Maori bowel screens advice not enacted
AUCKLAND: Maori and Pacific New Zealanders won’t get bowel cancer screening from 50 because of pressure on colonoscopy services despite the ministry’s own expert advisory groups wanting the change, given those groups develop cancer earlier in life.
The decision has dismayed experts who said it sent a message that ‘‘Maori and Pacific people have to wait for equity’’.
The bowel cancer screening programme was piloted for 50 to 74yearolds, but when extended nationally, that range was tightened to 6074, a good fit for the Pakeha majority, but less so for Maori and Pacific, given more of those groups develop cancer earlier.
About 26% of bowel cancers in Pacific peoples occur between 5059 years old, compared to about 11% in the nonMaori or Pacific population.
Amidst backlash, the ministry in 2019 held meetings with Maori and Pacific health leaders, resulting in overwhelming recommendations to drop the screening age.
The ministry has responded, with a decision not to act until after the screening programme is fully rolled out, by about December next year (11 of 20 DHBs now have screening).
Lowering the age would require about 10% more screening colonoscopies, the ministry estimated, and services were already struggling.
‘‘Whilst we acknowledge the need to extend the age range to increase health gains for Maori and Pacific peoples . . . the only viable and safe option is to introduce the change once the programme is fully rolled out,’’ the ministry’s deputy directorgeneral of population health, Deborah Woodley, wrote in an email announcing the decision.
A Ministry of Health report, jointly written with the new Cancer Control Agency, went to Health Minister David Clark on June 30, and was released to the Herald under the Official Information Act soon after Ms Woodley’s email on Friday night.
It was written after Prime Minister Jacinda Ardern and Associate Health Minister Peeni Henare asked for advice, and noted the ministry’s national screening advisory committee and bowel screening advisory committee, and the cancer agency’s advisory council advocate lowering the screening age for Maori and Pacific.
The report said ‘‘it is important to particularly focus on cancers where the most stark inequities exist’’, including lung and cervical cancers. Dropping the bowel cancer screening age ‘‘will have a minimal equity impact relative to other interventions’’.
Some DHBs had asked to pilot a lower age threshold, the ministry noted, but many health boards that started screening struggled with colonoscopy demand, resulting ‘‘in significant numbers of symptomatic people having to wait beyond the maximum clinically recommended timeframe’’.
‘‘Within current financial, clinical and other resource constraints there is always a question about the best value for money for addressing health inequities, including within cancers.’’
Lowering the screening age ‘‘risks setting back progress on delivering the overall programme’’.
Dr Rawiri McKree Jansen, cochair of the National Maori Bowel Cancer Screening Network, told the Herald that was ‘‘an assertion it is acceptable to delay a proequity intervention because a properly resourced programme has not been designed; that Maori and Pacific people have to wait for equity’’.
His cochair, Shelley Campbell, chief executive of the Cancer Society’s Waikato/Bay of Plenty division, said over the past 18 months there had been a wide range of ‘‘highly debatable’’ reasons why dropping the age was apparently problematic, including lack of DHB support and rickety IT systems.
‘‘We cannot keep talking about the importance of equity in health systems and then failing to take the steps necessary to achieve it.’’
Cancer screening expert Dr Nina Scott, chair of Hei huru National Maori cancer leadership group Mwai Maori said screening ‘‘cannot be left to just quietly steam ahead ignoring the advice of experts knowingly and needlessly making inequities worse’’.
That view was shared by Bowel Cancer NZ medical adviser and associate professor at the University of Otago Medical School, Dr Sue Crengle, who noted it jarred with the Government’s commitment to equity.
Dr Rhys Jones, senior lecturer at Te Kupenga Hauora Maori, University of Auckland, said there was a very clear message from the hui in February last year it was untenable to continue with the ‘‘manifestly racist’’ status quo.
Dr Melissa McLeod, senior research fellow in the Department of Public Health, University of Otago, Wellington, could not fathom why a pilot programme was not run, given there were DHBs with capacity to do so.