Position statement: National Bowel Cancer Screening Programme inclusion criteria

The National Bowel Cancer Screening Programme commenced in July 2017, with the inclusion criteria for age being 60–74 years.

The screening programme has adopted a one-size-fits-all age cut-off for inclusion. Based on the population average this means it is weighted heavily towards New Zealand European patterns of disease, and it would miss a substantial proportion of cancers in Māori and Pacific populations. As we know, Māori and Pacific populations experience higher disease prevalence and at a younger age. This means the programme is discriminatory by design from the outset.

Since the commencement of the programme there have been repeated calls for the eligibility to be extended to include Māori and Pacific people from age 50, including from Hei Āhuru Mōwai (Māori Cancer Leadership Aotearoa), the Cancer Society, and Bowel Cancer NZ. 

In response to ongoing pressure, the Ministry’s National Screening Unit held a hui in February 2019 that focused on achieving equity for Māori in bowel screening, with other hui throughout the motu also taking place. Whānau also had the privilege of attending these hui, which drew representatives of all the key national organisations and a host of experts from across the cancer care sector. Robust discussion commenced, and that led to a series of recommendations to address equity in the national screening programme. 

The highest priority recommendation was that screening eligibility should be extended down to 50 years of age for Māori. 

Immediate action was required to ensure that Māori would no longer be denied equitable access to bowel screening. It was recommended that the age range extension should be introduced as soon as possible.

Later in the year, a fono of Pacific health advocates and clinicians agreed that this recommendation should also be extended to include Pacific peoples.

At present, months later, we see continuing inaction in the face of need — one of the key manifestations of institutional racism. Unless something fundamental changes, the Ministry of Health will continue to enact bias practices that produce discriminatory outcomes. This is in direct conflict with the principles underpinning the Ministry’s recently published Whakamaua: Māori Health Action Plan 2020-2025.

Those in key decision-making roles seem to uphold this whākaaro, whether conscious or not.

We have to recognise within the machinery of health, government, justice, and the social sector “inequity” is not something that raises its head now again, it’s a feature. Pinnacle’s own strategic priority is now focused on addressing these inequities.

Therefore, the Pinnacle Incorporated Executive Committee strongly urges the Ministry of Health to reconsider it’s unacceptable decision to not screen Māori and Pacific communities from an earlier age as a priority for the system screening capacity, and to demonstrate its publicly expressed strategic aim to address inequity.

Ngā mihi,                                                                           

Craig McFarlane, Chairman                                                         

Dr Brendon Eade, Deputy chairman