The incidence and mortality of gastric cancer have significantly decreased in the US and globally over the past few decades. However, it remains a significant public health issue, ranking as the fourth most common cancer and the second leading cause of cancer-related deaths worldwide. The two main types of gastric cancer are distal (noncardia) and proximal (cardia) adenocarcinomas, with distinct demographic trends and risk factors. Distal gastric cancers are more prevalent in developing countries, among blacks, and in lower socio-economic groups, while proximal tumors are more common in developed countries, among whites, and in higher socio-economic classes. Helicobacter pylori (H pylori) infection and dietary factors are major risk factors for distal gastric cancer, whereas gastroesophageal reflux disease (GERD) and obesity play important roles in the development of proximal stomach cancer. The article reviews the epidemiology and risk factors of gastric cancer, emphasizing the need for primary prevention strategies targeting modifiable risk factors in high-risk populations.The incidence and mortality of gastric cancer have significantly decreased in the US and globally over the past few decades. However, it remains a significant public health issue, ranking as the fourth most common cancer and the second leading cause of cancer-related deaths worldwide. The two main types of gastric cancer are distal (noncardia) and proximal (cardia) adenocarcinomas, with distinct demographic trends and risk factors. Distal gastric cancers are more prevalent in developing countries, among blacks, and in lower socio-economic groups, while proximal tumors are more common in developed countries, among whites, and in higher socio-economic classes. Helicobacter pylori (H pylori) infection and dietary factors are major risk factors for distal gastric cancer, whereas gastroesophageal reflux disease (GERD) and obesity play important roles in the development of proximal stomach cancer. The article reviews the epidemiology and risk factors of gastric cancer, emphasizing the need for primary prevention strategies targeting modifiable risk factors in high-risk populations.