To investigate the relationship between green tea consumption and subsequent risk of gastric cancer at different anatomical subsites in a population-based prospective study. The Japan Public Health Center-based prospective study (JPHC Study) was established in 1990 for Cohort I and in 1993 for Cohort II. Among 72,943 subjects (34,832 men and 38,111 women), 892 gastric cancer cases (665 men and 227 women) were identified from 1990 to 2001. While no association between green tea consumption and gastric cancer was observed among men, a decreased risk of gastric cancer was observed among women after adjustment for potential confounding factors. This result was more remarkable when only the tumors in the distal portion were analyzed; for that subsite, the relative risk was 0.51 (95% confidence interval 0.30-0.86) in the highest category of green tea consumption (5 or more cups per day versus less than 1 cup per day) (p for trend = 0.01). The null association for upper-third gastric cancer was consistent for both sexes. An inverse association between green tea consumption and distal gastric cancer was observed among women. More prospective studies with detailed information are needed to confirm the role of green tea in the occurrence of gastric cancer. Copyright 2004 Kluwer Academic Publishers