Bowel Cancer Screening Age Not Lowered for Pacific Maori and New Zealanders, Expert Advice Despite

Maori and Pacific New Zealanders will not be screened for 50 bowel cancer due to pressure on colonoscopy services, despite the ministry’s own expert advisory groups wanting change.

The decision has dismayed experts who say it sends a message that “Maori and the Pacific have to ‘wait’ for fairness.”

The bowel cancer screening program was tested for people ages 50 to 74, but when expanded nationally, that range was reduced to 60-74, a good choice for most countries, but less so for Maori and the Pacific, since there are more of those groups. develop cancer sooner.

For example, about 26 percent of bowel cancers in Pacific people occur between the ages of 50 and 59, compared to about 11 percent in non-Maori or Pacific populations.

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Amid a backlash, the Ministry in 2019 held meetings with Maori and Pacific health leaders, resulting in overwhelming recommendations to lower the screening age.

The ministry has responded now, deciding not to act until after the screening program has been fully implemented, around December next year (11 out of 20 DHBs currently have screening).

Lowering the age would require about 10 percent more screening colonoscopies, the ministry estimated, and services were already struggling.

“While we recognize the need to broaden the age range to increase the health benefits of Maori and Pacific peoples … the only viable and safe option is to introduce change once the program is fully implemented.” said Deborah Woodley, deputy director of population health, wrote in an email announcing the decision.

, written in conjunction with the new Cancer Control Agency, went to Health Minister David Clark on June 30 and was delivered to the Herald under the Official Information Act shortly after Woodley’s email Friday night.

It was written after Prime Minister Jacinda Ardern and Deputy Minister of Health Peeni Henare asked for advice, noting that the ministry’s national screening advisory committee and bowel screening advisory committee, and advocate for the advisory council of the Cancer Agency to Lower Age Screening for Maori and Pacific.

• READ MORE: Jenny-May Clarkson, Breakfast Host, on her support for lowering the age of screening after her brother died from bowel cancer

However, the report stressed that “it is important to focus especially on cancers where there are the most stark inequalities,” including lung and cervical cancers. Reducing the age of bowel cancer screening “will have minimal impact on equity relative to other interventions,” and “we should consider introducing specific lung cancer screening tests.”

Some DHBs had requested to test a lower age threshold, the ministry noted, but many health boards that began screening had problems with demand for colonoscopy, causing “a significant number of symptomatic people to have to wait beyond the maximum clinically recommended time. “

“Within current financial, clinical and other resource constraints, there is always the question of the best value for money to address health inequities, including within cancers.”

Lowering the selection age “runs the risk of delaying progress in the implementation of the overall program”, and it was better to focus on increasing existing participation.

Dr. Rawiri McKree Jansen, co-chair of the National Maori Bowel Cancer Screening Network, told the Herald that it was “a statement that it is acceptable to delay an intervention in favor of equity because a program has not been designed with the resources adequate – that Maori and the Pacific have to ‘wait’ for fairness. “

Its co-chair, Shelley Campbell, executive director of the Waikato / Bay of Plenty division of the Cancer Society, said that over the past 18 months there had been a wide range of “highly debatable” reasons why lowering age was apparently problematic. , including lack of DHB Support and rickety computer systems.

“We cannot continue talking about the importance of equity in health systems and then stop taking the necessary steps to achieve it.”

Cancer screening expert Dr. Nina Scott, president of Hei Āhuru Mōwai Māori, the Maori national leadership group on cancer, said that screening “cannot be left to move forward ignoring the advice of experts, it that knowingly and unnecessarily makes inequalities worse. “

That view was shared by Bowel Cancer NZ Medical Advisor and Associate Professor at the University of Otago School of Medicine, Dr. Sue Crengle, who noted that it contradicted the government’s commitment to fairness.

Dr Rhys Jones, Senior Lecturer at Te Kupenga Hauora Māori, University of Auckland, said there was a very clear message from the hui convened by the ministry in February last year: it was untenable to continue the “manifestly racist” status quo.

One DHB who wants to lower the age is Tairāwhiti, who joined the screening program this month. Chief Executive Jim Green said he had agreed with the ministry to review things well before the end of the first year, and “we are confident that we will have capacity.”

Dr. Melissa McLeod, Principal Investigator at the Department of Public Health at the University of Otago, Wellington, said she could not understand why a pilot program was not being run, since there were DHBs with the capacity to do so.