Lowering the starting age for bowel screening for Māori and Pacific people
The Ministry of Health and Te Aho o Te Kahu (Cancer Control Agency) are aware of the interest in introducing a lower starting age for bowel screening for Māori and Pacific people. A significant amount of work has been done on seeking views and considering this issue.
It is important to note the proposal has not been ruled out but further consideration has been deferred until all regions of New Zealand have access to bowel screening (expected by November 2021). This strategy is considered to be the safest and most sustainable course of action and is based on the advice of other countries that have fully implemented their bowel screening programmes before making changes to age-eligibility criteria.
New Zealand chose 60 years the starting age for its National Bowel Screening Programme (NBSP) because data from the Bowel Screening Pilot established that 82 percent of bowel cancers occur in people over 60. Expert advice was that by initially starting bowel screening at 60 we would be able to introduce a bowel screening programme sooner, targeting those most at risk, whilst not overwhelming colonoscopy capacity or carrying out invasive procedures where cancer was unlikely to be found.
When the programme was being designed, bowel cancer incidence was lower for Māori than non-Māori. However, the most recent data show that incidence is now similar for the two groups. Because the Māori population is younger than the non-Māori population, a higher proportion of diagnoses occur in younger age groups but there is no evidence that Māori develop bowel cancer younger than non-Māori. However, we acknowledge that bowel screening delivers fewer health gains for Māori because of their overall lower life expectancy.
Increasing participation is key
While the roll out of the NBSP continues, efforts are focussed on increasing participation by Māori and Pacific people to ensure cancers are detected and treated early, which can result in a 90 percent rate of long-term survival. Currently the overall participation rate for the programme is 63 percent with Māori participation at 56 percent and Pacific people at 44 percent. There is much room for improvement in addressing these ‘inequalities of participation’ and achieving better outcomes for Māori and Pacific peoples. All DHBs providing bowel screening are expected to ensure significant effort is put into ensuring higher participation by these priority groups, accompanied by efforts in primary care to address the current later presentation by Māori and Pacific in all age groups, including under 60s. This, of course, applies to a range of cancers.
The National Bowel Screening Programme is a complex and challenging programme to implement. However we are still managing to roll it out at pace at the same time the health system is responding to a pandemic and other pressures. Significantly, thousands of New Zealanders already owe their lives to our newest screening programme.