National Cancer Control Plan 2024-2030

Objectives

The Bermuda National Cancer Control Plan provides a national framework to reduce the cancer burden and improve quality of life through prevention, early detection, diagnosis, treatment, integrated care, survivorship, palliative care and cross-cutting system improvements.[1][2]It aligns with the Bermuda Health Strategy 2022-2027 vision of healthy people in healthy communities and its commitment to equitable access to essential health services without financial hardship.[2]

• Promote healthy living and prevent cancer by addressing overweight and obesity, physical inactivity, tobacco use, harmful alcohol use, sun exposure, cancer-causing infections, chemical exposures and environmental contamination.[3][4]
• Provide evidence-informed, patient-centred, timely and equitable screening, diagnosis, treatment and integrated cancer care.[3][5]
• Optimise quality of life for people affected by cancer through palliative, end-of-life, supportive and survivorship care that recognises physical, emotional, psychosocial and spiritual needs.[6][7]
• Strengthen cancer control through better policy, surveillance, routine reporting, health information systems, workforce planning, health equity and on-island cancer research.[8][9][10]
• Meet defined prevention targets, including a 15% reduction in adult physical inactivity by 2026, a 25% reduction in tobacco use by 2030, no increase in adult or youth overweight and obesity, no increase in melanoma among adults under 40, and 90% human papillomavirus vaccination coverage among 15-year-olds by 2030.[11][12]
• Improve early detection through national screening guidance, reminder-recall systems, rapid diagnostic services, timely imaging, familial genetics where appropriate, targeted outreach and stronger general practitioner engagement.[13][5]
• Reduce inequities by ensuring access to prevention, screening, diagnosis, treatment and survivorship services while limiting financial hardship, particularly for underserved, underinsured and uninsured populations.[10][14]

Implementation

Implementation uses a collaborative, phased national model, with immediate actions in 2024, short-term actions in 2025-2026 and longer-term actions in 2027-2030; strategies have identified lead institutions and implementation timelines.[4][3]The Ministry of Health coordinates delivery with its entities and a broad network of public, private, professional, community and international partners.[2]

• Coordinate delivery through the Ministry of Health, Department of Health, Health Insurance Department, Office of the Chief Medical Officer, Bermuda Health Council, Bermuda Hospitals Board, Bermuda Tumour Registry, Epidemiology and Surveillance Unit, Bermuda Cancer and Health Centre and other providers.[2][7][14]
• Engage general practitioners, specialists, nurses, cancer navigators, care coordinators, insurers and payers, employers, schools, media, faith-based and community organisations, cancer survivors, patients and advocacy groups in prevention, care and advocacy.[3][15]
• Deliver services through public and private providers, with primary care predominantly privately delivered, secondary care provided through King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute, and overseas centres used where services are unavailable on-island.[16]
• Implement prevention through tobacco and alcohol control, smoking cessation support, healthy food and active environments, sugar-tax-supported fruit and vegetable subsidies, sun-safety education, hepatitis B and human papillomavirus vaccination, and strengthened occupational, pesticide, radiation and air-quality controls.[17][18][19][20]
• Redesign cancer pathways for breast, prostate, colorectal and acute oncology services; introduce rapid breast diagnostic pathways, standardised prostate pathways, nurse-led care, cancer navigation, multidisciplinary teams, automated follow-up and patient-safety controls.[21][22][23]
• Review palliative and end-of-life services, establish survivorship standards and tailored care plans, integrate supportive care with treatment, and plan staffing sufficient for future population needs.[6][7]
• Strengthen information systems through mandatory reporting of cancer cases to the Tumour Registry, National Healthcare Identifiers and a multi-institutional clinical registry using systems including PEARL and ARIA.[8][7]
• Monitor progress through key performance indicators, targets and timeframes set for each objective, with routine surveillance of cancer incidence, mortality, stage at diagnosis, survival, prevention risks, vaccine coverage, treatment timeliness, patient experience, palliative-care access, workforce capacity and health inequities.[3][24][25][26]
• Use baseline measures including late-stage diagnosis, cancer incidence and mortality, behavioural risk factors, vaccination coverage, insurance coverage and workforce measures, while establishing further baselines and targets where these remain to be determined.[27][11][25][26]
• Support affordability through screening and treatment included in the Standard Health Benefit without co-payments, specified Bermuda Cancer and Health Centre services without co-payments, and an Equal Access Fund subsidising care for underinsured and uninsured people.[10][14]
• Draw on technical collaboration with the Caribbean Public Health Agency, Pan American Health Organization, United States National Cancer Institute, International Agency for Research on Cancer and Union for International Cancer Control.[2]

Monitoring & Evaluation

The plan establishes a performance-oriented cancer-control framework combining key performance indicators, targets, baseline measures, surveillance, routine reporting, clinical audits and institutional responsibilities. Annex 3 sets indicators, targets and timeframes for each objective, although several measures and targets remain to be determined.[3]

• Monitor prevention through indicators for overweight and obesity, physical inactivity, tobacco use, harmful drinking, melanoma incidence, vaccination coverage, and chemical exposure-related events.[11][12]
• Track baseline prevention measures, including adult overweight or obesity at 74.6% in 2014, youth overweight or obesity at 34% in 2019, adult physical inactivity at 27.1% in 2014, smoking at 13.9% in 2014, harmful drinking at 28.2% in 2014, and melanoma incidence among adults under 40 at 2.8 per 100,000 during 2015-2019.[11][12]
• Set prevention targets to reduce adult physical inactivity by 15% by 2026, reduce tobacco use by 25% by 2030, avoid increases in adult and youth overweight and obesity, avoid increases in melanoma incidence among adults under 40, and achieve 90% human papillomavirus vaccination coverage among adolescents aged 15 years by 2030.[11][12]
• Establish a baseline for youth physical inactivity and conduct routine surveillance among young people and adults, potentially using the Global School-Based Health Survey to support behavioural monitoring and international comparison.[17][4]
• Monitor vaccine coverage, follow up unvaccinated patients, and maintain annual hepatitis B vaccination monitoring from 2023 to 2030.[28][11]
• Strengthen cancer surveillance through mandatory reporting of cancer cases to the Tumour Registry, National Healthcare Identifiers, and a multi-institutional clinical registry using PEARL and ARIA software to link diagnosis, treatment, pathology, demographic and survival data.[8][7]
• Standardise Tumour Registry reporting, improve recording of stage at diagnosis and survival, align race data with Census categories, and routinely report incidence, mortality and trends for priority cancer sites.[9]
• Report cancer incidence and mortality routinely from 2024 using the Tumour Registry and Epidemiology and Surveillance Unit, including three-year average age-standardised rates and trends by sex and cancer site.[25]Baseline incidence is 219 per 100,000 overall, 237 for males and 210 for females; baseline mortality is 81 per 100,000 overall, 98 for males and 70 for females.[25]
• Monitor early detection by recording stage at diagnosis and reducing late-stage diagnoses. Stage III and IV diagnoses comprised 20% of cancers in 2017-2019, compared with 24% in 2010-2012.[27]
• Measure integrated-care performance through referral-to-diagnosis and diagnosis-to-first-treatment waiting times, hospital length of stay, treatment timeliness and patient experience, with several baselines and future targets still to be established.[21][6]
• Conduct pathology and radiology audits, review inpatient volumes and length of stay, and apply multidisciplinary oversight, automated follow-up and patient-safety controls to support quality assurance.[22][23]
• Monitor palliative-care provider availability and access to palliative care, while establishing survivorship standards and related measures.[24][25]
• Maintain workforce reports on staffing, retention, vacancies, challenges and successes, and measure workforce satisfaction and cancer personnel per 100,000 population.[14][26]
• Monitor health equity through insurance coverage, recorded at 90% in 2016, and the proportion of households whose health expenditure exceeds 10% of household expenditure or income, aligned with Sustainable Development Goal indicator 3.8.2.[26]
• Submit quarterly radiation-safety reports to the Ministry of Health, covering incidents and follow-up, equipment safety, and dosimeter readings where applicable.[19]

Lead institutions and accountability mechanisms include the Ministry of Health, Bermuda Hospitals Board, Bermuda Cancer and Health Centre, Bermuda Health Council, the Tumour Registry and the Epidemiology and Surveillance Unit.[2][7]The supplied material does not provide a complete reporting timetable, evaluation methodology or formal accountability process for every objective.[10]

Costing & Financing

Financing is principally contextual rather than a costed implementation plan: cancer-control development received support through the Chronic Disease Innovation Programme, while health services are financed mainly through private insurance alongside public funding, out-of-pocket payments and charitable donations.[2][16]No overall cancer-control budget, implementation financing envelope, quantified funding gap or comprehensive resource-mobilisation plan is specified.[10]

• Finance health services primarily through private health insurance, which represented 62% of total health financing in FYE2018, alongside public funding at 23%, out-of-pocket payments at 15% and charitable donations at 1%.[16]
• Record total health expenditure of 427 million in FYE2006 and 737 million in FYE2018, with per capita expenditure of 11,529 in FYE2018.[16]
• Maintain screening through the Standard Health Benefit without co-payment and support access to cancer screening and treatment without co-payments where specified.[20][10]
• Use the Equal Access Fund, supported by community donations, to subsidise clinical services for underinsured and uninsured people.[10]
• Improve access to hepatitis B virus and human papillomavirus vaccines so that cost is not a barrier, and provide information on obtaining cancer services without financial toxicity.[19][13]
• Use fiscal measures including tobacco and alcohol taxation or price policies, a Sugar Tax to subsidise fruit and vegetables, and financial incentives for purchasing fruit and vegetables.[17][18]
• Provide funding to sustain sun-safety education programmes and undertake a cost-benefit analysis comparing nonavalent and quadrivalent human papillomavirus vaccines.[19]
• Monitor financial protection through the proportion of households spending more than 10% of household expenditure or income on health, although no monetary estimate or financing response is provided.[26]

Prevention is characterised as the most cost-effective cancer-control strategy.[3]The supplied sections do not quantify intervention costs, future allocations, affordability requirements, or economic assumptions for implementing the plan.[5][22][23]