Brown not backing down on bowel cancer screening

News that the health minister went against official advice will likely only amplify the calls for lower screening ages for Māori and Pasifika, writes Catherine McGregor in today’s extract from The Bulletin.

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Brown went against official advice

Health minister Simeon Brown rejected official advice to lower the bowel cancer screening age to 56 for Māori and Pacific people and 58 for the general population, RNZ Checkpoint’s Jimmy Ellingham reports. Documents released late last week show officials had recommended a lower age for the two groups, but Brown decided to instead set a universal age of 58, two years earlier than it is currently. The move is the first stage in the government’s plan to eventually align with Australia’s age, which was 50 when Christopher Luxon made the pledge during a pre-election debate in 2023 but has since been lowered to 45.

Projections estimate that the decision will result in 111 more preventable deaths over 25 years compared to the preferred option. However Brown says his plan will prevent 176 deaths over 25 years compared with keeping the age at 60 for the general population and lowering it to 50 for Māori and Pacific people. The government has also allocated funds to raise awareness and participation among Māori and Pasifika, which Brown says will also save lives.

Are Māori and Pasifika at higher risk?

The controversy rests on whether or not Māori and Pasifika should get ‘special treatment’ when it comes to screening. Defending his decision, Brown rightly says all ethnicities have the same risk of developing bowel cancer. However it is also true that some ethnic groups are more affected, at a lower age, than others.

As Rachel Thomas explains in The Post (paywalled), when assessing the statistics, the younger median age of Māori and Pasifika is key. There are fewer people in these groups living past 60, which makes their rate of bowel cancer at younger ages a major concern. Half of bowel cancer cases in Māori and Pacific people occur before the age of 60, compared with a third for other groups, according to oncologists. “Māori don’t live long enough to get the old age increase of bowel cancer. We don’t have a lot of older Māori getting it, because we don’t have a lot of older Māori,” says Dr Rawiri Jansen, former chief medical officer for Te Aka Wahi Ora, the Māori Health Authority.

Focus limited budgets where they’ll do most good, say doctors

When Brown announced his intention to lower the universal age for screening, he likely expected at least a few positive headlines in return. That wasn’t exactly the case. Doctors and cancer experts have lined up to condemn Brown’s decision as shortsighted, damaging and “driven by ideology, not facts”.

Writing in the Sunday Star-Times (paywalled), Dr Ros Pochin and Dr John Mutu-Grigg of the Royal Australasian College of Surgeons say the plan to lower the screening age to 50 for Māori and Pasifika “wasn’t about preferencing some Kiwis over others, it was about making an evidence-based decision backed by clinical recommendations”. They’re in favour of lowering the age to 45 or 50 for all, “but we recognise that healthcare budgets are finite. That’s why it’s crucial to focus limited resources where they will make the most impact – on the communities most at risk.”