According to the World Health Organization, an ambitious project in Mongolia to tackle cancer death rates has affected 40% of the country’s population.
Two years after the screening programme was launched in the world’s worst region for cancer survival, almost half of citizens have been tested for a number of non-communicable diseases, most notably cancer.
NCDs are just that; unlike, say, a virus, you can’t catch them. Instead, they’re caused by a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancer, chronic respiratory disease, diabetes, and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and they’re all increasing, spreading inexorably around the world as aging populations and lifestyles fueled by economic growth and urbanization make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now have a hold on the poor. Disease, disability and death are perfectly designed to create and increase inequality – and being poor makes you less likely to be diagnosed and treated correctly.
There is a staggeringly low investment in tackling these common and chronic diseases, which kill 71% of the population, yet the costs to families, economies and communities are staggering.
In low-income countries, NCDs – typically slow and debilitating diseases – receive only a fraction of the funding needed to treat them. Attention remains focused on the threats of communicable diseases, but cancer mortality rates have long surpassed the death toll from malaria, TB and HIV/AIDS combined.
‘A common condition’ is a Guardian series reporting on non-communicable diseases in developing countries: their prevalence, solutions, causes and consequences, and the stories of people living with them.
Tracy McVeigh, Editor
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The human toll of noncommunicable diseases (NCDs) is enormous and rising. These diseases end the lives of about 41 million of the 56 million people who die each year – and three-quarters of them are in developing countries.
NCDs are just that; unlike, say, a virus, you can’t catch them. Instead, they’re caused by a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancer, chronic respiratory disease, diabetes, and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and they’re all increasing, spreading inexorably around the world as aging populations and lifestyles fueled by economic growth and urbanization make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now have a hold on the poor. Disease, disability and death are perfectly designed to create and increase inequality – and being poor makes you less likely to be diagnosed and treated correctly.
There is a staggeringly low investment in tackling these common and chronic diseases, which kill 71% of the population, yet the costs to families, economies and communities are staggering.
In low-income countries, NCDs – typically slow and debilitating diseases – receive only a fraction of the funding needed to treat them. Attention remains focused on the threats of communicable diseases, but cancer mortality rates have long surpassed the death toll from malaria, TB and HIV/AIDS combined.
‘A common condition’ is a Guardian series reporting on non-communicable diseases in developing countries: their prevalence, solutions, causes and consequences, and the stories of people living with them.
Tracy McVeigh, Editor
Mongolia, a sparsely populated country wedged between China and Russia, has the highest cancer mortality rate in the world. While 111 people per 100,000 die from cancer worldwide, according to WHO age-standardized dataIn Mongolia, that figure is 194. Mongolian men are almost twice as likely to die from cancer than the global average.
“In terms of cancer incidence, Mongolia ranks 60th in the world,” said Erdenekhuu Nansalmaa, director general of the National Cancer Centre. The disproportionately high mortality rates, he said, are largely due to late diagnosis. “Most cancers in Mongolia are diagnosed in the advanced stages, when the prognosis becomes poor,” he said.
Mongolia’s geography and demographics contribute to the problem. Almost 30% of Mongolians lead a nomadic lifestyle, herding cattle in remote areas far from health facilities. Even those in more urbanized areas, but outside the capital, Ulaanbaatar, are often not screened for cancer because they are not aware that they are eligible for the service.
Khyuvasuren Lkhagvasuren, a school janitor in Erdenet, Mongolia’s second-largest city, had never heard of mammograms before she was diagnosed with breast cancer in 2019.
“I didn’t know breast cancer was possible,” she said.
Since 2012, a breast examination has been an official part of routine health checks for women, but it was never offered to the 48-year-old woman.
“Many practitioners in rural areas do not prioritize a public health approach,” said Undarmaa Tudev, head of the early detection department at the cancer center. “They focus on treating existing diseases instead of educating the public about preventive measures.”
Between 50 and 60 percent of Mongolians diagnosed with cancer live outside the capital, said Tsetsegsaikhan Batmunkh, director of Mongolia’s National Cancer Council, a nonprofit organization. But biopsies and inpatient treatment are available only in Ulaanbaatar, although some district hospitals have started offering chemotherapy.
“In a way, we were lucky that my wife was diagnosed during the wool combing season,” said Nergui, 35, a herder from Khentii province. “We were able to sell cashmere from our goats to finance her treatment.”
In Mongolia, clinical treatment is 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 medicine, more than they would normally spend in a year.
“We can only comb our goats once a year for cashmere. Normally we spend the money on school supplies and uniforms for our three children. This year we can’t buy them,” Nergui said. “I hope this round of treatment works. I don’t know how we’ll finance more medication if it doesn’t.”
While Lkhagvasuren was given the all-bald signal in 2020, the cancer returned in late 2023 and spread to her internal organs. She expects to spend the rest of the year in Ulaanbaatar.
“I have run out of ways to pay for medications. I am still paying off debt from my last rounds of medications and so is my husband. Even if we wanted to take out more loans, we wouldn’t qualify.”
Lkhagvasuren, like Tungalag Tamir, found affordable housing through the cancer council. This has been a great help to Lkhagvasuren who expects to be in the capital for months.
The early screening program offers six different test packages, depending on age. It has increased diagnoses, Nansalmaa said, particularly for stomach cancers that are notorious for their late onset of symptoms, but he worries the program is a band-aid solution rather than a long-term solution. “We are now spending a lot of resources on testing young people who are not in the risk groups,” he said. He wants to see investment in a national strategy and longer-term screening.
“Screening is very important, I wish I had known about it earlier,” Lkhagvasuren said. Since her diagnosis, her sisters and friends have been screened. But Nergui had never heard of the program. “It’s the kind of thing my wife would know about,” he said.