The real reasons for the surge in stomach cancers among the under-50s: Experts say these are the risk factors you need to know - and warn that the early symptoms are frighteningly easy to dismiss...

Just three months before she died from stomach cancer at the age of 34, influencer Carly Douglas shared a tearful but defiant message with her 140,000 Instagram followers.

Revealing her diagnosis after being rushed to hospital with extreme abdominal pain and bloating, she told them: ‘Cancer picked the wrong girl.’

At the time – March 24 – there had been little hint of what was to come. Weeks earlier she had been posting videos of herself doing pull-ups in her home gym, alongside snapshots of everyday life as a mother-of-three in Greenville, South Carolina.

Thousands flooded her page with messages of hope and prayer, but the news of her death earlier this month sent shockwaves through her online community.

But her story is far from an isolated tragedy, and instead points to a worrying trend that doctors say is emerging across the UK and the US.

Douglas is one of a growing number of young people being diagnosed with stomach cancer – a disease that until recently was thought to be in steady decline.

From the 1970s onward, cases fell sharply, largely driven by improvements in diet and food preservation. But now, alarmed experts say the trend is reversing, with diagnoses rising in under-50s for reasons that are still not fully understood.

Charities say that it is a trend they have certainly noticed in recent years.

‘I have been involved in this area for a decade, and when I started I would often speak to children whose parents had been diagnosed, but now it is almost entirely people aged 30 to 50 who have the disease,’ says Sheena Dewan, director of Stomach Cancer UK.

‘Big NHS cancer hospitals are now setting up specialist units to deal with the rise in young people with stomach cancer.’

Part of the danger lies in how easily the early warning signs can be dismissed.

Bloating after even a small meal, persistent indigestion and nausea are often explained away as minor digestive issues – until it is too late. Left undetected, the cancer can silently invade deep into the stomach wall before spreading elsewhere in the body.

And once it does, the outlook is bleak. Overall, just 37 per cent of patients survive for five years after being diagnosed.

For those like Carly Douglas, diagnosed at stage 4, the most advanced stage, that figure falls to less than 8 per cent. Experts say that improving those odds depends heavily on one thing – catching the disease early.

But with symptoms so vague and easily overlooked, many are diagnosed only after the cancer has already taken hold, raising urgent questions about how this once-declining disease is now slipping through the net.

So why is stomach cancer on the rise again, why are younger people being hit so hard and what are the early warning signs to watch out for?

First, it is important to understand the history of the disease.

Stomach cancer was one of the major causes of cancer death in the late 19th century.

But from the mid-20th century onwards, rates fell dramatically – largely because the biggest causes of the disease began to disappear.

One of the most important was a bacterium called Helicobacter pylori, which infects the stomach lining and is the single biggest risk factor for the cancer. Hygiene improved and antibiotics became widely used, so infection rates dropped sharply – cutting the long-term inflammation that can trigger tumours.

At the same time, the way people ate changed. Before widespread refrigeration, many relied on smoked, salted and pickled foods to preserve meat – all of which are known to damage the stomach lining and raise cancer risk. Tobacco is another established risk factor, and as fewer people smoked in the late 20th century, rates of stomach cancer fell further.

Together, these changes drove one of the most dramatic declines seen in any major cancer – with death rates falling by more than 80 per cent since the 1970s.

Today, stomach cancer is the 16th most common cause of cancer death in the UK – and in the US.

California-based gastroenterologist Dr Yanghee Woo says she has witnessed the concerning shift in her own practice.

Read More

‘Unfortunately, a large percentage of our patients that come to see us are very young – in their 20s, 30s, 40s, with young children,’ she says.

‘These patients are otherwise healthy in the prime of their lives. They’re studying, progressing in their careers, raising young families – and they simply never imagined they could have cancer.’

Could modern diets and lifestyles be behind the rise? Some research suggests so.

Studies have linked diets high in ultra‑processed foods – which now make up around half of the average UK diet – with a higher risk of several cancers, though the evidence for stomach cancer specifically is still emerging.

One possible explanation is the use of salt.

High salt intake, potentially attributable to eating processed foods, is known to damage the stomach lining and has been consistently linked to an increased risk of stomach cancer.

Alcohol also plays a role. Research suggests that drinking heavily – roughly three or more drinks a day – is linked to an increased risk of stomach cancer, with the strongest evidence seen at higher levels of intake.

More broadly, experts say that there is no completely safe level of alcohol when it comes to cancer – with the risk increasing gradually even at lower levels of consumption.

Some researchers have also pointed to a more unexpected factor: antibiotics.

Widespread antibiotic use helped reduce H. pylori infections, contributing to the disease’s long decline. But some experts now suggest this may have had unintended consequences.

‘We are seeing an increased risk of this cancer in people born after 1950, and that coincides with the introduction of antibiotics,’ says Dr Constanza Camargo, a researcher at the National Cancer Institute in the US.

One theory is that, while antibiotics can eliminate harmful bacteria such as H. pylori, they may also disrupt the delicate balance of microbes in the gut, potentially altering cancer risk in ways that scientists are only beginning to understand.

This community of microbes – called the microbiome – plays a crucial role in regulating inflammation and protecting the stomach lining. When it is thrown off balance, it may create an environment in which cancer is more likely to develop.

Whatever the underlying cause, one thing is clear: stomach cancer is often detected far too late.

Dr Woo warns that many patients live with symptoms for months, or even years, before seeking help.

‘Most of the patients had symptoms for quite some time,’ she says. ‘But they either ignored them or assumed it was something benign, like acid reflux.’

Early warning signs can be vague and easy to dismiss, including persistent abdominal pain, bloating and frequent burping. Rather than triggering alarm, these symptoms are often brushed off as stress, diet or minor digestive issues.

Instead of noting anything sudden or dramatic, many patients simply report a lingering sense that something is ‘off’ – a low‑level discomfort that gradually worsens over time.

Cancer specialist Dr Amar Rewari, based in Maryland in the US, says that by the time younger patients reach him the disease has frequently progressed. They may be struggling to swallow, vomiting regularly, losing significant weight or suffering from severe fatigue caused by iron deficiency. Some may also report black stools – a sign of dangerous internal bleeding.

Read More

For many, the biggest barrier to diagnosis is age. Patients and doctors alike often assume they are too young to develop cancer – an assumption Dr Woo describes as ‘very valid’ as it is still more commonly seen, in terms of numbers, in older people – which can delay vital testing.

This was the case for Chloe Sterling, from Liverpool, whose stomach cancer was initially mistaken for heartburn. The 31-year-old nurse waited 18 months, during which she also developed stomach and back pain, before she was finally checked for cancer.

Her treatment started straight away. It included chemotherapy and a seven-hour total gastrectomy – the full removal of her stomach.

‘They said it would be in my best interests to remove the entire stomach – and my mindset was that I wanted the cancer out of my body,’ says Chloe.

‘I would do anything to be alive, so I thought, I’ve got no choice – I just thought I’ve got to get through it.’

After the surgery, she was in intensive care for three days before starting on the long road to recovery, which included having to learn how to eat again.

Today, Chloe is cancer-free, but receiving regular check-ups to ensure it has not returned.

‘I do feel lucky that without my medical background I definitely would not have been so persistent or known exactly which tests to ask for, which meant it was caught early,’ says Chloe.

A similar pattern played out for Steven Kopacz, a drummer who at first put his persistent stomach pain down to nerves or a possible ulcer. When the pain refused to go away, he sought medical help – and was diagnosed at 33 with stage 3 gastric cancer. He has since had his stomach removed and is undergoing chemotherapy.

Stories such as these, doctors say, highlight a troubling pattern: symptoms that appear mild, patients who seem too young to be at risk – and diagnoses that come far too late.

Despite the grim statistics, specialists say there are reasons for cautious optimism.

A growing body of research suggests more cases are now being caught earlier, when they are far easier to treat.

One recent study found that, between 2004 and 2021, the number of stomach cancers diagnosed at an early stage rose by more than 50 per cent, while late-stage diagnoses declined.

Doctors say advances in both detection and treatment are beginning to shift the outlook for patients.

Greater awareness of cancer in younger people – among both patients and doctors – may also be helping more cases to be picked up sooner.

And, crucially, the treatment landscape itself has changed dramatically. In addition to traditional surgery, chemotherapy and radiotherapy, doctors now have access to targeted therapies that home in on specific genetic features of a tumour.

There are also immunotherapy drugs that help the immune system recognise and attack cancer cells.

These newer treatments are already improving outcomes for some patients.

Researchers are also testing combinations of therapies – alongside vaccines and personalised approaches based on a specific tumour – raising hopes that survival rates will continue to improve.

‘I do want people to know that treatments at all stages have got better,’ Dr Woo says.

‘A diagnosis does not necessarily mean it is terminal.

‘In the past, this was a very difficult cancer to treat. But we now have excellent targeted drugs and other methods that can be used to fight it.’