MOH and WHO concludes pilot on HPV testing for cervical cancer screening in Mongolia

Cervical cancer remains a significant public health concern in Mongolia. The incidence among Mongolian women is approximately 1.4 times higher than the global average, while mortality is about 1.3 times higher. Each year, more than 500 women are diagnosed, with over 40% detected at a late stage. Cervical cancer is currently the second most common cancer among women and the third leading cause of cancer-related deaths.

To address this challenge, Mongolia launched in April 2025 the Cervical Cancer Elimination Initiative, bringing together the Ministry of Health, the World Health Organization (WHO), the National Cancer Center (NCC), and the Ulaanbaatar City Health Department. The initiative aims to strengthen cervical cancer control through improved screening, early diagnosis and timely treatment, contributing to better health outcomes for women nationwide.

As part of this effort, human papillomavirus (HPV) testing was introduced through a cervical cancer screening pilot implemented at the Khan‑Uul District Health Center and its network of family clinics. The pilot marked an important step toward modernizing screening approaches in line with international recommendations and expanding access to high‑quality preventive services.

Launch of the National Acceleration Plan for Cervical Cancer Elimination, with Dr T. Munkhsaikhan, Minister of Health; Dr Socorro Escalante, WHO Representative to Mongolia; Dr N. Erdenekhuu, Director General of the National Cancer Center; and Dr N.Naranbaatar, Director General of the Ulaanbaatar City Health Department.

Preparatory activities were undertaken at the National Cancer Center and across family clinics in Khan‑Uul district to support the introduction of HPV testing. HPV sample collection was initiated simultaneously at 26 sites, with specimens transported directly to the NCC laboratory. This coordinated approach enabled broad coverage of the target population and ensured standardized laboratory analysis.

To strengthen service delivery at the primary care level, training materials were developed to support health education and community awareness on cervical cancer prevention and screening. Health care providers from Khan‑Uul district and primary health care facilities were trained in HPV sample collection, transportation, and client counseling. The training reached general practitioners and midwives from 25 family clinics, as well as gynecologists from the Khan‑Uul District Health Center. These efforts helped ensure that providers were equipped with the skills needed to deliver HPV testing services in a respectful, informed, and client‑centered manner.

Presentation on the National Acceleration Plan for Cervical Cancer Elimination by Dr L. Tumurbaatar, Advisor to the Minister of Health.

The pilot used the careHPV test, which detects 14 high‑risk HPV types and is designed for use in resource‑limited settings. The test is simple, rapid, and highly sensitive for identifying HPV infection. However, it does not identify cellular abnormalities or determine cancer stage. As a result, women with positive HPV test results required follow‑up cytology and, when indicated, further diagnostic assessment. 

Key findings from the pilot

During the pilot, 5382 women underwent HPV testing. Of these, 371 women tested positive and 5011 tested negative. Women with positive results were referred for cytology screening. Due to challenges in contacting participants, cytology samples were collected from 184 women, while 187 women could not be reached for follow‑up.

Among the 184 women who underwent cytology, 54 showed cellular abnormalities, while 130 had normal results. Of those with abnormal cytology, 19 women received histological examination with biopsy, while 35 could not be sampled. Histology findings identified nine cervical precancerous lesions and seven cases of stage 0 cervical cancer, alongside three normal results.

All seven women diagnosed with stage 0 cervical cancer received treatment at the National Cancer Center. Among women with precancerous lesions, two were treated at the NCC and two received specialist counseling.

Lessons learned

The pilot highlighted important gaps in community awareness. Knowledge of cervical cancer prevention and screening was limited, particularly in the initial target group of women aged 35–45 years, where participation was low. Targeted outreach activities were subsequently conducted through family clinics, and the eligible age range was expanded to 40–60 years, resulting in modest improvements in participation. These findings underscore the critical role of sustained community engagement and health education in improving screening uptake.

Several system‑level challenges were also identified. Many women seek care from private clinics and laboratories, yet data from these providers is not consistently reported to the National Cancer Center, limiting comprehensive disease surveillance and patient follow‑up. Weak data‑sharing mechanisms between public and private sectors contribute to fragmented information and increase the risk of interrupted care.

The role of HPV testing in early diagnosis and treatment

According to WHO guidance, cytology has relatively low sensitivity – approximately 50–75% for detecting precancerous lesions or cervical cancer – and this can fall to 30–50% in low‑resource settings due to sampling or interpretation errors. HPV testing, by contrast, demonstrates higher sensitivity and specificity, typically in the range of 85–95%.

HPV testing does not require extensive patient preparation or advanced technical skills and can be performed using self‑sampling methods, improving accessibility and participation. Findings from the Khan‑Uul pilot reaffirm that reliance on cytology alone limits screening effectiveness. HPV testing represents a cost‑effective, scalable, and evidence‑based approach that can strengthen cervical cancer screening nationwide.

HPV testing procedure with gynecologist Dr Y. Udval with a client in Khan-Uul District Health Center.

Launch of a nationwide roll-out

Upon conclusion of the pilot, Mongolia is now ready to launch a nationwide screening programme with support of Unitaid, the Government of Japan, and under the technical and strategic guidance of WHO.

The Khan‑Uul district pilot demonstrates that with careful planning, training, and coordination, cervical cancer screening services can reach thousands of women through the primary health care system. However, expanding coverage requires strengthened community awareness, robust data systems, improved laboratory capacity, and reliable follow‑up mechanisms.

Scaling up HPV testing for cervical cancer screening will be critical to advancing Mongolia’s national commitment to cervical cancer elimination and ensuring that no woman is left behind.