Mongolia’s ambitious programme to tackle cancer death rates reaches 40% of population

An ambitious project in Mongolia to tackle cancer mortality rates has reached 40% of the country’s population, according to the World Health Organization.
Two years after the screening programme began in the world’s worst place for cancer survival almost half its citizens have been tested for a number of non-communicable diseases, particularly cancers.
Mongolia, a sparsely populated country sandwiched between China and Russia, has the highest cancer mortality rate in the world. While globally 111 people per 100,000 die of cancer, according to WHO’s age standardised data, in Mongolia the figure is 194. Mongolian men are nearly twice as likely to die of cancer than the global average.
“When you look at the rate of cancer cases, Mongolia is 60th in the world,” said Erdenekhuu Nansalmaa, director general of the National Cancer Centre. The disproportionately high death rates, he said, are driven largely by late diagnosis. “Most cancer cases are not diagnosed in Mongolia until the advanced stages when prognosis becomes poor,” he said.
Mongolia’s geography and demographics contribute to the problem. Nearly 30% of Mongolians lead a nomadic lifestyle, herding cattle in remote areas far from health facilities. Even those in more urbanised areas but outside the capital, Ulaanbaatar, often are not screened for cancers as they are unaware that they are eligible for the service.
Khyuvasuren Lkhagvasuren, a school janitor from Erdenet, Mongolia’s second largest city, had never heard of a mammogram before her breast cancer diagnosis in 2019.
“I didn’t know that cancer of the breast is possible,” she said.
Breast examination has been officially part of routine health checks for women since 2012, but was never offered to the 48-year-old.
“Many practitioners in rural districts do not prioritise a public health approach,” said Undarmaa Tudev, head of early detection at the cancer centre. “They focus on treating existing illnesses rather than informing the public of preventive measures.”
Between 50% and 60% of Mongolians diagnosed with cancer live outside the capital, says Tsetsegsaikhan Batmunkh, director of Mongolia’s National Cancer Council, a non-profit organisation. But biopsies and inpatient treatment are only available in Ulaanbaatar, although a number of district hospitals have began offering chemotherapy.
“In a way, we were lucky that my wife was diagnosed during the wool combing season,” says Nergui, 35, a herder from Khentii province. “We were able to sell cashmere from our goats to finance her treatment.”
Inpatient treatment in Mongolia is provided free, but patients have to pay for some prescriptions. Tungalag Tamir, Nergui’s wife, was diagnosed with cervical cancer three months ago, and the couple have already spent more than 10 million tugriks (£2,300) on travel and medication, more than they would normally spend in a year.
“We can only comb our goats for cashmere once a year. Normally we spend the money on school supplies and uniforms for our three children. This year we will not be able buy this for them,” said Nergui. “I hope this round of treatment works. I don’t know how we will be able to finance more medication if it does not.”
While Lkhagvasuren was given the all-clear in 2020, in late 2023 the cancer returned, spreading to her internal organs. She is expecting to spend the rest of the year in Ulaanbaatar.
“I’m running out of ways to pay for medicines. I’m still paying off debt from my last rounds of medication and so is my husband. Even if we wanted to take on more loans we are not eligible.”
Lkhagvasuren, like Tungalag Tamir, found affordable accommodation through the cancer council. This has been a big help to Lkhagvasuren who expects to have to stay for months in the capital.
The early screening programme provides six different packages of test, depending on age. It has increased the number of diagnoses, Nansalmaa said, especially of stomach cancers which are notorious for late onset of symptoms, but he worries that the programme is a sticking plaster rather than a long-term cure. “We are now spending a lot of resources to test young people who are not in at-risk groups,” he said. He wants to see an investment in a longer-term national strategy and screening.
“Screening is very important, I wish I knew about it before,” Lkhagvasuren said. Since her diagnosis her sisters and friends have been screened. But Nergui had never heard of the programme. “It’s the kind of thing my wife would know about,” he said.