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We assessed the association between infection with CagA-positive and -negative Helicobacter pylori and the risk of gastric cancer in young adults.CagA IgG antibodies were measured in sera of subjects participating in a case-control study in Japan. The study subjects were 103 gastric cancer patients <40 yr of age, 100 inpatients with benign diseases, and 101 screenees younger than age 43 yr.Compared with the H. pylori-negative/CagA-negative (H. pylori-/CagA−) group, both the H. pylori-positive/CagA-negative (H. pylori+/CagA−) group and the H. pylori-positive/CagA-positive (H. pylori+/CagA+) groups showed elevated odds ratios for intestinal-type, diffuse-type, early, advanced, proximal, and distal gastric cancers. All the relationships were significant except for the H. pylori+/CagA− group in relation to proximal cancer. The overall odds ratios (95% confidence intervals) for gastric cancer in the H. pylori+/CagA− and the H. pylori+/CagA+ groups were 15.0 (6.4, 35.2) and 14.6 (6.7, 31.9), respectively. Between these two groups, no significant difference was observed in risks for intestinal-type, diffuse-type, early, advanced, proximal, or distal gastric cancer.In those <40 yr of age, it is concluded that both CagA-positive and CagA-negative H. pylori infections are related to risks of intestinal-type, diffuse-type, early, advanced, and distal gastric cancers.