Early-Onset Gastric Cancer in Brazil: Rising Hospitalizations and Persistent Regional Mortality Disparities
Martina de Sá, Vitório Serafim, Yasmin Marques Loureiro, Carolina Silva Fernandes, Rafaela Coelho PiresPURPOSE
Early-onset gastric cancer (EOGC, patients <50 years) is a distinct and aggressive clinical entity, often characterized by late-stage diagnosis and poor prognosis. In Brazil, despite the expansion of the public healthcare system (SUS), the specific impact of EOGC over the last quarter-century remains overlooked. This study critically evaluates the continuous 25-year trend (2000-2025) of EOGC hospitalizations and mortality, exposing a growing public health crisis and the failure to mitigate lethal regional inequities.
METHODS
We performed a retrospective longitudinal analysis of the National Hospital Information System (DATASUS) from 2000 to 2025. Data were extracted for hospitalizations and mortality rates related to malignant stomach neoplasms (ICD-10 C16) in individuals aged 0-49 years across all Brazilian macro-regions.
RESULTS
Between 2000 and 2025, Brazil recorded a total of 118,815 EOGC-related hospitalizations. The annual volume of admissions surged by 155%, rising from 2,283 in 2000 to 5,828 in 2025. Despite this massive increase in clinical demand, mortality outcomes have not only failed to improve but have worsened in the most vulnerable areas. The data reveals a catastrophic divergence in regional outcomes: the North region saw its mortality rate climb from 9.69 (in the 2000-2007 period) to a staggering 17.00 (in the 2008-2025 period), while the South maintained the lowest rate at 10.02. Nationally, mortality is highest in the 30-49 age cohorts, peaking at 13.02 in the 40-49 age group. This decoupling of rising hospitalizations from mortality reduction indicates that patients are entering an overburdened system too late, likely with metastatic disease.
CONCLUSION
The 25-year trajectory of EOGC in Brazil is a testament to systemic failure. The dramatic rise in hospitalizations without a concomitant drop in mortality—particularly the near-doubling of the death rate in the North—highlights a "postcode lottery" in cancer care. We argue that EOGC requires urgent, age-specific public health policies and a radical decentralization of oncology resources to address the geographic disparities that currently dictate survival.