Gastric cancer is a significant global health issue, with over 1 million new cases diagnosed annually. Despite a decline in incidence and mortality over the past five decades, it remains the third leading cause of cancer-related death. Understanding its epidemiology and risk factors is crucial for gastroenterologists to make informed decisions about risk stratification, screening, and prevention. The article reviews the global burden of gastric cancer, its incidence and mortality trends, and risk factors. It highlights that gastric cancer is more common in older adults, with men having higher incidence rates than women. The highest incidence rates are found in Eastern Asia, while the lowest are in North America and Africa. Gastric cancer incidence has declined in many regions, including the U.S., but disparities persist. In the U.S., gastric cancer was the leading cause of cancer death until the late 1930s, and while incidence has decreased, survival rates remain poor. The article also discusses risk factors such as Helicobacter pylori infection, which is the main cause of gastric cancer, and other factors like smoking, low socioeconomic status, and diet. Prevention strategies include screening and eradication of H. pylori. Screening programs in countries like South Korea and Japan have shown effectiveness in reducing gastric cancer incidence. The article emphasizes the importance of H. pylori screening and eradication in preventing gastric cancer, noting that eradication can significantly reduce the risk. While population-based screening for H. pylori is cost-effective in high-risk regions, it may not be warranted in low-incidence areas like the U.S. The article concludes that further research is needed to identify high-risk populations for targeted screening in the U.S. to reduce gastric cancer burden.Gastric cancer is a significant global health issue, with over 1 million new cases diagnosed annually. Despite a decline in incidence and mortality over the past five decades, it remains the third leading cause of cancer-related death. Understanding its epidemiology and risk factors is crucial for gastroenterologists to make informed decisions about risk stratification, screening, and prevention. The article reviews the global burden of gastric cancer, its incidence and mortality trends, and risk factors. It highlights that gastric cancer is more common in older adults, with men having higher incidence rates than women. The highest incidence rates are found in Eastern Asia, while the lowest are in North America and Africa. Gastric cancer incidence has declined in many regions, including the U.S., but disparities persist. In the U.S., gastric cancer was the leading cause of cancer death until the late 1930s, and while incidence has decreased, survival rates remain poor. The article also discusses risk factors such as Helicobacter pylori infection, which is the main cause of gastric cancer, and other factors like smoking, low socioeconomic status, and diet. Prevention strategies include screening and eradication of H. pylori. Screening programs in countries like South Korea and Japan have shown effectiveness in reducing gastric cancer incidence. The article emphasizes the importance of H. pylori screening and eradication in preventing gastric cancer, noting that eradication can significantly reduce the risk. While population-based screening for H. pylori is cost-effective in high-risk regions, it may not be warranted in low-incidence areas like the U.S. The article concludes that further research is needed to identify high-risk populations for targeted screening in the U.S. to reduce gastric cancer burden.