🇮🇩 Cancer in Indonesia

In GLOBOCAN 2024, breast cancer accounts for 93,236 new cases, lung 58,446, colorectum 39,751, cervix 31,116 and liver 24,489; nasopharyngeal cancer accounts for 16,064. The national cancer plan (Rencana Kanker Nasional 2024-2034) chose six priorities on this basis: breast, cervix, lung, colorectal, liver and cancers in children under 18. It reports that the registry's counts and BPJS Kesehatan's 2022 claims data show the same pattern, with breast cancer first in women and lung cancer first in men. The plan states that about 70 per cent of patients are already at an advanced stage when they begin treatment, and that BPJS Kesehatan's spending on cancer rose from 3.1 trillion rupiah in 2020 to 5.9 trillion in 2023, second only to heart disease.

The plan traces registration from pathology records at Universitas Diponegoro in 1970 to a hospital registry at RS Kanker Dharmais from 1996. The first population-based registry was a Jakarta pilot for cancers diagnosed in 2005 to 2007, which gathered data from 57 hospitals and 345 community health centres; IARC found coverage too low and quality below standard for Volume X. The ministry then set 26 districts and cities as the registry's area, with RS Kanker Dharmais as the national cancer data centre, and the 2008 to 2012 (Volume XI) and 2013 to 2017 (Volume XII) submissions also failed the quality criteria. The plan names the causes: no data transfer between the fourteen hospitals and district hospitals, passive reporting by private hospitals and laboratories, and staff turnover. It names the city of Yogyakarta, with the most complete data of eighteen priority areas, as the first candidate for Volume XIII; IARC's CI5 site lists volumes I to XII only.

The plan's chart compares Jakarta with Asia as a whole: five-year survival was 18 per cent for stomach cancer in Jakarta against 30 per cent in Asia, 29 against 55 for colon, 6 against 15 for lung, 41 against 45 for ovary and 54 against 55 for prostate, while for rectum (57 against 50), liver (19 against 15), cervix (67 against 60) and adult leukaemia (40 against 25) Jakarta's figure was higher. The plan's text lists adult leukaemia among the cancers where Indonesia lags, which its own chart does not show; the figures are given here as charted. In the BPJS Kesehatan cohort, survival was 95.4 per cent at one year, 64.9 per cent at three and 56.8 per cent at five. For children, the paediatric registry IP-CAR recorded about 2,000 new cancers in 2022 to 2023 against an estimated 10,000 a year, with three-year survival of 24 per cent. These are averages for people diagnosed years ago and say nothing about any one person.

BPJS Kesehatan's president director, Prihati Pujowaskito, gave the 284.72 million figure at the Satya JKN Awards 2026, against a 2026 national development plan target of 98.7 per cent, and said 28 provinces and 350 districts and cities met the priority universal coverage criteria of at least 98 per cent registration and 80 per cent active members. Inactive membership matters for a patient: the minister for villages said at an April 2026 BPJS Kesehatan event that people in villages find their card inactive just when they need treatment. The national cancer plan gives the share of health spending paid by government as 59.4 per cent in 2021 and out-of-pocket spending as 27.5 per cent, down from 60.6 per cent in 2010, and cancer's share of health spending as 2.78 per cent in 2022. Presidential Regulation 59 of 2024 added fourteen screening services to the JKN benefit, including cervical, breast, bowel and lung cancer, and introduced a standard inpatient ward class (KRIS).

The plan cites the Cipto Mangunkusumo radiotherapy study (Universitas Indonesia, 2024): 38 per cent mild, 39 per cent moderate and 2 per cent severe financial toxicity, for costs such as energy, housing and transport, because not every diagnostic test and essential treatment for the patient's cancer was covered. It also cites a 2015 George Institute for Global Health study across eight South East Asian countries in which 24 per cent of Indonesian patients faced financial catastrophe a year after diagnosis. BPJS Kesehatan claims data for 2022 put the median cost per patient at 34.4 million rupiah for pancreatic cancer and 23.6 million for colorectal cancer. To widen access the plan proposes three co-payment options for medicines: a drug outside the national formulary paid by another insurer or by the patient, co-insurance between JKN and private insurance for a formulary drug, or a branded drug with the patient's consent paid by another insurer while the generic stays covered by JKN.

The ministry's pharmaceutical directorate describes the formulary as the list of selected medicines that guides prescribing and serves as a quality and cost control instrument for the insurance programme, first drawn up in 2013 and revised four times with six addenda by September 2022. In July 2022 the formulary committee was merged with the committees for the essential medicines list and the phytopharmaceutical formulary into one national selection committee (Kepmenkes HK.01.07/MENKES/1295/2022), with a term to 31 December 2024. The national cancer plan cites Kepmenkes HK.01.07/MENKES/2197/2023 as the formulary in force, reports work to add cancer medicines and to widen morphine use for palliative care in primary care, and names the national development of an HPV DNA test kit. OnCo could not open the formulary text itself to list which cancer medicines it holds.

The plan lists completed cancer assessments of nilotinib for chronic myeloid leukaemia, trastuzumab for early and for metastatic breast cancer, bevacizumab for metastatic colorectal cancer, rituximab for non-Hodgkin lymphoma, lapatinib for metastatic breast cancer, pembrolizumab for metastatic non-small cell lung cancer, cervical screening by HPV DNA, visual inspection and Pap smear, and colorectal screening; and assessments in progress of abiraterone, biosimilar bevacizumab, cetuximab, brigatinib, nimotuzumab, palbociclib, ribociclib, sunitinib and maximum trastuzumab prescribing. The guideline is Permenkes 51 of 2017. For the 2026 round, opened on 30 April, topics are submitted through htaindonesia.kemkes.go.id and ranked by the committee, chaired by Professor Auliya Suwantika, on six criteria: volume, efficacy and safety, cost, fit with policy priorities, potential savings and public acceptability.

BPOM's press release of 31 December 2025 said Peraturan BPOM 23 of 2025, the fifth amendment to its 2017 drug registration rule, introduced the reliance mechanism cutting evaluation from 120 to 90 working days. In April 2026 it named the seven reference regulators and gave 50 working days for new medicines from companies investing in Indonesia and 100 working days for life-saving and orphan medicines, medicines for national health programmes, new medicines tested in Indonesian clinical trials, and first registrations by foreign companies investing in Indonesia. It reported the share of accelerated authorisations rising from 70.6 per cent in 2024 to 87.5 per cent in 2026. From 2023 to the end of 2025 BPOM issued 12,111 medicine authorisations, 86.26 per cent for domestic products. These are target clocks in working days; OnCo found no published median of actual approval times for cancer medicines.

The plan names reliance on imports and limited domestic capacity to make essential cancer medicines, innovative medicines and biotechnology products as challenges, and asks BPOM to keep registration and supply mechanisms working for essential and innovative cancer medicines, to support the special access scheme for those not made in Indonesia, and to review and update cancer drug indications on the evidence. One worked example: it records that BPOM was adding retinoblastoma to the registered indications of etoposide for children's cancer, planned for completion in 2025. OnCo did not find a public list of cancer medicines supplied through the special access scheme or how long a request takes.

HPV DNA screening was piloted in Jakarta from July 2023 with a target of 16,000 women aged 30 to 69 (14,790 tested, 99 per cent of a 15,000 target) and extended in 2024 to 35 districts and cities in 16 provinces with visual inspection as a co-test; by July 2024 it had reached 65,920 women, 12 per cent of 538,700, delayed by a laboratory consumable arriving late. The 2023 national action plan for cervical cancer elimination sets HPV DNA screening of 70 per cent of women aged 30 to 69, then 75 per cent, once every ten years; the cancer plan's target is 70 per cent by 2027. HPV vaccination: 90 per cent first-dose coverage nationally in 2023 for girls aged about 11, and 95.9 per cent second-dose coverage in 132 districts and cities of 8 provinces. The plan names hard-to-reach health centres and scarce cryotherapy for treating precancer as obstacles.

The plan sets the breast screening target population as women aged 30 to 69, with a baseline of 14 per cent (cumulative over three years) and a target of 60 per cent by 2027, and reports that the ministry has funded ultrasound machines for every community health centre. At the World Cancer Day event on 4 February 2026, the health ministry reported that the Cek Kesehatan Gratis programme targets about 40 million women over 30 for breast screening and that about 4 million had used it, and that the ministry and RS Kanker Dharmais launched a ten-year national action plan for breast cancer. The plan's other primary care screening is a lung cancer questionnaire with low-dose CT referral for men over 45 who smoke, faecal occult blood testing for bowel cancer, a liver risk questionnaire with blood tests, and a childhood cancer questionnaire; baseline coverage for these was not yet available.

The national cancer plan describes the programme as free screening for Indonesian citizens on their birthday at primary care facilities, separate from JKN, intended to raise screening coverage and find disease earlier, including cancer. The ministry reported on 4 August 2026 that of the 73.8 million people checked, 62.7 million were screened at health centres and community events and 11.1 million were schoolchildren, against a 2026 target of 130 million; its 2026 follow-up concentrates on blood pressure, blood sugar and cholesterol. The ministry has not published, in the pages OnCo read, how many cancers or precancers the programme has found, so its effect on cancer stage at diagnosis is not yet known.

Under Kepmenkes HK.01.07/MENKES/1277/2024 on referral hospital networks, the plan counts 570 hospitals in the cancer network: 512 madya, 43 utama and 15 paripurna. Its first-phase target was 257 districts and cities (half of 514) with a madya hospital by 2024, of which 65 (25 per cent) were met by August 2024, and all 514 by 2027; for provinces, 22 of 34 (65 per cent) had an utama or paripurna hospital against 38 by 2027. Its mapping of 514 districts found mammography with staff in 154 (30 per cent), anatomical pathology in 52 (10 per cent) and adult systemic therapy in 66 (13 per cent). The workforce gap it reports is 172 radiation oncologists (173 of 345 needed) and 1,407 anatomical pathologists (852 of 2,259). The ministry's launch statement lists 276 mammography units, 236 CT scanners, 34 SPECT-CT and 8 PET-CT to be added by 2027.

The plan's health resilience pillar lists domestic production of the 14 routine immunisation vaccines, HPV vaccine among them, and names the HPV vaccine project as development and production by PT Bio Farma through technology transfer from PT Merck Sharp Dohme, alongside domestic production of cervical cancer HPV DNA diagnostic kits and real-time PCR in 169 laboratories in 2024 with specimen transport to reference laboratories. BPOM reported in December 2025 that 85 per cent of medicines used in JKN are made in Indonesia. OnCo did not find a published date from which domestically made HPV vaccine is used in the national programme, so that is not stated.

OnCo queried the ClinicalTrials.gov API v2 for location Indonesia and the condition terms cancer, neoplasm, tumour, carcinoma, lymphoma or leukaemia; a keyword search can include some non-cancer studies. Of the 155, 89 have no phase (observational or device studies), 34 are phase 3, 10 phase 2 and 9 phase 4. The commonest lead sponsors are Universitas Indonesia (33), Gadjah Mada University (9), Dharmais National Cancer Center Hospital (8), Hoffmann-La Roche (7) and AstraZeneca (5). In OnCo's graph, the two trials whose ClinicalTrials.gov sites include Indonesia are a phase 1/2 trial of dendritic cells for advanced nasopharyngeal cancer by PT Prodia Stem Cell Indonesia (NCT05261750) and a phase 2 trial of simvastatin in breast cancer by Universitas Indonesia at Cipto Mangunkusumo (NCT05550415). OnCo's file of studies with an Indonesian site for any condition, built on 8 September 2026, counted 1,713.

The OpenAlex counts use works whose primary topic is oncology, counted wholly for each country with an author there. In OnCo's file of 8 September 2026: 582 in 2021, 508 in 2022, 604 in 2023, 671 in 2024 and 782 in 2025; in the live query on 4 November 2026: 615, 502, 622, 753 and 896. The plan notes that most Indonesian cancer research from 2016 to 2020 was clinical observation and early-phase experimental work, and sets out four needs: cross-disciplinary research, integrating electronic medical records and genomic data from the satuDNA platform with SATUSEHAT and with civil registration death records (Dukcapil), translational research, and infrastructure. It names the Biomedical and Genome Science Initiative (BGSi), which builds a national biobank for six diseases including cancer and offers genomic sequencing. Survival measurement, it says, depends on linking cancer cases to death records, which has not yet been done.

dharmais.co.id returned HTTP 200 with an empty body, so Dharmais's bed numbers, case volumes and services are not described here and its role is sourced from the national cancer plan. bpjs-kesehatan.go.id renders by script, so JKN membership figures are quoted from news reports of the BPJS Kesehatan director's statements rather than from BPJS's own release. The BKPK regulation repository (regulasi.bkpk.kemkes.go.id) did not respond, so the Formularium Nasional decree (Kepmenkes HK.01.07/MENKES/2197/2023) could not be opened to list its cancer medicines. canreg.fk.ugm.ac.id, the Yogyakarta population-based registry, redirected to the university's login, so the Yogyakarta registry's own incidence figures are not given. BPOM's 2017 registration rule could not be read as text, so pathway clocks are quoted from BPOM's own press releases.

The registry's latest published figures are counts for 2013 to 2017 in about 14 per cent of the population; a national rate would have to come from IARC's model. BPOM publishes target clocks in working days and the share of accelerated approvals, not the actual time from submission to approval for each medicine. The 14.6 per cent cervical and 13.7 per cent breast coverage figures are for 2023 from the national plan; the 2026 figure of about 4 million women using the free check for breast screening is a ministerial statement without a published denominator method. Presidential Regulation 59 of 2024 gave a one-year transition to set contributions, benefits and tariffs alongside the standard inpatient class, and OnCo did not confirm which rates are now in force, so what a member pays each month is not stated. Whether any Indonesian registry was accepted for Cancer Incidence in Five Continents Volume XIII could not be confirmed; IARC's site lists volumes I to XII.