Gastric cancer is one of the most common cancers worldwide. Gastric cancer is a multifactorial disease, and the incidence varies widely by geographic region, with half of new cases occurring in East Asia. Population-based nationwide screening for gastric cancer has been implemented in some Eastern Asian countries such as South Korea and Japan. In these countries, endoscopic screening decreased gastric cancer mortality. Endoscopic screening seems to be a cost-effective modality in countries with high incidence of gastric cancer. However, the usefulness of population-based screening has not yet been proved in countries with low incidence of gastric cancer.