70 A recent study by the Korean Gastric Cancer Association has shed light on the evolving risk factors associated with gastric cancer, emphasising the necessity for lifestyle modifications to mitigate these risks. Published in the Journal of Gastric Cancer, the study presents a comprehensive analysis of various risk factors, distinguishing between cardia and non-cardia gastric cancer types, and offers insights into effective prevention strategies. Gastric cancer remains a significant global health issue despite a steady decline in its incidence over the past 50 years. In 2020, over one million people worldwide were diagnosed with gastric cancer, accounting for 5.6% of all cancer cases. Notably, the incidence of gastric cancer shows significant regional and economic disparities, with higher rates observed in East Asia and Central and Eastern Europe. Males are disproportionately affected, with a cumulative lifetime risk of 1.87% compared to 0.79% for females. The study identifies Helicobacter pylori infection as the most significant risk factor for gastric cancer, particularly non-cardia gastric cancer. H. pylori, a gram-negative bacterium classified as a Group 1 carcinogen by the World Health Organization, increases the risk of gastric cancer by 2.9 times. The infection, prevalent in about 44% of the global population, directly affects gastric epithelial cells and induces inflammatory reactions that promote cancer development. However, the study notes that the correlation between H. pylori infection and gastric cancer is more pronounced in East Asia compared to Western regions . Smoking and alcohol consumption are highlighted as significant risk factors for gastric cancer, irrespective of anatomical location. Smoking increases the risk of gastric cancer by 1.5 to 2.5 times, with a dose-response relationship observed between smoking duration, the age of initiation, and daily cigarette consumption. Similarly, alcohol consumption, through the carcinogenic metabolite acetaldehyde, disrupts DNA methylation and induces mutations that lead to cancer. The study indicates that heavy alcohol consumption is associated with a higher risk of both cardia and non-cardia gastric cancers . Dietary factors also play a crucial role. High salt intake, particularly from processed and pickled foods, is strongly linked to non-cardia gastric cancer. The study explains that excessive salt can generate carcinogenic N-nitrosamines, damaging gastric cells and promoting H. pylori colonisation. Conversely, a diet rich in fresh fruits and vegetables, which are high in antioxidants, can mitigate this risk. Processed meats, containing high levels of salt, nitrites, and nitrates, are also associated with an increased risk of gastric cancer due to the formation of N-nitrosamines during processing and cooking . Obesity is identified as a significant risk factor for cardia gastric cancer. The study explains that obesity leads to increased levels of hormones such as leptin and insulin, which disrupt normal cell functions and promote cancer growth. Additionally, exposure to certain chemicals and radiation is associated with an increased risk of gastric cancer. Occupations involving exposure to high-temperature processes, metals, and radiation from sources such as X-rays and gamma rays are particularly high-risk. While most gastric cancers occur sporadically, familial aggregation is observed in about 10% of cases, with hereditary diffuse gastric cancer accounting for less than 3%. The study underscores the importance of considering both genetic and environmental factors in regions with high gastric cancer incidence. The association between family history and gastric cancer is stronger for non-cardia types compared to cardia types. Primary prevention of gastric cancer involves eliminating or reducing exposure to risk factors. The study advocates for H. pylori eradication, quitting smoking, reducing alcohol consumption, maintaining a healthy weight, and adopting a low-salt diet. Recent meta-analyses indicate that eradicating H. pylori can reduce the risk of gastric cancer by approximately 50%, even among asymptomatic individuals. Lifestyle modifications, such as following a balanced diet rich in fruits and vegetables and avoiding processed and high-salt foods, are emphasised as critical preventive measures.