Anim (nun) Bidha felt a lump in her right breast. It was a painless lump and so she did not give much attention to it.

Three years after her retreat, she heard that one of her friends, also a nun at Shechen Orgyen Chodzong nunnery in Sisina in Thimphu, went to the national referral hospital for a check-up because she felt a lump on her breast.

“I told my friend about it and she told me that I should visit the hospital as it could be a cancer,” said Bidha. But then, she did not go the hospital.

“After a few months, I felt the lump grow,” Bidha said. It was a cancer indeed.

Upon learning that she had breast cancer, Bidha was devastated. She thought she was going to die. “My friends and family members were unusually good to me. Maybe they thought I had only so much time to live.”

She underwent surgery at the national referral hospital in 2014, not long after the cancer was discovered. She kept herself mentally strong, healthy physically and spiritually. “There were other cancer patients at the hospital; not many survived.”

Upon Onco-surgeon, Dr Tashi Dendup Wangdi’s recommendation, Bidha went to a hospital in Siliguri, India for mammography to confirm cancer had not spread to her other breast. It hadn’t.

“I am feeling wonderful. I feel much better each year. Half the battle is won if you are strong. You can get through it. Of course, the support of family and friends is very important,” Bidha said.

Whenever people hear the word ‘cancer,’ she said they think about dying but not all cancer patients die. “They do get better if diagnosed early and get treated.”

Anybody could get cancer, she said, and recommended people to get blood tested every once in a while.

Records with JDWNRH show that more than 2,000 cancer cases were registered in the last four years, which means at least 500 new cancer cases are reported to the hospital every year.

Gynaecologist Dr Ugyen Tshomo said Bhutan has many upper gastro-intestinal cancers, which include cancer of stomach and food pipe. The other most common cancer is hepato-biliary cancer, which includes cancers of the bile ducts, liver or gallbladder.

“These two cancers have the highest mortality,” she said. “Most of the hepato-biliary cancer patients die soon after they are diagnosed.”

However, Dr Ugyen Tshomo said the cause of these cancers and the reason why hepato-biliary cancer patients die soon is not clear as no one had carried out a study on it.

Before, Lung cancer was rare in Bhutan. But now, it is among the top five to six cancers in Bhutan, she added.

According to the Annual Health Bulletin 2017, a total of 127 deaths were due to cancer in 2016, seven was due to Oesophagus cancer, eight due to stomach or gastric cancer, and three due to hepato-biliary cancer.

Dr Ugyen Tshomo said that most Bhutanese do not have the habit of visiting hospital until they really have to. By the time they visit, it is usually too late and most of the surgeries done are palliative.

“In Bhutan, many people disappear after being diagnosed with cancer and they reappear after a few months with advanced cancer. This affects survival,” she said.

She said that health workers should be aware of such cases. “Now, if we find that a patient has been suffering from stomach ache for a longer period of time, we send them for endoscopy because the process can detect tumours in the stomach,” she said. “If stomach cancer is diagnosed early and is treated, patients survive.”

Dr Ugyen Tshomo said cancers of cervix, breast and thyroid are seen mostly in young women. She added that about 50 percent of the patients diagnosed with cervical cancer between 2000 and 2005 are alive. “To study how many deaths and survivors are there from cancer is equally important so a study is necessary.”

The hospital also sees more number of recurrent cancer cases, Dr Ugyen Tshomo said. “They are at more risk of dying. In the first two years after diagnosis and treatment of cancer, follow up should be frequent because most of the cancers re-occur in the first two to three years.”

Recurrent cancer, if detected early, can be cured, she added.

Dechen Tshomo