Despite a lot of initiatives over the last 10 decades, cervical cancer is still the number one cancer among women in the country
Bhutan has a high cervical cancer incidence of 20.5 per 100,000 women, and mortality rate of 5.3 per 100,000 women.
In the last five years (2014-2018), there were 313 cases of cervical cancer and 82 women had died because of the disease which is preventable.
Every year, five women are dying of cervical cancer in the country. Cervical cancer is more common in women younger than 50 years of age, 70 percent of deaths occurred in older women.
No screening programs is the main reason along with prevailing risk factors including early age at marriage and first child birth, multiple childbirths, multiple sexual partners of a woman or her partner, HPV and other STIs, immunosuppression, and cigarette smoking.
Technical Advisor of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) Dr. Ugyen Tshomo said women between 25 to 65 years old has to go through screening and reach 70 percent of the target population. Screening must be quality assured. Each woman with abnormal report must be followed up and treated.
Dr Ugyen said the risk factors are already there among the women who falls under early age at marriage and first child birth, multiple child births and socio cultural beliefs. The people in rural parts does not visit health facilities or neither come for Pap smear due to lack of understanding.
According to Population and Houses Census of Bhutan (PHCB) 2019, Trashigang has recorded the highest number of cervical cancer along with Mongar, Wangdi Phodrang and Chhukha.
Also, Trashigang and Mongar has the highest death cases of cervical cancer. This is because although the women in easte do Pap smear but there is no facility to do colposcopy. Only Monggar has the facility.
Dr. Ugyen said till 2011, screening was mainly done in camps where sensitization of public and training of female HAs took place hand in hand but lack of public education and cultural attitudes affected service uptake
Another reason was the political commitment was lacking and no supervision and complacence was there at all levels.
Dr Ugyen said the shortage and transfer of trained female health workers affected the program. Motivation and dedication of these trained female health workers plays a crucial role. And the biggest bottle neck was lack of gynecologists which limited access to treatment of women with abnormal Pap reports with, only 4 centers till recently. Now they have six gynecologists, she added.
Many local initiatives were there to increase coverage. Now government is changing primary screening to HPV testing with more sensitivity and longer protection.
All the screening centers must be linked with colposcopy and treatment center and screening center must actively follow up with women needing these services. However, screening alone has no effect unless all women with pre cancers are treated.
“But we must start sensitizing women on early diagnosis to prevent premature deaths. It will take over cervical cancer soon. About 40 percent come for treatment at the last stage and cannot survive for even two months. So it is very important for women to understand the signs and symptoms of cervical cancer.Vaccination of boys will protect MSM, LGBT and will lead to decrease in oropharyngeal cancers which is second most common cancers in male presently,” Dr. Ugyen said.
Meanwhile, breast cancer is the fourth most common cancer (2014-18 PBCR) after cervix, stomach and thyroid cancers.
Dr. Ugyen said when there is decrease in the cervical cancer, the breast cancer will increase because of the women’s reproductive status. Women who does not give birth early are always at risk of getting breast cancer. Currently Bhutan has very less number of breast cancer cases and there is no screening test for breast cancer.