Background: GC is the 4th cause of cancer death worldwide and is associated with significant morbidity in the affected individuals. In the US, California has the highest number of GC cases per year. We designed a study to explore the disparities in the presentation and outcome of GC in the Asians. Methods: Using data from CCR, we investigated the GC incidence, presentation, and survival among Asians from 2000-2010. We explored the significance of race in the anatomic presentation and survival of GC in the Asians compared to non-Hispanic Whites (NHW). We identified 18,377 GC cases in this time period, 70% were NHW, 8% Chinese, 7% Korean and 5% Japanese, the rest included Filipino, Vietnamese and other Asian sub-groups. Results: The frequency of GC by anatomical sites were statistically significantly different between Asians and NWH for both males and females (p<0.001). Compared to NHW, Asians had significantly lower frequency of cardia and fundus cancers (44% in NHW and 14% in Asians). Asians presented at a younger age (p <0.001) and had lower rates of de-novo metastatic disease compared to NHW (p <0.001). Survival rates were higher in Asians compared to NHW when adjusted for age, gender, socio-economic status, nativity, stage, anatomical site, and type of treatment received. Prognostic factors for death from gastric cancer included age > 65 and immigration status, with immigrants doing better than US born. There was significant amount of disparity among Asians form different countries, Koreans had the highest age adjusted incidence rate of GC compared to all other Asians. Conclusions: The differences in the demographics, anatomical distribution of GC, and outcome in the Asians may be due to differences in etiologic factors that deserve further exploration. In Japan and Korea, early detection had resulted in a dramatic decline in mortality and morbidity. Although overall low incidence of the disease in US is prohibitive for a generalized screening program, there are subpopulations that may benefit from screening. Given that early detection has proven to be effective and cost saving in Asian countries with high incidence of gastric cancer consideration of screening for this population is intriguing and should be explored.