Population-level cancer screening and cancer care in Bhutan, 2020-2023: a review

Abstract

Screening of cancers is an important intervention in reducing the incidence and mortality related to cancers. Bhutan is one small country that is witnessing an increasing incidence and mortality related to cancers. The government implemented a time-bound population-level screening for gastric, cervical and breast cancers from 2020 to 2023 with an overall coverage of 91.2% of the eligible population. Among 370,225 individuals screened for H pylori, 32.4% tested positive; among 53,182 who underwent upper gastrointestinal endoscopy and biopsy, 255 (0.07%) had gastric cancer. Among 10,749 tested for HPV DNA, 9.3% were positive; among 9887 evaluated with colposcopy and biopsy, 154 (0.13%) had cervical cancer. For breast cancer screening, 72,283 underwent clinical breast examination, 845 mammography and cancer was detected in 73 (0.10%) individuals. In this article, we review how Bhutan implemented a population-level cancer screening programme with on boarding of multiple stakeholders and the participation of people across all districts.

Keywords: Breast self-examination; Early detection of cancer; Endoscopy; Malignancy; Mammography; Mass screening; Palliative care; Pap smear.

Fig. 1

Upper gastrointestinal endoscopy is available at 11 districts and HPV DNA testing and mammography available at the three tertiary care hospitals in Bhutan, 2023

Appendix 1

Testing algorithm for H pylori using stool antigen for the gastric cancer screening programme in Bhutan, 2020.

Appendix 2

Gastric cancer screening protocol for Bhutan, 2020. Those individuals positive for stool antigen for H pylori are treated and offered upper gastrointestinal endoscopy (UGIE). Follow up after endoscopy depends on the findings and histopathology report.

Appendix 3

Cervical cancer screening protocol for Bhutan based on HPV DNA testing, 2020. Follow up of women are based on detection of high risk human papillomavirus (HPV) types.

Appendix 4

Breast cancer screening protocol for Bhutan, 2020. Follow up of women with suspicious or malignant calcification depend on the histopathology findings on core needle biopsy of the lesion. ALND = axillary lymph node dissection; SLND = sentinel node lymph node dissection.