Just three months before she died from stomach cancer at just 36, influencer Carly Douglas shared a tearful but defiant message with her 140,000 Instagram followers.
Revealing her diagnosis after being rushed to hospital with extreme abdominal pain and bloating, she told them: ‘Cancer picked the wrong girl.’
At the time – March 24 – there had been little hint of what was to come.
Only weeks earlier, Douglas had been posting videos of herself doing pull-ups in her home gym, alongside snapshots of everyday life as a mother of three in Greenville, South Carolina.
News of her death this week sent shockwaves through her online community, with thousands flooding her page with messages of hope and prayer in her final weeks.
But her story is far from an isolated tragedy – and instead points to a worrying trend that doctors say is now emerging across the US.
Douglas is one of a growing number of young Americans being diagnosed with stomach cancer – a disease that until recently was thought to be in steady decline.
For decades, cases had fallen, largely driven by drops in smoking rates and improvements in diet and food preservation. But now, alarmed experts say the trend is reversing, with diagnoses rising in people under 50 for reasons that are still not fully understood.
Carly Douglas, 36, with her youngest child in April. She died after being diagnosed with stage 4 stomach cancer
The lifestyle and fitness influencer with her family of five. She told her followers she had gone to the hospital with a bloated stomach, convinced she had a bowel obstruction
Part of the danger lies in how easily the early warning signs can be dismissed.
Bloating after even a small meal, persistent indigestion and nausea are often explained away as minor digestive issues – until it is too late.
Left undetected, the cancer can silently invade deep into the stomach wall before spreading elsewhere in the body. And once it does, the outlook is bleak.
Overall, just 37 percent of patients survive for five years after diagnosis.
For those like Carly Douglas – diagnosed at stage 4, the most advanced stage – that figure falls to less than eight percent.
Experts say that improving those odds depends heavily on one thing – catching the disease early.
But with symptoms so vague and easily overlooked, many patients are only diagnosed once the cancer has already taken hold – raising urgent questions about how this once-declining disease is now slipping through the net.
So why is stomach cancer on the rise again, why are younger people being hit so hard – and what are the early warning signs to watch out for? The Daily Mail spoke to leading experts in the disease to find out.
Douglas and her husband. She said she felt like she was ‘living in a nightmare’ and that she ‘kept trying to wake up’
Lifestyle factors driving the rise in under-50s
Stomach cancer was once the leading cause of cancer death in the US, killing up to 40,000 Americans every year in the early 20th century.
But from roughly the 1930s onward, rates fell dramatically – largely because the biggest underlying causes of the disease began to disappear.
One of the most important was a bacterium called Helicobacter pylori, which infects the stomach lining and is the single biggest risk factor for the cancer.
Hygiene improved and antibiotics became widely used, so infection rates dropped sharply – cutting the long-term inflammation that can trigger tumors.
At the same time, the way people ate changed. Before widespread refrigeration, many relied on smoked, salted and pickled foods to preserve meat – all of which are known to damage the stomach lining and raise cancer risk.
Falling smoking rates also played a role. Tobacco is another established risk factor, and as fewer people smoked, rates of stomach cancer declined further.
Together, these changes drove one of the most dramatic declines seen in any major cancer – with death rates falling by around 90 percent over the past century.
Alt-rock band drummer Steven Kopacz with his family. He was diagnosed with stomach cancer at age 33 years after suffering from a lingering pain in his stomach
Since the 2010s, however, cases have begun to tick up again.
According to the American Cancer Society, there are around 31,500 new cases per year, and the average age of diagnosis is 68.
But the recent rise is not being driven by older patients. In fact, rates in over‑50s – who still account for the vast majority of cases – have continued to fall by around two percent per year in recent decades.
Instead, the increase is being fueled by a worrying shift in younger adults. Among under‑50s, diagnoses have risen by roughly one percent a year, reversing decades of decline.
Traditionally, stomach cancer has affected far more men than women. But that gap is now narrowing.
Dr Yanghee Woo, a gastroenterologist at City of Hope Hospital in California, told the Daily Mail how she had witnessed the same concerning shift in her own practice.
‘Unfortunately, a large percentage of our patients that come to see us are very young – in their 20s, 30s, 40s, with young children,’ she said.
‘These patients are otherwise healthy in the prime of their lives.
Alyssa Burks, from Houston, was diagnosed with stomach cancer at age 32 after she started to experience difficulty swallowing and heartburn. Doctors initially told her to cut down on acidic foods to control the symptoms
‘They’re in the middle of building their lives – studying, progressing in their careers, raising young families – and they simply never imagined they could have cancer.’
Dr Amar Rewari, a radiation oncologist at Luminis Health in Maryland, believes modern diet and lifestyle is behind the rise.
‘There is also evidence that suggests eating heavily salted or processed foods raises your risk.’
This has been borne out in research that found ultra‑processed foods – which make up more than half of the average American diet – are associated with a 20 to 25 percent increase in the risk of stomach cancer.
Doctors believe this may be because high levels of salt can directly damage the stomach lining, making it more vulnerable to cancerous changes.
Alcohol consumption also plays a role. Studies show that regularly drinking three or more alcoholic drinks a day is linked to an increased risk of stomach cancer.
Experts also suggest there may be no completely safe amount to drink, with cancer risk increasing gradually even at lower levels of consumption.
Some now also suspect that the rise of antibiotics that helped drive the decline in stomach cancer a century ago may also be playing a role in its return.
The above graph shows stomach cancer cases and deaths in the US as a rate – revealing the uptick in recent years, partly driven by cases in under 50s
The above shows stomach cancer survival rates based on the stage at which the disease is detected
‘We are seeing an increased risk of this cancer in people born after 1950, and that coincides with the introduction of antibiotics,’ Dr Constanza Camargo, a researcher at the National Cancer Institute, has said.
The theory is that while antibiotics wipe out harmful bacteria like H pylori, they also disrupt the delicate balance of microbes in the gut.
This so‑called microbiome plays a crucial role in regulating inflammation and protecting the stomach lining – and when it is thrown off balance, it may create an environment in which cancer is more likely to develop.
Hidden symptoms everyone should know
Detecting stomach cancer early is notoriously difficult – and that is one of the main reasons it remains so deadly.
Dr Yanghee Woo warned that many patients live with symptoms for months, or even years, before seeking help.
I never thought I would have cancer… I’m 28, I thought I was invincible
Georgia Gardiner, who was diagnosed with stomach cancer at age 28 after suffering from sickness and stomach cramps
When Georgia Gardiner visited her doctor complaining of nausea and stomach cramps, she was given heartburn medication and sent on her way.
The 28-year-old mother-of-one returned a total of nine times as her symptoms worsened before finally be handed a devastating diagnosis: stomach cancer.
Terrifyingly, she was told she may have just 12 months to live.
Speaking about the time her symptoms worsened, Georgia, from Leeds, West Yorkshire, said: ‘My body was just rejecting everything. I was experiencing pains in my upper stomach. It was really intense, it was a sharp constant pain.
She remains unsure as to why the disease hit her. ‘None of my immediate family have cancer and this type of cancer usually affects old people,’ she said.
‘I was fit and healthy. It’s just baffling.’
Georgia has launched a fundraiser to help pay for future treatment.
She added: ‘I never thought I would have cancer, I’m 28, I thought I was invincible. I’m just going to try and fight this in every way possible.
‘Most of the patients had symptoms for quite some time,’ she said, ‘but they either ignored them or assumed it was something benign, like acid reflux.’
Early warning signs can be vague and easy to dismiss, including persistent abdominal pain, bloating and frequent burping. Rather than triggering alarm, these symptoms are often brushed off as stress, diet or minor digestive issues.
Instead of anything sudden or dramatic, many patients simply report a lingering sense that something is ‘off’ – a low‑level discomfort that gradually worsens over time.
‘Things only got worse, which led them to see a doctor, and eventually be diagnosed,’ Woo said.
By then, it is often too late.
Dr Amar Rewari said that by the time younger patients reach him, the disease has frequently progressed. They may be struggling to swallow, vomiting regularly, losing significant weight or suffering from severe fatigue caused by iron deficiency.
Some also report black stools – a sign of internal bleeding.
For many, the biggest barrier to diagnosis is age.
Patients and doctors alike often assume they are too young to develop cancer – an assumption Woo describes as ‘very valid’ – which can delay vital testing.
For Alyssa Burks, from Houston, Texas, the first sign something was wrong was overwhelming exhaustion.
At 32, the mother-of-one found herself going straight to bed after work, too drained to socialize or carry on with daily life. She initially blamed stress.
Doctors also failed to spot the warning signs – first dismissing her symptoms as ‘just getting older’, then attributing her difficulty swallowing and heartburn to diet.
It was only after more than two years of pushing for answers that scans were finally carried out.
By then, the diagnosis was devastating: stage 4 stomach cancer that had already spread.
A similar pattern played out for Steven Kopacz, a drummer who at first put his persistent stomach pain down to nerves or a possible ulcer.
When the pain refused to go away, he sought medical help – and was diagnosed at 33 with stage 3 gastric cancer. He has since had his stomach removed and is undergoing chemotherapy.
For Janine Somma, who was just 28, the warning sign was a burning, gnawing pain. But like many others, she was initially told it was acid reflux.
Stories like these, doctors say, highlight a troubling pattern: symptoms that appear mild, patients who seem too young to be at risk – and diagnoses that come far too late.
New treatments that could offer hope
Despite the grim statistics, specialists say there are reasons for cautious optimism.
A growing body of research suggests more cases are now being caught earlier, when they are far easier to treat. One recent study found that between 2004 and 2021, the number of stomach cancers diagnosed at an early stage rose by more than 50 percent, while late-stage diagnoses declined.
Doctors say advances in both detection and treatment are beginning to shift the outlook for patients.
Greater awareness of early‑onset cancers – among both patients and physicians – may also be helping more cases to be picked up sooner.
And crucially, the treatment landscape itself has changed dramatically.
In addition to traditional surgery, chemotherapy and radiotherapy, doctors now have access to targeted therapies that home in on specific genetic features of a tumor – as well as immunotherapy drugs that help the immune system recognize and attack cancer cells.
These newer treatments, including drugs that target HER2-positive cancers or harness immune checkpoints such as PD‑1, are already improving outcomes for some patients.
Researchers are also testing combinations of these therapies – alongside vaccines and personalized approaches based on a patient’s individual tumor – raising hopes that survival rates will continue to improve in the coming years.
‘I do want people to know that treatments at all stages have got better,’ Woo said. ‘A diagnosis does not necessarily mean it is terminal.
‘In the past, this was a very difficult cancer to treat. But we now have excellent targeted drugs and other methods that can be used to fight it.’