Editorial Team
Publication Date
May 31, 2024
Odonchimeg Batsukh, GPJ Mongolia
Ganbold Ravjaa, right, speaks with senior oncologist Ulzii Nyamdorj at Arkhangai Province General Hospital. Ganbold, 58, was able to treat and cure his stomach cancer thanks to early detection.
ERDENEBULGAN, ARKHANGAI PROVINCE, MONGOLIA — For six years, Ganbold Ravjaa, 58, struggled with indigestion. The problem was persistent, but nothing an antacid couldn’t fix. So instead of seeing a doctor, he self-medicated. But in February 2023, after learning about the government’s nationwide early detection program for cancer, he thought he would give it a try.
Ganbold underwent a series of tests and learned the lining of his stomach was inflamed, which the doctor said could be a sign of cancer. He went to the National Cancer Center of Mongolia in Ulaanbaatar and underwent a biopsy. Ganbold had cancer.
Mongolia has the highest stomach cancer fatality rate in the world. Twenty out of every 100,000 Mongolians died from stomach cancer in the two decades ending 2021. And the incidence of stomach cancer is expected to rise. Sixty-one people out of every 100,000 are expected to get stomach cancer by 2045, according to a 2020 joint study by the Health Development Center and the National Statistics Office.
The Mongolian government began early detection testing in the country in 2022, and in its first year, the country’s stomach cancer death rate decreased fivefold from 2021. (Statistics for 2023 have not yet been compiled.)
“Before the implementation of the program, more than 80% of those who were diagnosed with stomach cancer were diagnosed at Stage 3 or 4, or even later,” says Khaliunaa Battulga, senior doctor at the National Cancer Center of Mongolia.
Early detection catches cancer cases at earlier stages. Patients then have the opportunity to use health insurance and receive more effective treatment, she says. “As a result of which we are seeing a decrease in the death rate.”
When Ganbold found out he had cancer, his doctors told him that it was in the early stages, meaning a cure was possible. He underwent a minimally invasive procedure to remove the abnormal tissues from the lining of the digestive tract, after which he was strictly advised on some lifestyle changes.
For someone who had barely done any health checkups before, Ganbold counts himself lucky that the government launched the early detection program, that he decided to undergo the tests, and that his cancer was caught at an early stage.
The government’s early detection program targets several serious diseases, including eight types of cancers. As of December 2023, 38.6% of the population has undergone testing, according to data provided by Bayarbold Dangaa, director of the Ministry of Health’s Public Health Department.
“Early detection checkups are the most effective way to reduce cancer death rates,” Bayarbold says.
He points to a study in 2021 — before the health camps were launched — that found 75% of cancer patients were diagnosed in later stages; 60% of them died within five years.
Meat, salt, bacteria — and heights
The high rates of stomach cancer can be directly linked to the unique eating habits and lifestyle of Mongolians, say experts including Dr. Dorjgotov Bars, former director of the National Center for Oncology, and author of “Epidemiology of Cancer in the Republic of Mongolia.”
To withstand subzero temperatures, many Mongolians eat lots of meat, piping hot tea and meals, and an excessive amount of salt — all risk factors for stomach cancer.
Mongolians eat more than three times the daily recommended amount of meat, according to a 2021 report released by Mongolia’s National Security Council and National Statistics Office.
Mongolians also eat twice as much salt as the daily amount recommended by the World Health Organization. Many drink salted tea daily, which damages the stomach lining and doubles the risk of getting stomach cancer, according to a 2020 study commissioned by the Ministry of Health.
The study also found that 57.4% of Mongolians with stomach cancer are infected with H. pylori, a common bacteria that attacks the stomach lining and is usually passed from person to person through contact with an infected person’s saliva or other bodily fluids. More than 6 in 10 Mongolians are infected with this bacteria. Treating these infections can reduce stomach cancer rates, according to the study.
But H. pylori is not always linked to stomach cancer. Researchers have found that some countries in Eastern Asia have a high rate of stomach cancer even though they have low H. pylori infection rates. And some countries that have a high prevalence of H. pylori infection still have low stomach cancer rates, pointing to the fact that there are multiple risk factors, including geography.
Studies in Mongolia and other parts of the world have found an association between altitude and stomach cancer incidence and mortality, meaning living at higher altitudes can contribute as a risk factor.
Playing with ‘stomach fire’
Traditional medicine in Mongolia also links the food people eat to stomach cancer. Baatar Puntsag, vice president of the World Traditional Medicine Organization, an association of traditional practitioners in China, says illnesses are inextricably linked with lifestyle. “People are eating too much of the wrong food, or foods that contradict each other,” he says.
“Since ancient times, Mongolians have been eating according to the heat of the fire in their stomachs and the four seasons of the year,” says Seesregdorj Surenjid, a professor of internal medicine at Mongolian International School of Medicine at the National University of Medical Sciences.
In traditional medicine, stomach fire refers to the ability of the stomach to absorb food. Seesregdorj says because the heat of the stomach fire is at its highest level in winter, meat is consumed more in winter to keep the body balanced and survive the cold. The temperature of the stomach fire decreases to the lowest level in the summer, he says, and meat consumption goes down.
For Ganbold, the brush with cancer has made him reflect on what he eats and doesn’t eat.
“I used to eat a lot of meat, particularly the fattiest cuts,” he says. Now, he consumes less sugar and salt, constantly checks his blood sugar level, and has quit smoking.
Uranchimeg Tsogkhuu is a Global Press Journal reporter based in Mongolia. Odonchimeg Batsukh is a Global Press Journal reporter based in Mongolia.
TRANSLATION NOTE
Enkhgerel Erdenechimeg, GPJ, translated this article from Mongolian.
