Health Flagship progress

Gastric Cancer is one of the common malignancies worldwide and it is still the 3rd leading cause of cancer-related deaths globally. In Bhutan gastric cancer is the commonest malignancy in male with an incidence rate of 8.3 per 100000 population and second commonest malignancy in females after cervical cancer with an incidence rate of 5.2 per 100000 population. The Flagship program aims at Reducing Gastric Cancer incidence & mortality through early screening & prevention.

Currently, all high-risk population within the age group of (40-75 years) are provided endoscopy services and simultaneously all the H. Pylori positive cases are treated with triple therapy treatment. The gastric cancer screening is currently ongoing in Bumthang, Monggar and Wangdiphodrang Dzongkhags. However, from June 2021 population age group (18-75 years) will be screened for H. Pylori using the H.pylori test kits. The details are reflected as follows:

Dzongkhags Target population of  H pylori screening (18-75 years) Target population for gastric cancer
(40-75 years)
Target population as per line listing No. registered for endoscopy Endoscopy service provided Triple Therapy Treatment 
Bumthang 12023 4054 4990 1040* 1040  591
Mongar 22834 10306 11103 934* 335 86
Wangdiphodrang 31180 11866 15716 771* 298 27
Gelephu 32621 13416 Institutional based screening service 1061 325
Thimphu 102007 30817 Institutional based screening service 3369
Chukha 46081 16270 Institutional based screening service 217 73
Punakha 19613 7799 Ongoing 31* 31 8
Paro 33172 12147 Ongoing
Trongsa 16428 5283 Ongoing

Worldwide, Cervical cancer ranks as the fourth most frequently diagnosed cancer and also the fourth leading cause of cancer deaths in women. It is the most frequent cancer diagnosed among Bhutanese women with peak incidence in women at 40-49 years of age. The project aims to reduce cervical cancer incidence and mortality through early screening & prevention. The projects will screen all the women within the age group of (30-65 years) for Human Papillomavirus (HPV) and the treatment for abnormality will be carried out as per the guidelines and standards

Pap smear method is used to screen women within the age group of (25-65 years). In addition, pre-cancer lesions are treated with LEEP, cryotherapy and cold coagulation procedures. Currently, cervical cancer screening in Bumthang, Mongar, Punakha and Paro Dzongkhag has been completed with a coverage of more than 99 percent. The screening coverage in the initial phase are as follows:

Sl. No Dzongkhag Target Population Total Screened Coverage Colposcopy Cervical Cancer Treatment
1 Bumthang 3486 3452 99 796 8 129
2 Punakha 4647 4198 90 308 14 89
3 Monggar 6542 5918 90 481 3 33
4 Paro 4377 4036 92 138 2 63
5 Lhuentse 3046 3046 100

The screening related to Breast Cancer has not been initiated, which is part of the flagship program. The Clinical Breast Examination and breast cancer imaging through mammography will be initiated to enable early detection of breast cancer for prevention.

A total of 8,704 women were screened for Breast Cancer in 4 Dzongkhags of Paro, Bumthang, Monngar & Lhuentse. The detail break down of screening by Dzongkhag are as follows.

Number of women Screened

  • Paro
  • Bumthang
  • Monggar
  • Lhuentse

Procurement of equipment’s and consumables

For early detection of gastric cancer, 10 sets of Endoscopy Machines are procured and a set each is distributed to and 1 set each at Monggar Regional Referral Hospital, Gelephu Hospital( CRRH), Bumthang Hospital, Paro Hospital, Dewathang Hospital, Wangdue Hospitai, Trashigang Hospital & 3 sets to the Jigme Dorji Wangchuck National Referral Hospital. In addition, viral marker kits re also procured and distributed to the districts conducting the camps.

Similarly, for the cervical cancer screening, Laboratory reagent and consumables for pap-smear are procured and distributed across the health facilities. Besides, to treat the early precancerous lesions, 2 sets of thermacoagulators and 5 sets of colposcopy machines are procured and the colposcopy machines are further distributed to Phuntsholing Hospital, ERRH and JDWNRH.

Guideline and Advocacy Materials

In order to roll out the cancer screening project, the cancer screening guidelines for gastric, cervical and breast cancer was developed and made available for all the end users.

Capacity Building

20 health workers (5 Doctors, 13 Nurses and 2 Engineers) were provided training virtually to use/operate endoscopy in collaboration with equipment  supplier to ensure the health workers to comfortably handle the equipment and deliver effective services.

 A week-long attachment program was provided to Nurses working in   Paro, Wangdue Phodrang, Bumthang, Trashigang and Gelephu RRH at Jigme Dorji Wangchuck National Referral Hospital & Monggar Regional Referral Hospital.