Experts On Why Bowel Cancer Screening Changes Are A Concern

Emma
Andrews, Henare te Ua Māori Journalism
Intern

Government
plans to lower the age for free bowel cancer screening for
all New Zealanders by “redirecting” money previously set
aside to lower the age for Māori and Pasifika has been
described as “disappointing”.

Health
Minister Simeon Brown said the age would progressively
drop from 60 to 58 at a cost of $36m over four years, and
“save hundreds of lives over the coming decades”.

Lady
Tureiti Moxon, a long-standing Māori health advocate and
managing director of Te Kōhao Health, said the “the
critical health crisis facing Māori” was being treated as
“unimportant and unnecessary” by the
government.

“What’s more disappointing is that the
funding that was targeted specifically towards Māori is now
going into the general pool for people who do not die or
suffer from the impact of bowel cancer as much as Māori
do.”

The previous government in 2022 announced the age
for bowel cancer screening would be lowered from 60 to 50
years old for Māori and Pasifika, yet the pilot programme
was
cancelled in December.

Dr Nina Scott, chairperson
of the Māori Cancer Leadership Network Hei Āhuru Mōwai,
said raising the age for Māori and Pacific peoples was a
form of “institutionalised racism”.

Moxon agreed,
saying the decision “undermines” the proven specific health
needs of Māori.

“Māori die prematurely because they
are not diagnosed early enough to take action. This is
deeply disappointing, as the policy is presented as if
everyone has equal access to the same health benefits, when
we know that is far from the reality.”

Te Tiratū Iwi
Māori Partnership Board, serving 114,000 Māori in the
Waikato rohe, welcomed the government’s
decision.

“Screening is an essential tool for
prevention and early detection, and expanding access will
definitely save lives,” co-chair Hagen Tautari
said.

“However, what we don’t want is to leave our
people who are high-risk behind as they face substantially
poorer health outcomes. What we need is an easier diagnostic
process that removes systemic barriers.”

Colorectal
cancer was the second-highest most fatal cancer for Māori
and Pasifika.

Dr Oliver Waddell, colorectal cancer
researcher and general surgical trainee at the Christchurch
Hospital, said although bowel cancer rates were lower in
Māori than non-Māori, the death rates in Māori were much
higher.

“Unfortunately, when they do get diagnosed
it’s much worse. And in young people they’re seeing much
faster rises than the rises that we’re seeing in the general
population, so that’s pretty concerning as well.”

Last
year, Waddell completed his PhD with a focus on early onset
colorectal cancer (EOCRC), which showed a significant rise
in younger people in the early stages of bowel cancer,
compared with decreasing rates in older age
groups.

Between 2000 and 2020, he looked at 56,761
cases of colorectal cancer, of which 3702 were early onset.
There was a 26 percent increase in EOCRC, and more
specifically the rate of Māori under 50 years old jumped up
by 36 percent, exceeding the growth in the overall
population.

For years, Waddell has called for New
Zealand’s bowel cancer testing age to drop to 45, as it was
in many other countries.

“Lowering the bowel cancer
screening to 50 [for Māori] was to try and help combat
that. The decision not to do that is pretty disappointing.
The decision to lower the bowel cancer screening [age] in
general is a good thing, but to go from 60 to 58 is just
nowhere near far enough.”

Although he did not think
New Zealand had the resources to drop the age to 45 yet,
Waddell wanted to see a 10-year plan in place to get it
there.

“We need to keep the pressure on to drop the
age of screening overall – first in Māori, but then
everyone else as well – because we are just so far behind
the rest of the world when it comes to bowel cancer
screening.

“It’s not going to happen tomorrow, we have
to be realistic, but making a 10-year plan to get there
would be a step in the right direction.”

Waddell said
factoring savings from the reduced incidence of cancer and
the reduced treatment costs, the $36m price tag for the
change would save money and lives.

“There’s modelling
from New Zealand data – modelling that they did when they
did the bowel cancer screening pilot – which found that
screening from the age of 50 actually saves
money.

“Yes, you have to invest the money to get the
screening underway but overall, you’ll save money due to
cheaper treatments as well as all the benefits of having
people not dying of cancer and carrying on living their
lives and working and paying tax, and all those kinds of
benefits.”

Bowel cancer treatment costs depended on
when it was found – stage 1 being the cheapest and stage 4
the most expensive. For younger people outside of the age
requirements, having health insurance was a big
saver.

Dr Bernard Leuthart, pou whakahaere
tākutatanga (clinical director) at kaupapa Māori health
provider Tui Ora, said it costs thousands of dollars for
young people who did not have health
insurance.

“[It’s] the input of the surgeon or the
gastroenterologist, the anaesthetist, just all those costs
that attend on private care. Some people can get that and
it’s not the domain of most New Zealanders, and nor should
it be.”

Leuthart said people making big health
decisions needed to consider that Māori had a lower life
expectancy at birth than non-Māori.

“If you were to
be looking to address what we know, and if we just took that
thing of life expectancy for Māori – seven years less than
Pākehā – you’d put a little bit of that thinking, you’d
apply a little bit of that thinking, so certainly just
applying the actual specific science around the
evidence.

“We need to be thinking like 10 years
earlier, because the evidence says if we make our
interventions then, we’re going to get outcomes that look
much more like good outcomes for New Zealanders.
Specifically, we look like we’re making a real attempt at
addressing inequity, so that overall we say, ‘Gosh, look at
the savings we made,’ because that 55-year-old Māori guy
didn’t end up at ED with a bleeding bottom.”

Both
Leuthart and Waddell agreed that bowel cancer screening
could be ’embarrassing’, leading people to become hesitant,
but it was better to be safe than sorry, they
said.

“For all sorts of reasons – and some of them
long institutional reasons – about dealing with certain
structures and not having confidence in those because
[patients may have] been served a poor deal in terms of some
of those Pākehā structures,” Leuthart said.

“You
know, that 45-year-old Māori man might be very hesitant to
come in, and he’s the guy that we’d like to see and do a
little bit of education, do a bit of screening and getting
confidence about healthcare activity – because that man at
55 might turn up at the ED with a bleeding bum and he’s got
stage four bowel cancer and it’s too late to do anything
significant.”

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