Rural divide: Why for some women,

When you’re forced to travel hours for breast cancer radiation, sometimes losing a breast is just the more straightforward option. By

Oncoplastic breast surgeon Josie Todd has got used to having the same conversation. She sits a woman down in Christchurch Hospital, tells them they have breast cancer and discusses their options.

Sometimes she can deliver semi-good news, and tell a woman all she needs is a lumpectomy and radiation, removing the lump and conserving the breast. However, women often say no, opting for a mastectomy instead. They feel it is their only option.

One in nine women are diagnosed with breast cancer in their lifetimes, and according to Breast Cancer Foundation NZ research, many are having unnecessary mastectomies. The research, based on data from 30,000 breast cancer patients over 20 years, showed New Zealand's mastectomy rates were extremely high, and that in fact, breast-conserving surgery and radiation had a higher survival outcome than mastectomy in applicable cases.

According to surgeons, one of the driving forces of this was women are sometimes forced to travel long distances to their nearest radiation centre, meaning that for many, mastectomy is the easier option.

Celeste Jones and her husband were both told they had cancer on the same day.

That morning, Jones found out she had breast cancer; it was caught early and meant she could have breast-conserving surgery and radiation if she wanted to.

But when her husband was told he had cancer that afternoon, she went straight downstairs, found her breast cancer nurse and told her she wanted a mastectomy.

“I haven’t got time to think about it, I need to be with my husband, so just get the breast off’,” she said.

Because Jones lived in Hastings, conserving her breast would have come with a two-hour drive to Palmerston North for radiation. It would also mean weeks away from her family and little to no support.

She knew the toll that drive could take on a person, after her daughter went through radiation in Palmerston North a few years prior. “Being away from the family was hard. You would go down Monday morning and travel home Friday and that whole weekend she’d be stuffed. I just thought I didn’t have time to be sick, I didn’t have time to die, because I needed to look after my husband and my kids.”

Tracy Purkiss, meanwhile, found out about her breast cancer diagnosis three days before the first Covid-19 lockdown in 2020. She lived in Napier and, like Jones, she would have had to travel to Palmerston North for radiation.

Therefore despite only having a small cancer, she took “a sledgehammer to a nut”, and got a mastectomy.

“At the time it was sort of a forced decision in my head because of all the uncertainty,” she said. “When you go down to Palmerston North, you’re leaving your family, you’re leaving your friends.”

According to the Royal Australian and New Zealand College of Radiologists (RANZCR), there are only 10 centres in New Zealand where patients can have radiation. Four of these are private.

There are a mere two publicly funded centres in the South Island, one located in Christchurch and one in Dunedin. The rest are in Waikato, Palmerston North, Wellington and Auckland.

These centres also have limited staff. According to RANZCR there are only 105 practising radiation oncologists in the country, including full-time, part-time and trainee staff.

“We are currently not training enough radiation oncologists to meet current, or future, service demand or to replace those practitioners who plan to retire,” RANZCR

President John Slavotinek said.

Only five radiation oncologists are trained each year; if this stays the same, RANZCR estimates there will only be 58 practising by 2029.

This is a statistic Todd fears as she has seen breast cancer cases more than double in Canterbury between 2007-2017. She hates to think what the numbers would be like now. Weekly, she sees and takes care of patients as far reaching as the West