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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.
A common condition
ShowThe human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
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.
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