Mobile Screening Drives Expanded Breast Cancer Care in Mongolia

Mongolia, a country defined by its vast landscape, poses some of the most difficult challenges in building rural health systems.

Overlaid on a map of the US, at its widest point, Mongolia would stretch from California to Texas, yet it is home to fewer than 3.5 million people. Nearly half of the population resides in the capital Ulaanbaatar, where the country’s hospitals, specialists, and diagnostic infrastructure are concentrated.

The rest of the country’s population is dispersed across a vast interior of steppe (grassy plain), desert, and mountain range, with an estimated 30% to 40% of these individuals living nomadic or seminomadic lifestyles.^1,2 For many of these individuals, access to healthcare requires hours of travel, and in some cases, days to reach the nearest healthcare provider.

In high-income countries, breast cancer systems have been built over the course of decades, supported by organized screening programs, established referral pathways, and integrated multidisciplinary teams. Bridging this standard of care in Mongolia, however, requires navigating complex geographical barriers in addition to clinical hurdles, especially when considering the care of patients with breast cancer. Breast cancer is a disease process that depends heavily on early detection and coordinated multidisciplinary management.

Between 2014 and 2019, 57% of women diagnosed with breast cancer at the National Cancer Center of Mongolia (NCCM) presented with stage III or stage IV disease, and of these, up to 88% died within 5 years.³ In contrast, data from high-income countries show that approximately 10%–20% of patients present with advanced-stage disease.⁴

These findings reflect not only the burden of disease, but the consequences of limited access to early detection and the difficulty of treating late-stage breast cancer. Since 1961, the NCCM has provided reliable oncologic care to patients who are able to make the journey to the center, but when the majority of patients present after the disease has advanced beyond the point of early intervention, systematic change is required in order to expand access to care.³

Building the Foundation for Breast Cancer Care

Recognizing the need to create a specialized breast cancer team to address the high mortality rate, the NCCM, supported by Batsukh Pushkin, MD, MPH, established the country’s first breast center in 2020 in collaboration with Mongolian stakeholders and international partners, including Raymond R. Price, MD, FACS, Kirstyn E. Brownson, MD, and Todd M. Tuttle, MD, MS, FACS. A central focus of this work has been the development of systems that support coordinated, multidisciplinary care, which previously did not exist for breast cancer care in Mongolia.

Due to the constraints of COVID-19 that prevented in-person collaboration, in 2021, a virtual tumor board was established in partnership with specialists from the NCCM, The University of Utah in Salt Lake City, and the University of Minnesota in Minneapolis. This initiative created a consistent forum for case-based discussions across surgical oncology, radiology, pathology, radiation oncology, and medical oncology, introducing a level of structured decision-making that led to the NCCM formalizing its first dedicated multidisciplinary breast cancer team.³

These developments established a foundation for more consistent, comprehensive treatment planning. The tumor board functioned as the central mechanism through which this coordination was operationalized, embedding case-based, guideline-informed decision-making into routine care.

Over time, this platform facilitated increased initiation of chemotherapy in the neoadjuvant setting, adoption of breast-conserving approaches, and the integration of sentinel lymph node biopsy into surgical practice.

At the NCCM, these changes coincided with measurable shifts in care patterns. For example, between 2021 and 2025, the mastectomy rate declined from 94% to 37%, alongside a reduction in axillary lymph node dissection following the introduction of sentinel node techniques.³

Although formal mortality data remain forthcoming, clinicians report year-on-year reductions in breast cancer mortality, consistent with broader system-level changes, including earlier detection and more individualized surgical management.

However, strengthening care at the national referral center addressed only part of the broader challenge. For much of the population in Mongolia, timely access to diagnosis and treatment remained a significant challenge.

Extending Early Detection Beyond the Capital

To better understand barriers to timely access to care, this article’s authors performed a nationwide assessment of breast cancer diagnostic, treatment, and service infrastructure. Of all 55 tertiary public hospitals surveyed, consistent mammography was available in only 11 facilities in Ulaanbaatar, and two in the countryside, while the 42 remaining city and rural tertiary hospitals reported no access to mammography services.⁵ These findings underscore the structural limitations of a system in which access to screening is largely centralized to one city.

In rural regions of Mongolia, clinical breast examination (CBE) has remained the primary screening modality. While this approach is widely available, its limitations are well documented.

Studies in comparable settings report sensitivity ranging from approximately 40% to 55%.^6,7 National screening data reflect similarly low detection rates. In 2021, more than 332,000 women were screened using CBE across Mongolia, resulting in only three cancer diagnoses, or a rate of 0.009 per 1,000.⁸

In contrast, organized mammography programs in higher-income countries detect approximately four to six cancers per 1,000 women screened, representing a more than 400-fold higher detection rate compared to CBE in Mongolia.⁹ This discrepancy likely reflects, at least in part, limitations in the ability and training required to detect disease at an early stage in Mongolia.

In response to these limitations, the NCCM developed an alternative approach centered on extending early detection services directly into communities. Rather than relying on patients to overcome geographic barriers, this model works to bring diagnostic capability to the patient, including use of local clinics when available or, in their absence, mobile units equipped with ultrasound machines to reach even the most remote regions.

Working in collaboration with the Mongolian Women’s Federation and local leaders, the NCCM created a rural ultrasound-based screening program that integrates public education, community engagement, and mobile screening. Educational initiatives are conducted in advance of screening visits, including school-based programs and community outreach designed to increase awareness and participation among women and their families.

In many regions, these efforts are coordinated in close partnership with local government officials and community leaders who play a critical role in organizing events that bring together widely dispersed populations. Public gatherings, including town meetings, cultural events, and community concerts, are used as entry points to engage nomadic families who may otherwise remain difficult to reach.

These events serve not only as opportunities for education, but also as a means of building trust and normalizing participation in screening. Following these gatherings, women are invited to attend scheduled screening sessions at local clinics or mobile units in the days that follow, creating a structured pathway from awareness to evaluation. This approach leverages existing social structures to improve participation and ensures that outreach efforts translate into meaningful clinical follow-up.

Screening teams, composed of NCCM breast specialists, radiologists, and surgeons, travel directly to these communities, often over long distances and difficult terrain. All these clinicians participate on a voluntary basis, dedicating their time without compensation to reach populations that would otherwise have little or no access to care, with the goal of improving early diagnosis.

Equipped with portable ultrasound devices, they establish temporary screening sites and provide on-site evaluations using a combination of clinical breast examination and bilateral handheld ultrasound. See the May 2026 ACS Bulletin article, “Real-Time Ultrasound Imaging Enhances High-Stakes Surgical Decisions,” for more information on point-of-care ultrasound.

Patients with concerning findings on CBE and/or ultrasound are identified immediately and referred to the NCCM for further evaluation. These visits represent more than a screening intervention. They are part of a broader effort to build trust, increase health literacy, and establish a sustained connection between communities and the healthcare system. For many patients, this is their first interaction with preventive care.

This model reflects a fundamental shift in how care is delivered away from a system that depends solely on patients reaching centralized facilities to one that is designed to reach patients where they live.

Implementation in Rural Mongolia

In September 2025, the NCCM breast cancer team carried out a mobile screening deployment in the Zavkhan province, which lacks any mammography services or resident breast specialists, and is one of Mongolia’s most remote regions, located more than 22 hours by road from Ulaanbaatar. In 2021, the province was reportedly home to 36,981 women.

Across the 21 districts in the Zavkhan province, the multidisciplinary breast cancer team screened 2,460 women, with a mean age of 45 years (range 20 to 84). Of these, 72% had no prior history of breast screening, and 8% reported a family history of cancer.⁸ Each participant underwent a standardized clinical breast examination followed by bilateral handheld ultrasound with prospective Breast Imaging-Reporting and Data System (mobile screening, community engagement, and decentralized diagnostics) classification.

The majority of examinations that month were benign, with 2,331 classified as BI-RADS 1 and 64 as BI-RADS 2. Fifty-five patients were classified as BI-RADS 3, and nine as BI-RADS 4.5 Fifty-three patients were referred for further evaluation, of whom 89% completed follow-up. Thirteen underwent biopsy, and three breast cancers were diagnosed, including two stage I and one stage II. In each cancer case, the lesion was first identified via ultrasound and subsequently confirmed through core needle biopsy and mammography at the NCCM.

In a region where breast cancer has historically presented at advanced stages, these findings represent a meaningful shift toward earlier detection. Equally important, evaluating most patients locally reduced unnecessary referrals and eased the burden on centralized services, offering a level of diagnostic evaluation that, while not equivalent to gold-standard mammographic screening, is substantially better than no access at all. More than 2,400 women received assessment at no cost and without the expense or time of traveling to the capital.

Another benefit of these visits is the opportunity to address one of the underlying drivers of advanced-stage disease in Mongolia: limited awareness.

Among nomadic and rural women, breast cancer is often diagnosed late not only because care is unavailable, but because the early signs and symptoms are unfamiliar, and the importance of seeking evaluation when they appear is not widely understood. Education delivered alongside screening, however modest in any single deployment, may contribute over time to greater recognition of these symptoms and, in turn, to fewer women presenting only after disease has advanced.

The impact of these efforts reflects not only the value of portable diagnostic technology, but the commitment of clinicians, including specialists such as radiologists and surgeons, who travel long distances on a voluntary basis to communities they would otherwise rarely reach. By building trust and reducing barriers to entry, this approach has enabled sustained participation in screening efforts that would otherwise be inaccessible.

Implications for Expanding Access to Care

The challenges addressed due to Mongolia’s geographic isolation, namely limited access to diagnostic services and delayed presentation, are experienced around the world. Similar barriers persist in many health systems, including rural and underserved regions in the US.

Mongolia’s experience highlights an important consideration: Effective health systems are not built solely through infrastructure, but through deliberate efforts to ensure that care reaches patients. The approach developed by the NCCM prioritizes accessibility as a central design principle, using mobile screening, community engagement, and decentralized diagnostics to create entry points into the healthcare system for patients who might otherwise remain outside of it. These efforts do not replace comprehensive cancer care infrastructure, but they enable it to function more effectively by ensuring that more patients present earlier in the course of their disease.

Equally important to the diagnostic component of this work is the awareness it brings to rural patients. For many of the women reached through these deployments, the screening visit is also their first sustained exposure to information about breast cancer, including the early signs and symptoms, the value of evaluation when those symptoms appear, and the role of routine screening in detecting disease before it advances. Education delivered alongside screening, reinforced by trusted local leaders and repeated across successive visits, builds health literacy that persists long after the screening team has moved on. Over time, this growing awareness may prove as consequential as the screening itself, preparing rural communities to recognize disease earlier and to seek care sooner.

For surgeons and healthcare leaders in the US, these findings offer a practical perspective. Addressing disparities in cancer outcomes may require not only advances in treatment, but also innovation in how patients access care. Extending services beyond traditional clinical settings, investing in community engagement, and reducing structural barriers to access are strategies that can be adapted across a range of healthcare environments, and may be especially valuable in rural communities.

Building breast cancer care in Mongolia has required addressing multiple components of the health system simultaneously, including institutional capacity, workforce development, community engagement, and geographic access. Progress has been driven by locally led initiatives supported by sustained collaboration and adapted to the realities of the environment.

A defining feature of this model relies on the engagement of communities and the commitment of clinicians to extend care beyond traditional settings. The results to date demonstrate that meaningful improvements in early detection are achievable, even in some of the most resource-constrained and geographically challenging settings.

Leif Sorensen is a research scholar and recent graduate of the Master of Science in Clinical Investigation program at The University of Utah in Salt Lake City, where his work centers on global surgery and health systems strengthening. Over the past several years, he has contributed to surgical training and capacity-building initiatives across Cambodia, Mongolia, and Ghana. This fall, Sorensen begins medical school at The Ohio State University College of Medicine in Columbus, with the long-term goal of practicing as a global surgeon.

References

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