The underestimated global burden and projections of early-onset stomach and early-onset esophageal cancers
I commend the authors of the recent study on the global, regional, and national burden of gastrointestinal (GI) cancers in early onset and young women from 1990 to 2021 (1). This study offers invaluable insights into the epidemiology of GI cancers and highlights significant trends and disparities across regions and countries. The authors’ findings, which reveal that the highest burden of colorectal and gastric cancers in young women along with the marked regional variations, contribute to an important understanding of the growing challenge posed by GI cancers in early life (1).
However, while the authors’ analysis provides a robust understanding of global trends, there are several additional considerations and emerging concerns that could enrich the discussion and help to shape future public health strategies. In particular, the increasing burden of early-onset stomach cancer (EOSC) and early-onset esophageal cancer (EOEC) in young women demands further attention. These cancers are displaying a distinct epidemiological pattern that is increasingly divergent from the general trends seen in older populations.
It is important to highlight that persistently high incidence of EOSC in high-income countries, despite declining trends in older populations, is a critical issue that warrants further investigation. To complement the sociodemographic index (SDI)-stratified Global Burden of Disease (GBD) 2021 analysis, we examined International Agency for Research on Cancer (IARC) GLOBOCAN 2022 incidence and projections stratified by human development index (HDI) (2). Early-onset gastric cancer has become an alarming and distinct entity, primarily affecting younger populations in regions with high HDI. According to these data from GLOBOCAN 2022, the incidence of EOSC has increased in high-HDI countries, with age-standardized rates (ASR) reaching 1.5 per 100,000 in 2022. In contrast, low-HDI countries exhibit an ASR of only 0.85 per 100,000, signaling a clear disparity in the global burden of this cancer. While high-HDI regions benefit from better healthcare infrastructure and screening programs, the persistent rise in EOSC in these countries suggests a “shift” in underlying risk factors, such as obesity, dietary habits, and changes in the microbiome, which deserve further exploration (3,4).
The increasing incidence of EOSC is not confined to high-income nations alone. In low- and middle-HDI regions, projections indicate a substantial increase in cases by 2045, driven primarily by population growth rather than rising risk factors. Specifically, the incidence in low-HDI countries is expected to double by 2045, emphasizing the importance of developing region-specific prevention and early detection strategies. The rising prevalence of obesity, dietary shifts, and the changing landscape of Helicobacter pylori (H. pylori) infection, combined with genetic predispositions, may all contribute to this unexpected rise in early-onset gastric cancer.
Similarly, EOEC, defined as esophageal cancer diagnosed before the age of 50, has emerged as a growing concern. Global estimates indicate 45,399 new cases of EOEC in 2022, with the highest burden in middle-HDI regions. Projections for 2045 suggest that EOEC incidence will more than double in low-HDI countries, with a 40% increase expected in middle-HDI regions. Conversely, high-HDI regions are expected to see a decline in EOEC incidence. These projections underscore the widening global disparities in the burden of EOEC, driven by demographic factors and differing access to healthcare.
The rising burden of EOEC in middle- and low-HDI regions is a multifactorial issue, with tobacco use, alcohol consumption, and limited access to early detection contributing significantly to the increasing incidence (5,6). These cancers, which are often diagnosed at later stages in these regions, underscore the pressing need for early screening programs, better diagnostic tools, and improved treatment access in areas with fewer resources. The effectiveness of these interventions could be substantially enhanced by tailoring them to the specific risk factors prevalent in each region.
From a global perspective, both EOSC and EOEC illustrate a concerning trend in which the burden of early-onset cancers is increasingly concentrated in lower-HDI countries (2). The projected increase in the incidence and mortality of these cancers in these regions highlights the urgent need for a comprehensive, region-specific approach to cancer prevention, diagnosis, and treatment. The growing disparity in the global burden of these cancers demands a concerted effort to address the structural inequities that limit access to healthcare, particularly in low- and middle-income countries.
While the study provides important insights into the epidemiology of GI cancers in young women, it is critical to emphasize the importance of early detection and prevention strategies that are tailored to regional needs. In high-HDI countries, strategies should focus on understanding the role of dietary changes, microbiome alterations, and other lifestyle factors in the rise of early-onset gastric and esophageal cancers. In contrast, in low- and middle-HDI regions, the focus should be on improving healthcare access, implementing screening programs, and addressing the rising prevalence of risk factors such as tobacco use and obesity. Additionally, improving public awareness through education campaigns is crucial in all regions, as early detection significantly improves cancer outcomes.
The rising burden of GI cancers in young women also highlights the need for a renewed focus on research into the genetic and molecular mechanisms that underlie these diseases. Understanding the biological underpinnings of early-onset cancers could lead to the development of more targeted therapies and personalized treatment strategies, which would ultimately improve survival rates and quality of life for affected women. Furthermore, greater emphasis on maternal and child health is necessary, as the health of young women directly impacts the broader community, including reproductive outcomes.
In conclusion, the study’s findings, which show a significant burden of GI cancers in early-onset and young women, reflect a growing public health challenge. The rising incidence of EOSC and EOEC, particularly in high-HDI countries, coupled with the projected increases in low- and middle-HDI regions, highlights the need for region-specific cancer control strategies. The global burden of these diseases calls for more tailored interventions, enhanced surveillance, and greater investment in research. Addressing the growing disparities in cancer outcomes will require both national and international efforts to ensure equitable access to healthcare and improve outcomes for young women affected by GI cancers.
Acknowledgments
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Footnote
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Funding: None.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-2026-1-0113/coif). The author has no conflicts of interest to declare.
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