Women under age 50 diagnosed with stomach cancer have poorer outcomes than men in the same age group, according to a new study by researchers at Seoul National University Bundang Hospital.
The research team, led by Drs. Nayoung Kim and Yong Hoon Choi of the hospital’s Department of Gastroenterology, analyzed data from 14,739 patients diagnosed with stomach cancer at the hospital between 2003 and 2023.
According to South Korea’s 2023 National Cancer Registry statistics, stomach cancer ranks as the fourth most common cancer among men and the fifth most common among women. However, the clinical characteristics and prognosis of stomach cancer in women remain unclear, with previous studies producing mixed findings. Some have reported higher survival rates among women, while others found worse outcomes in younger women and patients with advanced disease.
To investigate further, the researchers examined differences in survival rates by sex, age, cancer stage and tumor subtype, taking into account hormonal changes across a woman’s lifespan.
The analysis found no significant overall difference between men and women in gastric cancer-specific survival, which measures deaths directly attributable to stomach cancer.
However, age-based analysis revealed a different pattern. Among patients younger than 50, women had lower survival rates than men. In contrast, women age 60 and older tended to have better survival outcomes than their male counterparts.
The researchers attributed much of the difference to variations in tumor subtype.
Women were more likely than men to develop diffuse-type gastric cancer, in which cancer cells spread throughout the stomach wall. The disparity was particularly pronounced among patients younger than 50.
Diffuse-type gastric cancer is generally more difficult to detect at an early stage and is associated with poorer outcomes than intestinal-type gastric cancer, the more common subtype.
Among men, the proportion of diffuse-type tumors declined rapidly with age, with intestinal-type cancers accounting for more than 60% of cases beginning in patients’ 50s. Among women, the decline was more gradual, reaching similar levels only in patients in their 70s.
The researchers said estrogen may play a role in these differences. Previous studies have suggested that estrogen alpha receptors are associated with the development and progression of diffuse-type gastric cancer, while estrogen beta receptors may help suppress intestinal-type tumors.
“The prognosis of stomach cancer should be evaluated not only by sex but also by considering factors such as age and tumor subtype,” Kim said. “Women younger than 50 show a higher prevalence of diffuse-type gastric cancer and more advanced disease characteristics, highlighting the need for more proactive screening and management.”
She added that women younger than 40 are currently excluded from South Korea’s national stomach cancer screening program.
“Discussions are needed on lowering the eligibility age for national screening or providing support for Helicobacter pylori testing to identify high-risk individuals,” Kim said.
The findings were published in the international journal Cancer Research and Treatment.
