Health flagship project tackles cancer burden in Bhutan

Jigmi Wangdi

The Bhutan Health Flagship Project, to be implemented from 2020 to 2023, aims to address major health challenges such as gastric, cervical and breast cancers, which contribute significantly to the disease burden in Bhutan. The project focuses on early detection, prevention and treatment.

As part of the wider 12th Five Year Plan, which targets areas previously underrepresented in the national health service, the project aims to reduce the incidence and mortality of these cancers through several key strategies.

For gastric cancer, it involves large-scale eradication of Helicobacter pylori infection, a known cause of gastric cancer. The screening program targets people between 18 and 75 years of age, using either a rapid stool antigen test or a urea breath test to identify infection.

Patients with positive test results are treated with triple therapy. Endoscopy services are also used to screen for early gastric cancer in high-risk groups between the ages of 40 and 75. This comprehensive approach ensures that patients diagnosed with gastric cancer receive timely and effective treatment.

For cervical cancer, the project integrates high-sensitivity HPV testing and liquid-based cytology into the screening process for women aged 30 to 65. This approach is expected to reduce smear failure rates and increase early detection rates.

The project also emphasizes strengthening advocacy and awareness programs to educate the public and health workers about prevention and early detection.

Breast cancer prevention includes screening through mammography and clinical breast examinations for women between the ages of 40 and 65. Similar to strategies for stomach and cervical cancer, the breast cancer program also includes public awareness campaigns and training for medical staff.

Health ministry officials said significant progress has been made in large-scale eradication of Helicobacter pylori infection among the target population.

“We have achieved 90.17 per cent coverage for gastric cancer screening,” the official said, adding that incorporating gastric cancer screening into routine services would help achieve the project’s goals.

Despite the success, some challenges remain. “Even with repeated campaigns through various media channels, encouraging people to participate in the screening programme remains difficult,” the official said.

The pandemic, coupled with a shortage of human resources, has also hampered the implementation of screening programmes.

The official said the publicity and awareness programme made effective use of various media channels and social media platforms.

“The ministry has provided training to health workers on prevention and early detection of stomach cancer, cervical cancer and breast cancer,” the official said.

The official, however, stressed the need for sustained health promotion and awareness programmes, stressing that joint efforts of all citizens were crucial.

On cervical cancer screening, the official said coordination among health institutions has improved. “Those women who are HPV positive are followed up and referred to health institutions that can provide services.”

Because HPV testing has higher sensitivity and specificity, replacing traditional Pap smear testing with HPV testing has significantly reduced the rate of unsatisfactory smears.

The official added that resource and infrastructure challenges remain a concern, especially in managing screening and treatment programs for these cancers.

“Keeping in view the resource constraints and the burden of these three cancers, the screening programme was implemented as a ‘flagship project’ during the 12th Five-Year Plan. Through this programme, we have expanded the scope of services, purchased high-end equipment and enhanced the capacity of health workers,” the official said.

Despite the shortage of health workforce, the Ministry has been managing it within the available resources.

Looking ahead to 2023, the Ministry of Health has included gastric cancer, cervical cancer and breast cancer screening in routine services and the 13th Five-Year Plan. This will ensure the sustainability and long-term impact of these initiatives.

“We will continue to provide early detection, diagnosis and timely treatment at all health facilities above primary health centres,” the official said.

The government will also expand palliative care services and strengthen advocacy and education to reduce cancer risk factors. The government will continue to offer the HPV vaccination program for eligible boys and girls, and standard screening using a highly sensitive HPV DNA test.

“We will enhance the capacity of health workers to provide quality cervical cancer prevention and control services,” the official added.

Health Minister Lyonpo Tandin Wangchuk said the flagship project achieved 90 percent coverage nationwide through comprehensive screening, and said the ministry must continue to promote the project during the 13th Five-Year Plan to cover the remaining 10 percent.

Leonpo said Bhutan’s goal is to eliminate cervical cancer by 2030, and all efforts are made to achieve this goal. The ministry will also prioritize advocacy and awareness campaigns to educate the public about cancer risk factors such as smoking and drinking alcohol and maintaining healthy eating habits.