Bowel cancer and colonoscopy inequities in New Zealand
New Zealand launched a national program to fight bowel cancer but a health centre publicly apologized for the lack of diagnoses. Health professionals asked for a public inquiry in the context of unequal access to health services.
Bowel cancer is the second highest cause of cancer death in New Zealand behind lung cancer. It is among the 15 countries with the largest incidence of colorectal cancer, with more than 35 cases for 100,000 people. Moreover, an international study on colon and rectal cancer in 2019 revealed the incidence increased among people under 50 in New Zealand in the last 10 years.
It was of concern considering 90% diagnosed with bowel cancer are over 50, looming for much greater issues in the years to come at the generation gets older.
In 2018, it was projected that by 2035, there would be 917 deaths of colorectal cancer in New Zealand, which would account for a 52% increase while the population is expected to grow to 5.3 million, or 23%.
The cancer is more present in rich and developed countries and factors increasing risks of getting colorectal cancer are the diet high in processed or red meats, lack of fibre, alcohol, cigarettes, and heredity. However, the cancer can be cured for 90% of the cases if diagnosed early.
To fight the disease, New Zealand therefore invested about $197 million (US $142 million) and launched the national bowel screening programme in 2017. The goal was to have 700,000 people tested every 2 years which could lead between 500 and 700 diagnoses of colorectal cancers.
Concerning wait times for colonoscopy but no case for a public inquiry
But one District Health Board, a structure responsible for providing health services in their district, covering the screening program for the southern regions of Southland and Otago, had to publicly apologize. It followed a report that reflected “long-standing and highly publicised concerns regarding the service“. “On behalf of the Southern DHB I offer a sincere apology for lapses and inadequacies in colonoscopy services over the past several years” the chair of the Southern DHB, where there is one of the highest incidences of the country, wrote in October 2020. Because of mismanagement, people were not seen soon enough while others with symptoms were denied a screening.
A surgeon and a cancer researcher who question the efficiency of the program even demanded the Health Minister, Andrew Little, for a public inquiry about the Southern DB. But despite concerning wait times, the Minister said he saw no case for an inquiry the media Stuff reported. The Southern DB’s colonoscopy service was “more or less meeting the target times and the target volumes expected for that population“.
When 181 patients in Southland had to wait for more than 120 days for a colonoscopy procedure, only 10 were in that case in Otago. The bowel cancer association called the “ongoing ethnic, socioeconomic and regional inequities in bowel cancer outcomes a national disgrace”. In 2008, the five-year risks of death from colorectal cancer was 47% for Māori, 59% for Pacific and 38% for the other ethnic groups.
Unequal access to health services is a concern for New Zealand’s government. Māori die 7 years younger than Non-Māori in New Zealand. To specifically tackle this health inequity challenge, the Health Minister announced the creation of the first specific Māori Health Authority in April. He also announced the system of district health boards would be abolished and replaced by a single national agency by 2022.
Media sources and useful links:
- Colorectal cancer statistics, World Cancer Research Fund, 2018, Free access
- Changes in colorectal cancer incidence in seven high-income countries: a population-based study, The Lancet, 2019, Restricted access
- Global trends in colorectal cancer mortality: projections to the year 2035, Wiley Online Library, 2018, Restricted access
- Statement from Dave Cull, Chair, SDHB – Colonoscopy Services, Southern Health, 2020, Free access
- Health Minister sees no case for Southern DHB inquiry, Stuff, May 2021, Free access
- Call to action 2025, Bowel cancer New Zealand, 2020, Free access
- Colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation-results from a retrospective cohort study, PubMed, 2018, Restricted access
- New Zealand Creates The First Māori Health Authority, Newsndip, April 2021, Free access