ABSTRACT
This article delves into Bhutan's adept execution of a nationwide cancer screening initiative within the Health Flagship Programme, concentrating on gastric, cervical, and breast cancers. Despite challenges like the COVID-19 pandemic, infrastructure constraints, logistical complexities, health human resource shortages, and data management issues, the programme succeeded. The procurement and logistics management ensured the timely provision of essential medical equipment and test kits. Robust political commitment, a comprehensive advocacy programme, and community engagement were pivotal for the programme's success. Impressive screening coverage for all three cancers showcased the transformative impact on cancer care, integrating technology and fostering community involvement. Recommendations highlight the need for strengthened integration, strategic approaches, and ongoing evaluation, positioning Bhutan's programme as a potential model for nations facing similar health challenges.
Subject(s)
COVID-19 , Early Detection of Cancer , Humans , Bhutan/epidemiology , Female , COVID-19/epidemiology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Stomach Neoplasms/diagnosis , Stomach Neoplasms/epidemiology , Male , Middle Aged , Mass Screening , AdultABSTRACT
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.