Simeon Brown announces changes to bowel screening programmes on 6 March, 2025. Photo: Nathan Mckinnon / RNZ
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.
Lady Tureiti Moxon is a long-standing health advocate Photo: Supplied / Murdoch Ngahau
"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."
Samples of a colon biopsy to be sent to a laboratory. Photo: A. BENOIST / BSIP
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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