# Stomach cancer serology screening for high-risk migrant communities in low-incidence countries

Source: https://onco.cc/ideas/idea-prev-gastric-serology-migrant-screening/  
OnCo record `idea-prev-gastric-serology-migrant-screening` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People who grew up in East Asia, Eastern Europe or Latin America keep a high stomach cancer risk after migrating. Cheap blood tests could select who needs an endoscopy.

## Summary

Pepsinogen I/II ratio plus H. pylori serology (the ABC method) stratifies gastric cancer risk in Japan. Western countries do not screen because average incidence is low, but first-generation migrants from high-incidence regions carry two- to five-fold risk. Propose targeted serological screening with endoscopy for high-risk groups.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Serology-directed endoscopy in first-generation migrants from high-incidence regions aged 50 and over yields early gastric cancer or high-grade dysplasia in at least 1% of endoscopies, comparable to Japanese and Korean programmes.
- Rationale: Risk follows birthplace and childhood H. pylori acquisition; the serology is cheap and validated.
- Proposed test: Pilot in 5,000 participants in a large migrant community (e.g. California, London); yield and cost per early cancer.
- Maturity: speculative
- Actor: clinic

## Sources

- Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022): https://doi.org/10.1126/science.aay9040

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- bottlenecks: [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- key papers: [Early detection of cancer](https://onco.cc/key-papers/paper-crosby-science/)

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