Nativity as a Clinical Variable in Gastric Cancer Prevention: An Immigrant Health Perspective

Marked differences in gastric cancer risk among immigrant populations have long been recognized, yet migration-related information remains underutilized in routine clinical care. Nativity is more than a demographic characteristic; it serves as a pragmatic surrogate for cumulative life-course exposures, including early-life environmental conditions, Helicobacter pylori acquisition, dietary patterns, and socioeconomic influences that shape gastric cancer risk long after migration. Although birthplace and exposure history are routinely incorporated into prevention strategies for conditions such as hepatitis B virus infection and latent tuberculosis, comparable approaches remain underdeveloped in gastric cancer prevention. This narrative review examines the epidemiologic, biologic, and clinical evidence supporting nativity as an important component of gastric cancer risk assessment in immigrant populations. We review evidence that gastric cancer risk declines after migration from high-incidence to low-incidence countries but does not fully converge with host-population levels, suggesting persistent effects of early-life exposures. We further discuss how declining H. pylori prevalence and increasing eradication rates may weaken the ability of current infection status alone to reflect cumulative carcinogenic exposure and lifetime risk. We argue that the principal challenge is increasingly one of implementation. Despite growing recognition of migration-related disparities, healthcare systems rarely capture or use nativity in ways that inform gastric cancer prevention. Incorporating nativity and migration history into electronic health records, clinical decision-support tools, and risk-stratification frameworks may help to identify high-risk individuals and support more equitable, risk-based prevention strategies. More broadly, this framework illustrates how life-course exposure history can be translated into actionable clinical care for increasingly diverse populations.