15 Aug 2014

Govt defends cancer screening progress

8:09 pm on 15 August 2014

The Health Minister has defended progress being made to introduce national screening for bowel cancer, following studies showing death rates from cancer are much higher in New Zealand than Australia.

Medical researchers say the difference in death rates are costing hundreds of lives every year.

During the study period significant numbers of New Zealand women were going to Australia for treatment.

During the study period significant numbers of New Zealand women were going to Australia for treatment. Photo: AFP

Studies published in the New Zealand Medical Journal today show death rates from cancer in this country are 10 percent higher than across the Tasman. Medical specialists say it's disappointing, and appalling inaction over bowel cancer screening is partly to blame.

Health Minister Tony Ryall said the Government was doing a huge amount of work to pave the way for national screening including a pilot programme at Waitemata in Auckland. He said the start date for national screening could not be announced until it was certain the workforce was in place and the technology available to provide a quality service.

Researchers studied the incidence and death rates from cancer in both countries for the years 1996-97 and 2006-07.

They found that over the 11-year time period, cancer-specific death rates decreased in both countries and cancer mortality fell in both countries, but there was no change in the difference between the death rates New Zealand and Australia. These rates remained 10 percent higher in New Zealand.

Health Minister Tony Ryall.

Health Minister Tony Ryall. Photo: RNZ

Mr Ryall said other improvements over the past six years will already have reduced the gap with Australia.

But a lobby group says the Government is acting unethically by waiting to introduce a national screening programme for bowel cancer. The chief executive of Beat Bowel Cancer Aotearoa says that's largely due to differences in early detection and screening for the disease.

Megan Smith says the Government is waiting for the end of the pilot programme in Waitemata, but 100 people lose their lives to bowel cancer a month - and that wait is unthinkable and unethical.

Brent Wray had bowel cancer and said he was lucky that he was eligible for it the pilot programme, because it saved his life.

"I had absolutely no symptoms at all, I felt well. There must have been an angel on my shoulder or something that was in the Waitemata district to be able to be in the screening programme. Otherwise, you'd have probably been ringing 0800 Heaven by now."

Research suggests NZ patient survival lower

Writing in today's journal, Otago University professor David Skegg said if the Australian death rates applied in this country, 616 fewer New Zealand women would have died a year and 215 fewer men.

Professor Skegg said most of the "excess" deaths in New Zealand compared to Australia were in people under 70 years old. He said the higher death rate from all cancers combined cannot be attributed to higher incidence rates of cancer, and this suggests that overall patient survival is lower in New Zealand.

In New Zealand there is free screening for women aged between 45 and 69.

In New Zealand there is free screening for women aged between 45 and 69. Photo: AFP

Researchers say colorectal, or bowel cancer (for both sexes), lung and breast cancer (both for females rather than males) make up most of the difference in outcomes. Between 2000 and 2007, deaths from bowel cancer were 35 percent higher than in Australia for women and 24 percent higher for men.

Lung cancer deaths in women were 20 percent higher in New Zealand compared with Australia over this period, while deaths in men were about the same as Australia, although the incidence of lung cancer among men in New Zealand is 10 percent lower than in Australia.

One of the studies says this suggests that clinical survival rates are lower in both sexes. Researchers say the main problem is smoking among Maori women in particular, who may also be worse than males at seeing a doctor early with symptoms.

Deaths from breast cancer were 19 percent higher in New Zealand than Australia between 2000 and 2007. Both countries have screening programmes, and the studies say in New Zealand it's estimated deaths decreased by as much as 40 percent for those being screened.

But the researchers say treatment differences could also have played a role, with the anti-cancer drug Herceptin available in Australia for longer than it has been in New Zealand, where it was funded from 2008.

They also say there were substantial delays in the past to many women beginning radiation therapy in New Zealand, with significant numbers of women going to Australia for treatment.

Dr Peter Dady, a former medical director of the Cancer Society.

Dr Peter Dady says national screening is a "no-brainer'. Photo: RNZ / Karen Brown

Overall, the authors say the mortality gap may be due to lifestyle and ethnic differences , and partly due to New Zealanders presenting with more advanced cancers, along with less easy access to some treatments.

An author of one of the studies, the former medical director of the Cancer Society, Peter Dady, says there's been a lack of progress over national screening for bowel cancer and it's a disgrace. "They've been dragging the chain forever on this and in the meanwhile, people are dying. And that I think is appalling."

He says national screening for bowel cancer in Australia means it's detected at an earlier stage, treated earlier and people have a better chance of surviving.

Dr Dady says introducing national screening in this country is a "no-brainer".

"What should happen is that the Ministry [of health] should say, Well it looks as if bowel cancer screening is coming and OK we're going to have to increase the number of colonoscopies. Put some money out there saying there's x number of bucks for a colonoscopy, public system, private system, do it. How are you going to do it? Do you want the money? They generally do."

Another author, Wellington-based Otago University cancer specialist David Lamb, says he was "very very disappointed" to see death rates had not decreased across the Tasman.

"What is disappointing is really that we knew the main areas where there were deficiencies in New Zealand 10 years ago and yet ... particularly in the area of colorectal cancer, we've made so little progress in turning it around."

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