Gastroscopy in Korea: A Cancer Screening Many Americans Miss

The Screening Gap

In the United States, the population-average stomach cancer incidence rate is low. The average obscures substantially higher risk in some populations. A 2020 Gastroenterology analysis (Shah et al., Vanderbilt) of US adults aged 50 and over found non-cardia gastric cancer incidence of approximately 49 per 100,000 in Korean Americans, 24 in Vietnamese, 19 in Japanese, 18 in Chinese, 14 in Hispanic, and 11 in non-Hispanic Black Americans — compared with 3.7 in non-Hispanic Whites. In the same group, Korean American men carried 12.0-fold higher risk and women 14.5-fold higher risk versus non-Hispanic Whites.

There is no routine screening program for stomach cancer in the United States; gastroscopy is generally ordered when symptoms appear. In Korea, gastroscopy is part of the standard health checkup. No referral or prescription is required, and it can be added to a checkup for around $150.

For me, this is personal. My paternal grandfather died young, before I was born. In 1960s–70s Korea, given the country's economic conditions and my family's circumstances, a proper diagnosis was rare. My father believes he died of stomach cancer. I get a gastroscopy every year.

 

 

In 2023, at SCH Seoul’s health checkup center, I was waiting for my upper endoscopy after being assessed for sedation eligibility. At the time, we were already preparing to introduce Korean health checkups to the U.S. market, and SCH Seoul became the very first checkup center we introduced.

 

 

Korea

In February 2026, I met with Heejoon Kim, MD — a high school friend, Director of Yoomin Internal Medicine, Board-Certified Specialist in Gastrointestinal Endoscopy with over 20,000 endoscopic procedures, and an instructor for other endoscopists — to ask what distinguishes Korean gastroscopy. His answer was direct: few countries perform gastroscopy at Korea's scale, and that volume, sustained year after year across thousands of endoscopists, produces a level of operator skill that is hard to find elsewhere.

Stomach cancer has long been among Korea's most common cancers, and since 2002 the National Cancer Screening Program — administered by the National Health Insurance Service (NHIS, 국민건강보험공단) — has funded biennial gastroscopy for every adult 40 and older, at little or no cost. Participation rose from 39.2% in 2004 to 77.5% in 2023, and since 2018 endoscopy has been the only primary screening method (Korean National Cancer Screening Survey, 2023).

The outcomes reflect this. Korea's gastric cancer 5-year survival rate is 77.5%, compared to 35.7% in the United States (KCCR 2015–2019; SEER 2013–2019). Korea's mortality-to-incidence ratio is 0.24 — the lowest among major comparison countries (Cancer Statistics in Korea, 2022). The gap is closely associated with early detection through screening.

 

 

Comparison

* While no referral is required, all patients undergo a pre-procedure health assessment to confirm they are fit for gastroscopy, in accordance with standard safety protocols.

 

 

What a Gastroscopy Can Find

A gastroscopy directly visualizes the lining of the esophagus, stomach, and duodenum, and can biopsy or treat findings in the same session.

• Helicobacter pylori infection — the Group 1 carcinogen (IARC, 1994) linked to 75–80% of stomach cancers. Tested during the procedure; eradication therapy reduces long-term gastric cancer risk by 30–40%.
• Stomach cancer — often asymptomatic at early stages. Localized detection carries substantially higher 5-year survival than late-stage detection.
• Atrophic gastritis and intestinal metaplasia — precancerous conditions that can progress over years if undetected.
• Peptic ulcers and Barrett's esophagus — conditions that may need monitoring or treatment.

When lesions are found in Korea, biopsies and removal of small polyps or early lesions (endoscopic mucosal resection) typically occur in the same session, with tissue sent for pathology. If a polyp or early lesion is removed, a wait of about two weeks before flying is generally recommended.

 

 

SNU Gangnam Center’s endoscopy center. Because sterilization is critical, the space is carefully separated. I took this photo while waiting for my upper endoscopy in April 2026.

 

 

Image from Yonsei Mirae IFC’s official website, with Korean text translated by AI. Yonsei Mirae has a strong GI endoscopy team, and its endoscopy equipment is carefully cleaned and disinfected under strict infection prevention protocols

 

 

Quality & Safety

Gastroscopy is a routine procedure at major Korean health checkup centers, performed under standard endoscopy protocols. Serious complications are uncommon for diagnostic gastroscopy — bleeding in fewer than one in 1,000 cases, perforation in fewer than one in 10,000 — though risks rise modestly when biopsies or endoscopic resection are performed.

For volume context: Hanshin Medipia, one of Himedi's checkup partners, performed 66,559 endoscopy procedures (upper and lower combined) in the past year. Partner centers operate current-generation systems such as the Olympus EVIS EXERA III (CV-290), a high-end system that provides clearer, more detailed imaging.

 

 

A Different Approach to Preventive Screening

In the United States, gastroscopy is reserved for symptomatic patients or those identified as high-risk. In Korea, gastroscopy is the entry point — a routine part of preventive care rather than a follow-up after symptoms.

A gastroscopy with no significant findings typically does not need to be repeated for two to three years for elevated-risk individuals. For Americans already planning a trip to Korea — particularly those with elevated risk from heritage or family history — adding a gastroscopy to a checkup may be more accessible and conclusive than the US referral pathway.

Interested in booking a gastroscopy in Korea? Contact Himedi to get started.

 

 

About the Author

Donkyo Seo
Co-founder & CEO, Himedi

For the past 9 years, Donkyo has helped international patients navigate Korean healthcare. Himedi is licensed by Korea's Ministry of Health & Welfare (License #A-2016-01-01-2345). 

 

 

Sources

Stomach cancer disparity by ethnicity Shah SC, McKinley M, Gupta S, Peek RM Jr, Martinez ME, Gomez SL. "Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Age 50 Years and Older." Gastroenterology, 2020;159(5):1705–1714. PMID: 32771406. (Non-cardia gastric cancer incidence by ethnicity in adults aged 50 and over: Korean Americans 49 per 100,000 vs non-Hispanic Whites 3.7; Korean American men 12.0-fold and women 14.5-fold higher risk.)

Stomach cancer statistics American Cancer Society. Cancer Facts & Figures 2026. National Cancer Institute, SEER Program. Cancer Stat Facts: Stomach Cancer. 5-year relative survival rate: 35.7% (U.S., 2013–2019).

Korea screening data Korean National Cancer Screening Survey, 2023. Stomach cancer screening rate: 77.5% in 2023, up from 39.2% in 2004. Hong S, Lee YY, Lee J, Kim Y, Choi KS, Jun JK, Suh M. "Performance of the National Cancer Screening Program for Gastric Cancer in Korea." Korean Journal of Helicobacter and Upper Gastrointestinal Research, 2024. Park SH, Kang MJ, Yun EH, Jung KW. "Epidemiology of Gastric Cancer in Korea: Trends in Incidence and Survival Based on Korea Central Cancer Registry Data (1999–2019)." Journal of Gastric Cancer, 2022;22(3):160–168. 5-year relative survival rate: 77.5% (Korea, 2015–2019). Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2022. Cancer Research and Treatment, 2025. Mortality-to-incidence ratio for gastric cancer: 0.24, lowest among major comparison countries.

US gastric cancer screening guidelines National Cancer Institute. Stomach (Gastric) Cancer Screening (PDQ®) — Health Professional Version. Shah SC, Wang AY, Wallace MB, Hwang JH. "AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States." Gastroenterology, 2024.

Helicobacter pylori International Agency for Research on Cancer (IARC). Schistosomes, Liver Flukes and Helicobacter pylori. IARC Monographs Vol. 61, 1994. Group 1 carcinogen classification. Lee YC, Chiang TH, Chou CK, et al. "Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis." Gastroenterology, 2016;150(5):1113–1124. Eradication associated with approximately 30–40% reduction in gastric cancer incidence.

Subspecialty certification Korean Society of Gastrointestinal Endoscopy (KSGE). Subspecialty Certification (소화기내시경 세부전문의) Guidelines and Renewal Requirements. Minimum 1,000 upper GI endoscopies + 300 colonoscopies, written and oral examinations, 5-year renewal cycle.

US gastroenterology access AMN Healthcare. 2025 Survey of Physician Appointment Wait Times. Average new-patient wait for a gastroenterologist: 40 days, range 1–208 days, across 15 major US metropolitan areas. (Gastroenterology was added to the survey for the first time in 2025.)

US gastroscopy cost GoodRx; Healthcare Bluebook. Diagnostic upper endoscopy without insurance: $1,500–$3,000 typical out-of-pocket range.

Hanshin Medipia volume Hanshin Medipia, internal procedure data. Past 12-month endoscopy procedures: 66,559.