Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate. TheAsian population of the United States (US) is growing rapidly and over 17 million Americans are of Asian descent.A majority of Chinese, Korean and Vietnamese Americans are immigrants. Americans of East and SoutheastAsian descent experience marked gastric cancer disparities and the incidence rate among Korean men in the USis over five times higher than the incidence rate among non-Hispanic white men. Randomized controlled trialshave provided evidence for the effectiveness of helicobacter pylori identification and eradication in preventinggastric cancer. Additionally, Japan and South Korea have both experienced improvements in gastric cancermortality following the implementation of programs to detect early stage gastric cancers. There are currently noclear US guidelines regarding the primary and secondary prevention of gastric cancer in high-risk immigrantpopulations. However, it is likely that a proportion of US physicians are already recommending gastric cancerscreening for Asian patients and some Asian immigrants to the US may be completing screening for gastriccancer in their native countries. Surveys of US primary care physicians and Asian American communities shouldbe conducted to assess current provider practices and patient uptake with respect to gastric cancer preventionand control. In the absence of clinical guidelines, US health care providers who serve high-risk Asian groupscould consider a shared decision-making approach to helicobacter pylori identification and eradication, as wellas gastric endoscopy.