Gastric cancer (GC) is the 5th most common cancer and the 4th leading cause of cancer-related deaths in the world. It accounts for 769,000 deaths annually. GC is a curable disease if diagnosed at an early stage but it is traditionally associated with poor prognosis due to late presentation. Screening enables early detection of GC and hence reduce mortality. In populations with high prevalence of GC, population screening by endoscopy is feasible, as in Japan and Korea. A microsimulation modelling study suggests endoscopic screening program in Japan would be cost-effective when implemented between age 50 and 75 years, with the screening repeated every 3 years (BMC Medicine 2020;18:257). In populations with low to intermediate prevalence of GC, screening would not be cost-effective in countries. Two approaches are instead suggested: (1) targeted screening for people at high risk for GC by endoscopy (Clin Gastroenterol Hepatol. 2006 Jun;4(6):709-16); (2) screening with non-invasive biomarker. A serum miRNA test has recently been described, with a sensitivity of 87% (95% CI 79.4% to 92.5%), specificity of 68.4% (95% CI 67.0% to 69.8%) for the detection of GC (Gut 2021;70:829–837). It might be a useful screening tool to identify people with high risk, for endoscopic screening. Cost-effectiveness analysis showed the miRNA blood test as the primary screening test for GC in high risk population (Chinese males, 50-75 years) would be cost-effective compared to the current practice of no screening in Singapore, with an incremental cost-effectiveness ratio of US$40,971/quality-adjusted life-year (Value Health. 2020 Sep;23(9):1171-1179).