Bhutan on the road to eliminating cervical cancer

Dechen Tshomo

Cervical cancer is preventable. Yet at least three women die of cervical cancer every month in Bhutan.

According to the health ministry, about 36 women die of cervical cancer every year in the country.

Cervical cancer is the most common cancer and the number one killer among Bhutanese women. While cervical cancer is more common in women younger than 50 years of age, 70 percent of deaths occurred in older women.

Last year, cervical cancer constituted one-fifth percent of all new cancer cases among women and 14.8 percent of all female deaths are related to cancer.

Bhutan has high cervical cancer incidence with age-adjusted incidence rate (AAR) of 20.5 per 100,000 women, and mortality rate of 5.3 per 100,000 women.

In the last five years, the country saw 313 cervical cancer cases and 82 deaths.

Prime Minister Dr Lotay Tshering, at the launch of the first phase of comprehensive package of cervical cancer screening camp in Thimphu yesterday, said cervical cancer is easily preventable, if contracted, it can be easily diagnosed. If diagnosed early, it is treatable.

“When we lose our mothers and daughters to this disease, we are failing as a society,” Lyonchhen said.

Health Minister Dechen Wangmo said today when cervical cancer is a disease that can be prevented, treated and cured, not taking bold steps towards elimination of cervical cancer is unacceptable. “We must collectively come together to save our women and girls from dying prematurely from this disease.”

Elimination of cervical cancer was first tabled by the Health Minister Dechen Wangmo, during the 144th session of the World Health Organisation Executive Board meeting in Geneva, Switzerland in January 2019. Following the initiative, Bhutan became the first country in the region to launch a comprehensive strategy to eliminate cervical cancer.

Bhutan further committed to improving overall women’s health including cervical cancer at the International Conference on Population and Development 25 at Nairobi last month.

 

Screening camp

The implementation of the first phase of the comprehensive cervical cancer screening camp will kick start in three dzongkhags -Punakha, Bumthang and Mongar from the first week of January 2020.

The three dzongkhags were prioritised based on the current Pap smear coverage data. Today, of the 20 dzongkhags, the three dzongkhags have the lowest Pap smear coverage in their respective region.

Pap smear is a test carried out on a sample of cells from the cervix to check for abnormalities that may be indicative of cervical cancer. It is one of the screening tools for cervical cancer.

STEPS 2019 show that 60.4 percent of Bhutanese women aged between 25 and 65 years have done Pap smear within the last three years.

Health officials said HPV (human papillomavirus) is the cause of cervical cancer, which is a sexually transmitted infection. According to studies, one in four Bhutanese women were infected with HPV.

The health flagship programme kick starts with this launch. Prevention of cancers including gastric, oral and breast cancers is one of the four areas of intervention of the flagship. Of a total of Nu 1.9B (billion), about Nu 1.127B, the highest has been estimated for prevention of cancers.

Following the launch, the screening will go nationwide.

All eligible women between the age of 25 and 65 years will be provided a comprehensive package of services. Bhutan currently has 169,908 women eligible for a Pap smear test.

The package includes non-communicable disease (NCD) screening, cervical cancer screening, clinical breast examination, screening for Pelvic organ prolapse, STI (sexually transmitted infections) screening and information on gender-based violence prevention.

Following the screening camp, a multipronged communications strategy will be adopted to sensitise and raise awareness on healthy living and disease prevention along with targeted programmes on disseminating information on cervical and breast cancer prevention will be intensified.

All the expertise and health workers are in place in the three dzongkhags to carry out the cervical screening camp.

In the first phase of one and a half month, the programme is expected to cover over 16,000 women in the three dzongkhags.

 

A collective effort

Health officials said unique to this screening camp is the design of the programme where, government, developmental partners, local government and CSO are collectively coming together to save women and girls to achieve elimination of cervical cancer in Bhutan.

“For the first time CSO, local government and developmental partners are coming together to collectively save our women and girls from cervical cancer,” health officials said.

Through this partnership, the health ministry looks forward to working closely with Bhutan Cancer Society, Bhutan Nuns Foundation, and RENEW. The ministry yesterday signed a letter of understanding and commitment with the representatives from the CSOs and the three dzongkhags.

Bhutan launched a plan for cervical cancer programme (2019 -23) towards the elimination of cervical cancer in Bhutan.

Speaking to Kuensel, Lyonpo said this is a programme that is going to have a huge impact on women’s health. “If we don’t do something, our women will continue to die. Our women must come forward for a pap smear, STI testing because HPV is a sexually transmitted disease.”

Lyonpo said screening will go nationwide. “Within a year, we want to complete the screening.”

Currently, if a Pap smear report is found to have some problem, the patient is asked to come to the national referral hospital in Thimphu. However, no one follows up if the patient comes for treatment and the health ministry does not have resources to do that.

With this programme, the ministry in collaboration with its partners and stakeholders will ensure that those with abnormal Pap smear report will get the treatment.

“Ultimately the objective of the screening is treatment. If we are not able to provide the treatment then our job is just to tick that we have screened. It is not making a difference,” Lyonpo said.

The first phase of the screening camp is funded by UNFPA and WHO.

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