We investigated whether previously reported differences between the frequency and survival of patients with early gastric cancer in Europe and Japan represent a selection phenomenon or differences in tumor biology. Within a 10-year period, early gastric cancer was diagnosed in 51 outpatients and advanced gastric cancer in 190 patients, amounting to a 21.2% incidence of early gastric cancer. Patients with early gastric cancer had an age distribution and clinical presentation similar to those of patients with benign gastric ulcers (589) but markedly different from those in patients with advanced cancer. Histological types and tumor locations were comparable in patients with early and advanced gastric cancer, indicating a close relationship between the two neoplasms. Patients with early gastric cancer had markedly higher 5-yr survival rates (83.4%) than those with advanced gastric cancer (14.5%) and did not differ in this regard from patients with benign gastric ulcers (82.9%). None of the 51 patients with early gastric cancer died of disseminated cancer. If survival rates were estimated for matched pairs with comparable age, sex, and length of follow-up, these data remained essentially unchanged (early gastric cancer: 83.4%, 95% confidence interval 73.2%-93.4%; gastric ulcer: 87.8%, 95% confidence interval 74.7%-94.3%). We conclude that early gastric cancer in European patients is comparable to early gastric cancer in Japan with regard to its morphology, clinical presentation, and curability. Early investigation of patients with significant gastrointestinal symptoms may improve the prognoses of patients with gastric cancer.