Stomach cancer screening: who is offered it, H. pylori tests, and what results mean
In the United States, there are no standard or routine screening tests for stomach cancer in people at average risk. (NCI, 2023) Some people at higher risk may be offered upper endoscopy, and AGA says testing for H. pylori infection should be considered in people at increased risk. (NCI, 2023)(AGA, 2025)
Why there is no routine screening in the US
No major medical organization in the US recommends routine screening for stomach cancer in people who are not at increased risk. ACS says this is largely because the disease is not common in the US, so the benefits of screening most likely would not outweigh the possible risks, such as needing further tests or procedures. (ACS, 2026) MedlinePlus says screening programs succeed in finding disease early in parts of the world where the risk is much higher, and that the value of screening in the United States is not clear. (MedlinePlus, stomach cancer) NCI notes that no randomized trials of screening and deaths from stomach cancer have been reported. (NCI PDQ, 2025) The USPSTF has no stomach or gastric cancer screening topic. (USPSTF topics)
Who may be offered screening
- AGA (2025): high-risk groups in the US who should be considered for screening include first-generation immigrants from high-incidence regions and possibly other non-White racial and ethnic groups, people with a family history of stomach cancer in a first-degree relative, and people with certain hereditary gastrointestinal polyposis or hereditary cancer syndromes. (AGA, 2025)
- NCI: some people at higher risk may benefit from screening with upper endoscopy, including older people with chronic gastric atrophy or pernicious anemia, people who have had a partial gastrectomy, people with a family history of stomach cancer, people with certain genetic syndromes, and people from countries where stomach cancer is more common. (NCI, 2023)
- ACS: the benefits might outweigh the risks for people with possibly precancerous stomach conditions, stomach polyps or pernicious anemia; inherited syndromes such as Lynch syndrome or familial adenomatous polyposis (FAP); close family members who have had stomach cancer; past stomach surgery; and first-generation immigrants from countries where the risk is higher. Some doctors might recommend upper endoscopy at regular intervals for these people. (ACS, 2026)
- Hereditary diffuse gastric cancer: ACS says regular thorough upper endoscopies might be an option for some people with a CDH1 or CTNNA1 gene change that causes this syndrome. Other options for this group are treatment decisions this page does not cover. (ACS, 2026)
If you have risk factors, ACS suggests talking with your doctor about the possible pros and cons of stomach cancer screening for you. (ACS, 2026) See family history: when screening starts earlier for how a relative's diagnosis can change screening.
Upper endoscopy
Upper endoscopy looks inside the esophagus, stomach and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope, a thin tube-like instrument with a light and a lens, is passed through the mouth and down the throat, and may have a tool to remove tissue that is checked under a microscope. (NCI, 2023) AGA says endoscopy is the best test for screening or surveillance in people at increased risk, because it allows direct viewing and biopsies. (AGA, 2025)
NCI lists these potential risks of screening: (NCI, 2023)
- False-negative results: results may look normal even though cancer is present, which may delay care even if there are symptoms.
- False-positive results: results may look abnormal when no cancer is present, which can cause anxiety and is usually followed by more tests and procedures that also have risks.
- Risks of endoscopy itself: rare but serious complications, including a small hole in the esophagus or stomach, heart problems, breathing problems, lung infection from inhaling food, fluid or stomach acid, severe bleeding that needs hospital treatment, and reactions to medicine used during the procedure.
H. pylori tests and what results mean
H. pylori is a common type of bacteria that infects the stomach lining. Most people with it never have symptoms. Without treatment, H. pylori gastritis can last a lifetime and increase the chance of developing stomach cancer. (MedlinePlus, H. pylori tests) The International Agency for Research on Cancer classifies H. pylori infection as a cause of noncardia gastric cancer. (NCI PDQ, 2025) AGA says testing for H. pylori should be considered in people at increased risk for stomach cancer, and in adult household members of people who test positive. (AGA, 2025)
- Breath test (urea breath test): you breathe into a container, swallow a pill or liquid containing urea with special carbon atoms, then give a second breath sample. If H. pylori is present, the special carbon atoms show up in the second sample. (MedlinePlus, H. pylori tests)
- Stool tests: antigen tests, the most common type, check the sample for proteins that come from H. pylori; PCR tests check for its genetic material. (MedlinePlus, H. pylori tests)
- Biopsy during endoscopy: if other tests do not give enough information, small tissue samples taken during endoscopy are tested for H. pylori. (MedlinePlus, H. pylori tests)
- Blood antibody tests: not commonly used to diagnose H. pylori, because they cannot show whether the antibodies come from a current infection or a past one. (MedlinePlus, H. pylori tests)
Before an H. pylori test, you may need to stop certain medicines for two weeks to a month, so tell your provider about every medicine you take. There is no known risk to breath or stool tests. (MedlinePlus, H. pylori tests)
- Negative (normal) result: you probably do not have an H. pylori infection. Your provider may order more tests to find the cause of any symptoms. (MedlinePlus, H. pylori tests)
- Positive result: you have an H. pylori infection. After treatment, your provider may order repeat tests to make sure the bacteria are gone. (MedlinePlus, H. pylori tests)
- Negative blood antibody test: usually means you did not have an infection when the sample was taken. (MedlinePlus, H. pylori tests)
After a screening endoscopy
- No atrophy, intestinal metaplasia or neoplasia found: AGA says the decision to continue screening should be based on a person's risk factors and preferences; ongoing screening should be considered with a family history of stomach cancer or multiple risk factors, and the best intervals are not well defined. (AGA, 2025)
- Severe atrophic gastritis, or multifocal or incomplete intestinal metaplasia: AGA says endoscopic surveillance should be considered every 3 years, though intervals are not well defined and shorter intervals may be advisable with multiple risk factors. (AGA, 2025)
- Dysplasia or early cancer: AGA advises referral to a center with expertise. This page does not cover treatment. (AGA, 2025)
- Stopping: AGA says only people fit for endoscopic or possibly surgical treatment should be screened, and screening and surveillance should stop when a person is no longer fit for it. (AGA, 2025)
MedlinePlus, when to contact a medical professional: (MedlinePlus, stomach cancer)
- Contact your health care provider if you develop symptoms of gastric cancer.
Screening by age: US, South Korea and Japan
| Program | Who | Test | How often |
|---|---|---|---|
| United States, average risk | No routine screening is recommended for people who are not at increased risk. (ACS, 2026) (NCI, 2023) | None | Not applicable |
| United States, increased risk (AGA 2025) | First-generation immigrants from high-incidence regions and possibly other non-White racial and ethnic groups, a first-degree relative with stomach cancer, certain hereditary polyposis or cancer syndromes. (AGA, 2025) | Upper endoscopy; H. pylori testing considered | After a first endoscopy with no atrophy, metaplasia or neoplasia, continuing depends on risk factors and preferences; optimal intervals are not well defined. |
| South Korea, national program | Adults aged 40 and older. (Korea NCSP review, 2025) | Endoscopy or selective upper gastrointestinal series | Every 2 years |
| Japan, national program | Since the revised 2014 guidelines: people over age 50 (before that, over age 40). (Japan review, 2022) | Endoscopy added to radiographic (barium) screening | Every 2 years (before that, once a year) |
Where they differ:
- US (ACS, NCI, USPSTF): no routine screening for people at average risk; the USPSTF has no topic on it. (ACS, 2026)(NCI, 2023)(USPSTF topics)
- AGA (US, 2025): identifies high-risk groups who should be considered for endoscopic screening and H. pylori testing, without a set starting age. (AGA, 2025)
- South Korea: the national program screens all adults aged 40 and older every 2 years. (Korea NCSP review, 2025)
- Japan: a national program of barium X-ray screening has run since the 1960s, with participation of only 10% to 20%. (NCI PDQ, 2025) Since 2014, endoscopy is a recommended method, every 2 years over age 50. (Japan review, 2022)
Your doctor decides what your result means for you.
This page does not give treatment advice. If you have an abnormal result, see after an abnormal screening result for questions to ask.
Questions people ask
Is there a routine stomach cancer screening test in the US?
No. In the United States, there are no standard or routine screening tests for stomach cancer in people at average risk, and no major medical organization recommends routine screening for people who are not at increased risk. (NCI, 2023) (ACS, 2026)
Who may be offered stomach cancer screening?
AGA (2025) says high-risk groups who should be considered for screening include first-generation immigrants from high-incidence regions and possibly other non-White racial and ethnic groups, people with a first-degree relative with stomach cancer, and people with certain hereditary polyposis or cancer syndromes. NCI also lists older people with chronic gastric atrophy or pernicious anemia and people who have had part of the stomach removed. (AGA, 2025) (NCI, 2023)
What test is used to screen for stomach cancer?
AGA says endoscopy is the best test for screening or surveillance in people at increased risk. In upper endoscopy, a thin lighted tube is passed through the mouth to look at the esophagus, stomach and first part of the small intestine, and tissue may be removed to check under a microscope. (AGA, 2025) (NCI, 2023)
What do H. pylori test results mean?
MedlinePlus says a negative (normal) result means you probably do not have an H. pylori infection, and a positive result means you have an H. pylori infection. A blood antibody test cannot show whether antibodies come from a current or a past infection. (MedlinePlus, H. pylori tests)
At what age do Korea and Japan screen for stomach cancer?
South Korea's national program offers endoscopy or a selective upper gastrointestinal series every 2 years from age 40. In Japan, the revised 2014 guidelines changed screening from once a year over age 40 to once every 2 years over age 50. (Korea NCSP review, 2025) (Japan review, 2022)