procedures\u003c/h3\u003e\n\u003cp\u003eWe searched the databases PubMed, LILACS, and SciELO using combinations of the following terms: \"risk factors\", \"gastric cancer\", \"stomach cancer\", \"Latin America\", \"Colombia\", \"early detection\", \"screening\", and \"primary care\". The searches were not restricted by year or type of study, but articles not mentioning risk factors or early detection were excluded. In addition, we conducted a descriptive analysis of the gastric cancer situation in Latin America and Colombia using epidemiological data from secondary sources, covering the period 2020 to 2024. The variables reviewed included surveillance indicators such as incidence, prevalence, and mortality.\u003c/p\u003e \u003cp\u003eWe extracted global and Latin American data from the World Health Organization's Global Cancer Observatory 2022 database. We obtained national data from the 2020\u0026ndash;2024 administrative records of the High-Cost Account (CAC in Spanish), a non-governmental organization responsible for managing the data obtained from mandatory reports submitted by health insurers in Colombia concerning high-cost diseases such as cancer. The target population included adult patients with a histopathological or clinical diagnosis of gastric cancer. According to the High-Cost Account, incidence was specified as the proportion of newly reported cases during the period analyzed. Prevalence was labeled as the total number of people diagnosed with gastric cancer, regardless of vital status. Mortality was reported by entities and validated using the Unique Affiliate Database (BDUA in Spanish).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eA descriptive and comparative statistical analysis was conducted to characterize the temporal and territorial distribution of gastric cancer in Latin America and Colombia between 2020 and 2024. For the regional context, incidence and mortality estimates were obtained from international population-based sources, while national and subnational estimates for Colombia were derived from administrative surveillance records. All indicators, including incidence, prevalence, and mortality, were expressed as age-standardized rates per 100,000 inhabitants according to the population structures used by the original data sources. National estimates were calculated for each year and compared with subnational estimates at the departmental level to describe geographic variation within Colombia.\u003c/p\u003e \u003cp\u003eTo support interpretation of the quantitative findings, evidence from a structured literature review was used to contextualize risk factors and screening or early detection strategies relevant to Latin America and Colombia. For the Colombian analysis, the three territorial entities with the highest rates for each indicator were identified annually and contrasted with national values. Temporal changes in national incidence, prevalence, and mortality were assessed using percentage variation across the study period. Given the descriptive objective of the study and the use of population-based data, no inferential statistical testing was performed. Data management and analyses were conducted using Stata version 18 (StataCorp LLC, College Station, TX, USA), and results were summarized in tables and figures following international standards for population-based cancer epidemiology studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEpidemiology of Gastric Cancer in Latin America and Colombia\u003c/h2\u003e \u003cp\u003eAccording to the distribution of gastric cancer mortality in the Americas, the burden of disease is concentrated in countries located along the Pacific rim, following the geographical alignment of Central America and the Andean mountain ranges. Data from the 2022 Global Cancer Observatory show a marked gradient in gastric cancer incidence across Latin America and the Caribbean, with higher rates per 100,000 population reported in Chile, Costa Rica, Peru, and Colombia. These countries, together with Guatemala, also presented elevated gastric cancer mortality rates, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to the latest information from the High-Cost Account (period January 2023\u0026ndash;January 2024), 62,000 new cancer cases were diagnosed in Colombia, of which 2,262 and 10 cases were invasive and in situ gastric carcinoma, respectively (accounting for 3.66% of all new cancer cases in the country). This positioned gastric cancer as the fifth most common cancer among the 11 prioritized cancer types, with 15,704 prevalent cases and 2,988 reported deaths. The median age of diagnosis was 65 years, with 59.1% of cases occurring in men and 49.8% of patients diagnosed with stage IV gastric cancer [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe estimated age-standardized prevalence of gastric cancer in Colombia changed from 25.28 in 2022 to 29.13 in 2024 per 100,000 inhabitants. The age-standardized mortality of gastric cancer also changed from 4.97 in 2022 to 5.66 in 2024 per 100,000 inhabitants [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. When assessing the surveillance indicators by the geographical regions defined by the National Administrative Department of Statistics (DANE in Spanish), Bogot\u0026aacute; reported the highest prevalence of gastric cancer in 2024 (38.36 per 100,000 inhabitants), followed by the Central and Pacific regions (30.94 and 25.83 per 100,000 inhabitants, respectively) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Bogot\u0026aacute; also reported the highest mortality of gastric cancer in the country (6.79 per 100,000 inhabitants), followed by the Pacific and Central regions (5.75 and 5.37 per 100,000 inhabitants, respectively) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. When assessing the territorial entities, Quind\u0026iacute;o, Risaralda, Caldas, Bogot\u0026aacute;, and Huila reported the highest prevalence of gastric cancer in 2024 (61.09, 59.55, 46.24, 46.03, and 39.03 per 100,000 inhabitants, respectively). Besides, Risaralda, Nari\u0026ntilde;o, Quind\u0026iacute;o, Caquet\u0026aacute;, and Bogot\u0026aacute; reported the highest mortality of gastric cancer in the country (10.08, 9.65, 9.41, 8.23, and 8.14 per 100,000 inhabitants, respectively) (Table\u0026nbsp;1) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eGastric cancer burden among Latin American populations outside the region\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;2 summarizes reported gastric cancer burden and associated characteristics among Latin American populations residing outside the region. These populations represent a substantial demographic group in low-incidence settings and show higher gastric cancer incidence and mortality compared with reference populations. Reported incidence rates were higher in both men and women, with consistent excess risk observed across sex-specific analyses, and mortality rates showed similar patterns during the evaluated periods.\u003c/p\u003e \u003cp\u003eHigh Helicobacter pylori seroprevalence has been reported in these populations, with variation according to region of origin and age group. Additional characteristics reported in association with higher prevalence included non-native countries of birth, lower educational attainment, smoking, and reduced healthcare utilization. Differences in gastric cancer patterns were also reported according to region of origin and degree of acculturation. Clinical guidance in low-incidence settings describes consideration of gastric cancer screening in first-generation individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years originating from high-incidence regions, including Latin America, as summarized in Table\u0026nbsp;2.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMain Risk factors reported for Latin-American population\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;3 summarizes the main risk factors associated with gastric cancer reported in Latin America and Colombia. Helicobacter pylori infection showed a high prevalence across the region, with higher estimates among adults than among children and adolescents. The infection was consistently reported as the principal risk factor associated with the intestinal histological subtype of gastric cancer. Differences in gastric cancer risk among infected individuals were described according to bacterial genetic characteristics, with higher-risk profiles reported for CagA-positive strains and vacA s1/m1 genotypes, as well as marked geographic variability in genotype distribution across South American countries.\u003c/p\u003e \u003cp\u003eLifestyle habits and dietary factors were also frequently reported in association with gastric cancer risk in Latin America. Increased risk was observed in relation to tobacco smoking, alcohol consumption, chili pepper intake, frequent consumption of processed or salted meats, high red meat intake, and high salt consumption. In contrast, higher intake of fruits and vegetables was associated with reduced gastric cancer risk. Genetic factors were described at both bacterial and host levels, including regional differences in H. pylori ancestral haplotypes in Colombia and the presence of host genetic variants within the interleukin-1 gene cluster associated with gastric cancer in Latin American populations.\u003c/p\u003e\n\u003ch3\u003eScreening and Early Detection Strategies in Primary Care\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;4 summarizes the main gastric cancer screening and early detection strategies reported across different global and Latin American settings. Population-based screening programs in East Asia, notably in Japan and South Korea, have relied on radiographic and endoscopic approaches, with the latter demonstrating a substantial reduction in gastric cancer mortality of up to 47%. In contrast, other countries such as Singapore and Taiwan have adopted targeted screening strategies focused on high-risk populations. Non-invasive approaches, including pepsinogen-based serological testing and volatile organic compound breath analysis, have been evaluated as tools for identifying individuals with premalignant gastric conditions prior to endoscopy, reporting variable diagnostic performance.\u003c/p\u003e \u003cp\u003eIn Latin America, no country has implemented nationwide population-based gastric cancer screening. Instead, the strategies described include expert consensus\u0026ndash;based recommendations, opportunistic endoscopic detection among symptomatic adults, and structured surveillance of premalignant gastric conditions. In Chile, consensus documents and clinical guidelines report risk-based prevention strategies and endoscopic surveillance guided by premalignant lesion staging, while in Colombia, national clinical practice guidelines describe prevention and early detection pathways centered on Helicobacter pylori diagnosis and treatment, targeted endoscopic evaluation, and standardized management of early gastric cancer. Non-invasive approaches, such as pepsinogen-based serology, volatile organic compound breath testing, and combined risk stratification before endoscopy, have been reported as adjunct strategies across settings, with variability in target populations, reported outcomes, and implementation status, as detailed in Table\u0026nbsp;4.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present review shows that gastric cancer in Latin America continues to be driven by a confluence of biological, environmental, and structural determinants that remain insufficiently addressed by current health systems. In line with the objective of this study, the analysis of epidemiological trends reveals a clear geographic concentration of the disease along the Pacific rim [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and, in Colombia, in Bogot\u0026aacute; and the Central and Pacific regions [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These patterns, consistent across regional surveillance sources, strengthen the hypothesis that gastric cancer in the region is shaped not only by H. pylori prevalence and host susceptibility but also by long-standing socioeconomic inequities that modulate exposure, acquisition age, access to care, and treatment delays [19, 41, 42\u0026ndash;45].\u003c/p\u003e \u003cp\u003eThe identification of high-risk subpopulations aligns with global evidence, but the Latin American context presents distinctive characteristics. H. pylori infection remains highly prevalent in the region [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], and particularly virulent genotypes such as CagA\u0026thinsp;+\u0026thinsp;and VacA s1m1 have been repeatedly associated with premalignant lesions and cancer progression [\u003cspan additionalcitationids=\"CR48 CR49 CR50 CR51 CR52 CR53\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. This biological vulnerability is further amplified by structural determinants-limited access to safe water, overcrowding, low educational level, high salt intake, and dietary patterns shaped by economic constraints-that foster early infection, persistent inflammation, and accelerated carcinogenic pathways [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. Consequently, gastric cancer in Latin America reflects a syndemic interaction between biological risk, environmental exposures, and social inequities.\u003c/p\u003e \u003cp\u003eDespite robust evidence, no Latin American country has implemented a population-level gastric cancer screening strategy [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. International experiences, particularly from Japan and South Korea, show that early detection through endoscopy or H. pylori eradication programs can substantially reduce mortality [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. In Colombia, although diagnostic and treatment intervals have improved between 2018 and 2024 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e], gaps persist. Gastroenterology services remain concentrated in major cities [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e], and fragmented referral pathways contribute to delayed diagnosis, disproportionately affecting rural and socioeconomically vulnerable communities.\u003c/p\u003e \u003cp\u003eThis review offers several strengths. It compiles and synthesizes epidemiological indicators from multiple Latin American surveillance systems, providing a consolidated overview of regional burden and geographic hotspots [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. It integrates biological, behavioral, and socioeconomic factors into a comprehensive interpretation of gastric cancer risk, shifting the discussion beyond traditional clinical framings [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It also identifies priority regions within Colombia and Latin America where targeted early detection strategies could deliver the greatest public health benefit.\u003c/p\u003e \u003cp\u003eNevertheless, the review has limitations. Although broad and rigorous, it was not conducted as a systematic review, which may have led to the omission of relevant studies. Additionally, heterogeneity in data availability across countries limits comparability. Critical research gaps persist in areas such as the cost-effectiveness of screening strategies, longitudinal progression of premalignant lesions, and the feasibility of implementing endoscopic programs in resource-limited settings [\u003cspan additionalcitationids=\"CR76\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom a public health perspective, the implications are clear. High-risk Latin American populations would benefit from a multi-tiered early detection strategy that includes H. pylori eradication [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], risk-based endoscopy [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e], and strengthened diagnostic capacity. For Colombia, where the burden is substantial and rising, further research is needed to assess cost-effectiveness in high-incidence regions [\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e], expand endoscopic infrastructure [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e], and establish coordinated pathways to reduce time to diagnosis and treatment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Adopting context-specific screening models, similar to those implemented in high-incidence countries [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e] but adapted to local epidemiology and resource constraints, may meaningfully improve survival and reduce longstanding inequities.\u003c/p\u003e \u003cp\u003eConsidering the persistently high incidence and late-stage diagnosis of gastric cancer in Latin America, strengthening early detection strategies emerges as an urgent regional priority. Evidence from high-burden countries demonstrates that early detection is the most effective pathway to reduce mortality, while in middle-income settings, targeted approaches such as H. pylori test-and-treat programs, risk-stratified endoscopic surveillance, and prioritization of high-risk geographic areas have been identified as cost-effective interventions [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. Strengthening diagnostic capacity, improving timely access to endoscopy, and implementing coordinated treatment pathways are essential steps to reduce diagnostic delays and improve survival rates in the region. Ultimately, adopting context-specific screening and treatment strategies, aligned with regional epidemiological patterns, represents a critical public health priority to mitigate the growing burden of gastric cancer in Latin America.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a comprehensive description of the current burden and distribution of gastric cancer in Latin America, with a detailed focus on Colombia during the period 2020\u0026ndash;2024. The findings highlight marked geographic heterogeneity across the region and within Colombia, with persistently elevated incidence and mortality rates in specific territories. Together with evidence from the literature, the results document the continued relevance of established risk factors, including Helicobacter pylori infection, lifestyle and dietary exposures, and population-specific genetic characteristics, as well as the absence of organized population-based screening programs in the region.\u003c/p\u003e \u003cp\u003eThe integration of population-based epidemiological data with contextual evidence on risk factors and early detection strategies underscores the need for risk-adapted approaches to gastric cancer control in Latin America. While population-wide screening has not been implemented, the findings support the relevance of targeted prevention, early detection, and surveillance strategies tailored to high-risk populations and geographic areas. These results provide an evidence-based foundation to inform future research, surveillance efforts, and policy discussions aimed at improving gastric cancer outcomes in Colombia and the broader Latin American region.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAG, atrophic gastritis;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;ASGE, American Society for Gastrointestinal Endoscopy;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;BDUA, Unique Affiliate Database (Base de Datos Única de Afiliados);\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CAC, High-Cost Account (Cuenta de Alto Costo);\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CI, confidence interval;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;GC, gastric cancer;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;GCO, Global Cancer Observatory;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;GIM, gastric intestinal metaplasia;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;IARC, International Agency for Research on Cancer;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;IL-1, interleukin-1;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;NCGA, non-cardia gastric adenocarcinoma;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;NCSP, National Cancer Screening Program;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;OGD, esophagogastroduodenoscopy;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;OLGA, Operative Link on Gastritis Assessment;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;OLGIM, Operative Link on Gastric Intestinal Metaplasia;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;OR, odds ratio;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;PGI, pepsinogen I;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;PGII, pepsinogen II;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;RR, relative risk;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;SES, socioeconomic status;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;VOC, volatile organic compounds;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;WHO, World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful for the contributions provided by the Clinical Condition team of gastric cancer and acid peptic disease at Fundaci\u0026oacute;n Santa Fe de Bogot\u0026aacute;: Sebasti\u0026aacute;n Perico, Catalina Villar, Laura Rodr\u0026iacute;guez, and Nacxiry Fonseca. We also acknowledge Dr. Dar\u0026iacute;o Londo\u0026ntilde;o, for his guidance and support throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e Conceptualization-OVE, GRM, and GEHA; Collection and assembly of data-MCLM, AMOB, DASZ, LFCO; Data analysis and interpretation-All authors; Manuscript writing-All authors; Final approval of manuscript-All authors; Accountable for all aspects of the work: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003eData used in this study were obtained from secondary population-based sources, including the Global Cancer Observatory and administrative records from the High-Cost Account of Colombia. Aggregated data are available from the corresponding author upon reasonable request, subject to data use policies of the source institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e This study was reviewed and approved by the Research Ethics Committee of Fundaci\u0026oacute;n Santa Fe de Bogot\u0026aacute; (approval code: CCEI-14898-2022). The analysis was conducted using secondary, de-identified population-based data, and no direct contact with patients was involved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229-63. doi:10.3322/caac.21834.\u003c/li\u003e\n \u003cli\u003eGlobal Cancer Observatory (GCO). International Agency for Research on Cancer (2022) Cancer Today 2022. Cancer Fact Sheets. Digestive Organs: Stomach [Internet]. 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High frequency of gastric colonization with multiple Helicobacter pylori strains in Venezuelan subjects. J Clin Microbiol. 2005;43(6):2635\u0026ndash;2641. doi:10.1128/JCM.43.6.2635-2641.2005\u003c/li\u003e\n \u003cli\u003eBustos-Fraga S, Salinas-Pinta M, Vicu\u0026ntilde;a-Almeida Y, de Oliveira RB, Balde\u0026oacute;n-Rojas L. Prevalence of Helicobacter pylori genotypes and association with gastrointestinal diseases in Quito, Ecuador. BMC Gastroenterol. 2023;23:197. doi:10.1186/s12876-023-02838-9\u003c/li\u003e\n \u003cli\u003eZamani N, Hajifaraji M, Fazel-tabar Malekshah A, Keshtkar AA, Esmaillzadeh A, Malekzadeh R. Relationship between gastric cancer and meat consumption in Iran. Arch Iran Med. 2013;16:324\u0026ndash;329.\u003c/li\u003e\n \u003cli\u003eGao Y, Hu N, Han XY, Ding T, Giffen C, Goldstein AM, et al. Risk factors for esophageal and gastric cancers in Shanxi Province, China. Cancer Epidemiol. 2011;35:e91\u0026ndash;e99. doi:10.1016/j.canep.2011.06.006\u003c/li\u003e\n \u003cli\u003eWu Y, Fan Y, Jiang Y, Wang Y, Liu H, Wei M. Risk factors associated with precancerous gastric lesions in eastern China. J Cancer Res Ther. 2013;9:205\u0026ndash;209.\u003c/li\u003e\n \u003cli\u003eFang X, Wei J, He X, An P, Wang H, Jiang L, et al. Dietary factors associated with gastric cancer risk: a systematic review and dose-response meta-analysis. Eur J Cancer. 2015;51:2820\u0026ndash;2832. doi:10.1016/j.ejca.2015.09.010\u003c/li\u003e\n \u003cli\u003eShikata K, Doi Y, Yonemoto K, Arima H, Ninomiya T, Kubo M, et al. Cigarette smoking and Helicobacter pylori infection on gastric cancer incidence. Am J Epidemiol. 2008;168:1409\u0026ndash;1415.\u003c/li\u003e\n \u003cli\u003eBagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Alcohol consumption and site-specific cancer risk. 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Cancer Sci. 2010;101:508\u0026ndash;516.\u003c/li\u003e\n \u003cli\u003eJarosz M. Impact of diet on long-term decline in gastric cancer incidence in Poland. World J Gastroenterol. 2011;17:89\u0026ndash;97.\u003c/li\u003e\n \u003cli\u003eBanks M, Graham D, Jansen M, Gotoda T, Coda S, di Pietro M, et al. British Society of Gastroenterology guidelines on gastric adenocarcinoma risk. Gut. 2019;68:1545\u0026ndash;1575.\u003c/li\u003e\n \u003cli\u003eKim B, Cho SJ. Endoscopic screening and surveillance for gastric cancer. Gastrointest Endosc Clin N Am. 2021;31:489\u0026ndash;501.\u003c/li\u003e\n \u003cli\u003eSugano K. Screening of gastric cancer in Asia. Best Pract Res Clin Gastroenterol. 2015;29:895\u0026ndash;905.\u003c/li\u003e\n \u003cli\u003eQuach DT, Hiyama T, Gotoda T. Identifying high-risk individuals for gastric cancer surveillance. World J Gastroenterol. 2019;25:3546\u0026ndash;3562.\u003c/li\u003e\n \u003cli\u003eCuenta de Alto Costo (CAC). Situaci\u0026oacute;n del c\u0026aacute;ncer en la poblaci\u0026oacute;n adulta atendida en el SGSSS de Colombia [Internet]. 2018.\u003c/li\u003e\n \u003cli\u003eRegistro Especial de Prestadores de Servicios de Salud (REPS). Ministerio de Salud y Protecci\u0026oacute;n Social de Colombia. Registro de servicios de gastroenterolog\u0026iacute;a [Internet]. 2025.\u003c/li\u003e\n \u003cli\u003eInternational Agency for Research on Cancer (IARC). Helicobacter pylori eradication as a strategy for preventing gastric cancer [Internet]. Lyon; 2014\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the supplementary files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gastric cancer, Epidemiology, Risk factors, Helicobacter pylori, Early detection, Latin America","lastPublishedDoi":"10.21203/rs.3.rs-8475256/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8475256/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eGastric cancer remains a major cause of cancer-related morbidity and mortality worldwide, with a disproportionate burden in Latin America. Despite global declines, incidence and mortality remain high in several countries in the region, including Colombia. Comprehensive, population-based descriptions integrating epidemiological trends, risk factors, and early detection strategies are limited.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA sequential exploratory mixed-methods study was conducted. A structured literature review was performed to identify key risk factors and early detection strategies relevant to Latin America and Colombia. These findings informed us of a descriptive and comparative analysis of population-based epidemiological data. Regional estimates for Latin America were obtained from international cancer surveillance sources, and national and subnational data for Colombia (2020\u0026ndash;2024) were derived from administrative records. Incidence, prevalence, and mortality were analyzed as age-standardized rates per 100,000 inhabitants. Temporal trends and geographic variation were described without inferential statistical testing.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAcross Latin America, gastric cancer incidence and mortality showed marked geographic heterogeneity, with higher rates concentrated in countries along the Pacific rim, including Chile, Costa Rica, Peru, and Colombia. In Colombia, national incidence remained relatively stable between 2020 and 2024, while prevalence and mortality increased over time, with persistent high-burden departments identified. The literature review highlighted Helicobacter pylori infection as the predominant risk factor, along with dietary, lifestyle, and genetic determinants. No country in Latin America has implemented population-based gastric cancer screening; reported strategies focus on risk-based prevention, opportunistic detection, and surveillance of premalignant gastric lesions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eGastric cancer continues to impose a substantial and uneven burden across Latin America and within Colombia. The integration of population-based epidemiological data with contextual evidence on risk factors and early detection strategies underscores the relevance of risk-adapted approaches to gastric cancer control. These findings provide a regional evidence base to inform surveillance, research priorities, and the development of targeted prevention and early detection strategies in high-risk populations.\u003c/p\u003e","manuscriptTitle":"Gastric cancer burden, risk factors, and early detection strategies in Latin America and Colombia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 09:28:14","doi":"10.21203/rs.3.rs-8475256/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-12T12:50:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T22:12:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T17:38:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-27T16:02:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88199620735123968458888613274178335904","date":"2026-01-20T21:15:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251948195635666828175274038222432159172","date":"2026-01-15T22:58:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19404469409911177341714614584072046862","date":"2026-01-15T21:28:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-15T21:03:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-07T16:10:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-06T08:05:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-06T07:59:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-12-29T18:17:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d115bcb4-cee4-4c97-be99-e7f1ea14197c","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T19:09:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 09:28:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8475256","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8475256","identity":"rs-8475256","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}