Gastric cancer is the leading cause of death from cancer in China. Samples of fish sauce, a traditional seasoning, were collected in the high-risk area for gastric cancer in the Fuzhou area, Fujian Province. When fish sauce samples were nitrosated at pH 2.0, direct mutagenicity and high contents of N-nitrosamide were detected (30.9-78.0 microM); the N-nitrosamide content of three samples of fish sauce made in Guangdong and purchased from a market outside Fujian were low (2.1-6.0 microns). When the nitrosated fish sauce extract was given to newborn rats by gavage, dysplasia and adenocarcinoma were induced in the glandular stomach in the 4th and 16th experimental week, respectively. N-Nitrosamides were also found in fasting gastric juice from patients with chronic gastritis in the high-risk area of Putian. The mean concentration of total N-nitrosamides in the extracts correlated with the severity of gastritis in the stomach. These findings indicate that N-nitrosamides may play an important role in causing gastric cancer in China.