A growing public health issue in Bhutan, cancer is one of the main causes of death in the country. The cost of cancer has been rising continuously for a number of years. The population based cancer registry, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) recorded 2648 cancer cases during the period 2014-2017. Of these 1156 were in males and 1492 were in females.
Stomach cancer is predominantly the highest number of cancers in the country followed by cervical, head and neck, lung and esophagus cancers, which are the top five cancers for the period of 2014-2018. Stomach, head and neck, lungs, esophagus and liver cancers are most common in men whereas in women, cervix, stomach, thyroid, breast and leukemia predominate.
Without adequate action and intervention, cancer incidence in Bhutan is expected to rise by more than 80% over the next 2 decades, from about 570 cases in 2020 to 1,030 cases in 2040 Cancer-related mortality. Meanwhile, it is expected to rise more than 85%, from 456 to 845 deaths between 2020 and 2040.
According to Dr. Prabhat Pradhan, Surgical Oncologist, JDWNRH, the lifestyle, food habits and last stage detection of cancer is some of the reasons behind the highest mortality rate due to cancer in Bhutan.
He said, “Although there is no specific reason for cause of cancer, in Bhutan the highest rate of cancer is due to type of life style, the food habit and late detection of cancer and consumption of alcohol and smoking.”
Concordance to the Bhutan Cancer Control Strategy 2019-2025, about one-third of cancer related deaths have been attributed to the behavioral and dietary risks like high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco and alcohol use.
A total of 94 (from 477 in males and 464 in females) individuals including children died from cancers during the period 2014-2018 with stomach, liver, esophagus, cervix and lung cancer.
According to National statistics bureau, the highest mortality rate due to stomach cancer is between the age group of 60 plus for both male and female with 97 fatality for men and 43 for female while, cervical related death with 89 fatality is mostly among the age group of 15-49 years.
However, a number of successful programs and policies have been implemented to address the country’s cancer burden. The national cancer registry, for example, has laid a foundation for addressing the burden of cancer in Bhutan by enabling cancer cases to be monitored and recorded.
Dr. Prabhat Pradhan further added that with institution of Bhutan cancer Society, the organisation has launched a number of aggressive public awareness campaigns targeting the general public and health care professionals. Bhutan Cancer Society works tirelessly to educate the public, the media, and health professionals about the steps people can take to stay healthy, and ways everyone can fight back against the disease.
He said, “Cancer in earlier days was due to lack of awareness among the people and when they come to us it was mostly in last stage which neither can be treated nor be operated but with the help of Bhutan Cancer Society it has helped to create awareness and with the installation of treatment facilities better treatments are given”.
However, with limited qualified oncologists, JDWNRH has just one Oncology Unit, most of the patients coming from far-flung villages to the centre are unable to receive follow up care due to distance and cost which hinder the treatment.
Dr. Prabhat Pradhan further added, “ With only two qualified oncologist in Bhutan the treatment of cancer is difficult and those patients are sent abroad especially to India for the treatment which become expensive for government and patients as well.”
In 2018 alone, the government has sent 1,500 patients as referral cases out of the country for the treatment of which 550 are cancer related patients spending Nu. 200 million for the treatment.
According to Dr. Prabhat Pradhan, he alone has operated around 31 cancer cases in 2022 and 57 couldn’t be operated due to last stage detection of cancer. With this figure we can gauge the surge in number of cancer cases in 2022 alone.
Most of the cancer causing factors are attributed to poor lifestyle and dietary habits in the country.