Transcript
The lead researcher on this new paper from Waikato University, Ross Lawrenson, says the data shows the biggest factor impacting Pasifika women is the late presentation for diagnosis.
"The most important thing that we found was that almost thirty percent of Pasifika women had stage three or stage four disease at diagnosis. So they're being diagnosed much later than New Zealand European women were with around 14 percent being diagnosed at stage three or stage four."
Krystal Hekau was first diagnosed in September 2016 with stage three cancer. She is now at stage four which means she's no longer curable but is treatable.
"I can fall into that category of Pasifika women being diagnosed because I had just stopped breast feeding my daughter and I felt a lump so naturally it felt like a milk duct blockage so I massaged it out, expressed and that was it."
That was in June. The lump returned but life got in the way - full time work and children - and it wasn't until September that she sought treatment.
"In that time I was actually living in Niue and the only thing they can do there was have an ultrasound so I had to come here. I came here on a Saturday, I was diagnosed on a Tuesday. And the doctor who did the initial test, which was like a punch biopsy, and then I went to have a mammogram and on the way out he said look Krystal if I were you I wouldn't worry too much about it."
Ms Hekau's tests confirmed the cancer was at stage three and that it was the HER2-positive strain. Professor Lawrenson says thirty percent of Pasifika women with breast cancer are being diagnosed with this strain of the disease.
"So they had a particular type of cancer which is more aggressive and normally in the general population is only around 10 to 11 percent of women have HER2-positive cancers. So Pasifika women have poor outcomes because they have that particular cancer."
He says the disease is also developing earlier in Pasifika women. Two thirds of Pasifika women in the study sample were under 60 compared with half the Europeans. Around half of them were diagnosed while younger than 45 compared to less than a third for the Palagi women. Free breast cancer screening is not available for women like Krystal Hekau who are below 45. She says the health system stacks the odds against Pasifika women from South Auckland in a number of ways and talks about meeting another woman in her 30's from the North Shore of Auckland.
"But North Shore has cancer treatment. Middlemore South Auckland don't have any. Because she was also in her 30's and she was diagnosed on a Tuesday. Her treatment started on the Friday. Of course she's Palagi and I was thinking like 'Oh wow! And I had to wait from September to October.' I had to wait."
Ms Hekau says funding between different health authorities causes a disparity in care. She adds that oncolgists and other health professionals appeared to minimise her attempts to draw their attention to other symptoms. When she spoke about a contsant ache in her femur she was prescribed Voltaren. The cancer spread throughout her thigh bone before it was diagnosed when she had the core extracted and a hip replaced. In terms of treatment, Herceptin is an effective weapon in the arsenal against breast cancer but is not effective in patients with other illnesses like diabetes, which is not uncommon in Pacific women. New Zealand's associate minister of health Julie Anne Genter says there are a range of inequities in the health system which the government is aiming to address in its current review.
"It is extremely problematic. We're aware that unconscious bias is a factor in the way our health system operates. I think that there needs to be greater engagement with Pasifika communities. It already is a priority group for Breast Screen Aotearoa but there is no question that we can do much better."
Ms Genter draws attention to the way Pasifika communities have led the way in getting more women involved in breast cancer screening and that she expects this model to be broadened in the community. She says she will be working with DHB's to provide a more effective care model for the Pasifika women of South Auckland and beyond.
