Patients with advanced breast cancer in New Zealand are dying twice as fast as those in comparable countries.
The "I'm Still Here" report from the Breast Cancer Foundation has found the average survival rate for someone whose cancer has spread beyond the breast and lymph nodes to another part of the body is just 16 months, compared with two or three years or more in Australia, Germany and France.
For Māori, the five-year survival rate was just five percent, compared with 15 percent for non-Māori.
The foundation's research manager Adele Gautier said New Zealand was "world class" at treating early breast cancer.
"Sadly, the numbers prove the same can't be said once breast cancer spreads."
The study, which used data from the Breast Cancer Foundation National Register (covering patients in Auckland, Waikato, Wellington and Christchurch) has found half did not receive chemotherapy and those who did were often bumped to the back of the queue.
Up to a quarter did not get any treatment at all.
The chair of the foundation's medical advisory committee, Dr Reena Ramsaroop, said the findings backed up patients' complaints they felt "forgotten".
"No-one wants to think we are falling behind the rest of the world, yet the evidence is clear that this is happening."
Ōtaki woman Sandi Davison, 54, was diagnosed with breast cancer seven years ago.
Persistent back pain a year ago prompted her GP to refer her for scans at Palmerston North Hospital, but the results - which would have shown cancer in her spine - were lost in the system.
This experience prompted her decision to go under a private specialist eight months ago.
"It will end up costing me but at least I know that I'm not going to fall through the cracks, especially at this tentative stage where unfortunately it's still coming up in my bones and it hasn't actually stopped.
"We kill it in one area and it pops up somewhere else, so very close monitoring is what they're doing at the moment."
She had radiation treatment for her back but the cancer is now in her pelvis and she is facing the prospect of paying $10,000 a month for chemotherapy.
Ms Davison, who still works full-time as a nurse manager, said greater access to treatment would not only extend lives but also quality of life for many people.
She was not surprised that survival rates were better over the Tasman.
"In Australia they always do 'markers' - blood tests that show if you've got activity happening in your blood, so potentially cancer happening somewhere. They do it as a matter of routine.
"I have it done now - my oncologist requests it - but when I've had treatment in the public system, the nurses in the Blood and Cancer Unit have said 'Don't you realise this is really expensive testing you're asking for?' And I say, 'My oncologist is asking for it, so I want to have it done'."
Ms Davison, who is Māori, said the abysmal survival rates for tangata whenua could be partly due to the fact Maori were being diagnosed later.
"I think the younger generation are better at looking after themselves, but those my age and older are not so good at getting things checked out.
"It could also be the type of cancers they're getting are harder to detect, or that people living outside the main centres don't have access to the same treatments."
In response to questions about the study's findings, the Ministry of Health said there was "debate" about the benefits of additional chemotherapy for those with advanced breast cancer.
Dawn Wilson, the manager of cancer services commissioning for the Ministry, said people with late stage cancer could have had multiple courses of chemotherapy before getting to that stage.
The Ministry was working with specialists to improve the quality of cancer treatment options and data collection, she said.