KINLEY KHANDU CHODEN | Thimphu
Stomach cancer is the leading cancer among men in Bhutan, while cervical cancer remains the most common among women, with a national registry recording 5,906 new cancer cases over nine years (2014 – 2022).
The study, Cancer pattern in Bhutan (2014–2022), was conducted by researchers affiliated with Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) and Bhutan’s Ministry of Health, in collaboration with researchers from Tata Memorial Centre in India. It analysed data from Bhutan’s population-based cancer registry, established at JDWNRH in 2014 with support from the Ministry of Health and the International Agency for Research on Cancer (IARC).
Of the 5,906 cases registered during the period, 3,247 were women and 2,659 were men. Women accounted for 55 percent of all cases, while men made up the remaining 45 percent.
The registry also recorded 2,510 cancer-related deaths between 2014 and 2022, comprising 1,265 men and 1,245 women.
The age-adjusted incidence rate stood at 113.2 cases per 100,000 women and 88.3 per 100,000 men. These rates account for differences in population age structures, allowing cancer incidence to be compared more meaningfully across populations.
Stomach and cervical cancers remain leading concerns
Stomach cancer was the most frequently recorded cancer among men, followed by oesophageal, liver, lung and rectal cancers.
Among women, cervical cancer ranked first, followed by stomach, breast, lung and thyroid cancers.
The age-adjusted incidence rate for stomach cancer among men was 20.9 per 100,000, while the rate for cervical cancer among women was 19.5 per 100,000. Stomach cancer among women recorded a rate of 15.3 per 100,000.
The researchers also compared Bhutan’s cancer patterns with those reported by other cancer registries in neighbouring countries and elsewhere. Bhutan recorded comparatively high rates of stomach cancer among both men and women, while its cervical cancer rate was the highest among the registries included in the study’s comparison.
The findings highlight the importance of understanding the factors contributing to these cancers and strengthening prevention, screening and early diagnosis.
𝗘𝘀𝘁𝗶𝗺𝗮𝘁𝗲𝘀 𝗽𝗼𝗶𝗻𝘁 𝘁𝗼 𝗮 𝗰𝗼𝗻𝘁𝗶𝗻𝘂𝗶𝗻𝗴 𝗯𝘂𝗿𝗱𝗲𝗻
Separate estimates published by IARC through its Global Cancer Observatory provide a more recent indication of the country’s cancer burden.
For 2024, IARC estimated 644 new cancer cases and 466 cancer-related deaths in Bhutan. Stomach cancer was the most common cancer overall, with an estimated 99 new cases, accounting for 15.4 percent of the total.
Cervical cancer accounted for an estimated 75 cases, followed by lung cancer with 50, thyroid cancer with 42 and oesophageal cancer with 40.
Among men, stomach cancer accounted for an estimated 58 cases, followed by oesophageal cancer with 29 and liver cancer with 26. Among women, cervical cancer led with 75 estimated cases, followed by stomach cancer with 41 and thyroid cancer with 36.
Stomach cancer also accounted for the highest estimated number of cancer deaths in 2024, at 86. Lung cancer was estimated to have caused 48 deaths, while cervical cancer accounted for 46.
These figures are statistical estimates rather than a final count of cases registered in 2024. They cover a different period and use a different methodology from the national registry study and should not be directly compared with its findings.
Screening efforts target major cancers
Bhutan implemented a nationwide Health Flagship Programme from 2020 to 2023, focusing on stomach, cervical and breast cancers. The programme sought to expand screening, support early detection and connect people requiring further investigation or treatment with health services.
A published review of the programme reported that 370,225 people were screened for Helicobacter pylori (H. pylori), a bacterium associated with stomach cancer. Of those screened, 119,854 tested positive.
Among 53,182 people who underwent upper gastrointestinal endoscopy and biopsy, 255 stomach cancers were detected.
For cervical cancer, 10,749 people underwent HPV DNA testing, with 9.3 percent testing positive. A total of 9,887 people underwent colposcopy and biopsy investigations, which identified 154 cervical cancers.
The programme also recorded 73 breast cancer cases among women who underwent screening and follow-up investigations.
A positive H. pylori or human papillomavirus (HPV) test does not mean a person has cancer. Further clinical assessment is required to determine whether cancer is present.
The programme has since been integrated into routine health services, according to the published review. Continued monitoring will be important to assess screening coverage, ensure that people with positive results receive follow-up care and determine whether cancers are being detected at earlier stages.
The number of people screened alone, however, does not establish how many cancer deaths have been prevented or whether survival rates have improved.
Prevention and surveillance remain important
H. pylori infection, smoking and diets high in salt are among the established risk factors for stomach cancer. The infection can cause chronic inflammation of the stomach lining and increase the risk of developing the disease.
Cervical cancer is primarily caused by persistent infection with high-risk HPV. Vaccination, screening and timely treatment of precancerous changes can prevent many cases, while smoking is a major established risk factor for lung cancer.
However, the national registry study does not establish the extent to which individual risk factors contribute to Bhutan’s cancer patterns. Further research is needed to clarify the roles of infection, dietary habits, smoking, and other exposures.
The population-based cancer registry remains an important tool for tracking changes in cancer incidence and mortality, identifying priority areas and assessing cancer-control activities. Its nationwide coverage provides a basis for monitoring the country’s cancer patterns over time.
The researchers highlighted the role of the registry in strengthening links between screening programmes and cancer surveillance, including the follow-up of people identified during screening.
The nine-year findings establish stomach and cervical cancers as major concerns in Bhutan’s cancer profile. Sustained prevention efforts, accessible screening, timely diagnosis, and reliable data will be important in guiding future cancer-control measures.
