Gender‐neutral HPV elimination, cervical cancer screening, and treatment: Experience from Bhutan

Abstract

Cervical cancer is preventable and also curable when detected early and treated adequately, yet it remains a leading cause of morbidity and mortality among women. In Bhutan, cervical cancer is the most common cancer among women. Bhutan was the first country among the low- and middle income economies to have instituted a national human papillomavirus (HPV) vaccination program in 2010 and has achieved >90% coverage. In 2019, Bhutan launched a cervical cancer elimination flagship program well ahead of the World Health Organization's launch of the global strategy for accelerated elimination of cervical cancer. Bhutan initiated vaccination of adolescent boys and adopted a gender-neutral vaccination program beginning September 2020 through its well-established network of primary health care centres. The flagship program aims to screen women aged 30-69 years with HPV testing using liquid based cytology (LBC) as triaging for screen positive women. For women 25-29 years, LBC will be continued as per ASCCP guideline. Colposcopy and treatment will be done in camps to decrease loss of follow-up of screen positive women. This program is also expected to improve early diagnosis of cervical cancer and provide timely and adequate cancer treatment and palliative care services. This article reviews the progress made and the challenges facing the 2030 cervical cancer elimination targets in Bhutan.