Breast cancer remains deadlier for Māori, Pasifika and younger women despite significant improvements in overall survival rates, according to a new report published by Breast Cancer Foundation NZ on World Cancer Day.
The first report that analyses data from Te Rēhita Mate Ūtaetae - the Breast Cancer Foundation national register, which holds information on more than 40,0000 patients since 2000, found that despite overall improvements in survival, many women have not benefited to anywhere near the same extent.
“The improvements in survival are a tribute to our dedicated cancer specialists and the BreastScreen Aotearoa screening programme," Breast Cancer Foundation NZ chief executive Ah-Leen Rayner says. "But we need to stop talking about five-year survival. That’s no longer an acceptable measure of success.
“We’re still losing more than 650 women to breast cancer every year, and our comprehensive review of the register data shows our Māori, Pasifika and younger women, and those with larger or more aggressive cancers, are being left behind.
Drastic differences exposed
“On top of this, Covid-19’s devastating impact on breast screening is putting even more women at risk. We can’t allow the pandemic to keep pushing other health issues to the sidelines, as our most vulnerable women will be the ones to suffer.”
The report, entitled 30,000 voices: Informing a better future for breast cancer in New Zealand, shows that while the five-year risk of dying of breast cancer has halved since 2003, the 10-year rates exposed drastic differences for the most vulnerable groups and those with high-risk cancers.
Wāhine Māori at 33%, and Pacific women at 52% were more likely to die of breast cancer within 10 years than Pākehā.
Māori were also more likely to have higher-risk HER2+ breast cancer, and Pasifika women had the highest rate of stage 3 and 4 breast cancers and of HER2+ cancers, and more grade 3 tumours than all other ethnicities.
Women under 45 had a much lower 10-year survival rate than the 45-69 age group, 82% compared to 89%.
Of all breast cancers diagnosed in 2020, 7% fewer were found by mammogram than in 2019, probably as a result of paused and reduced screening during the Covid-19 lockdown. The Breast Cancer Foundation believes that led to women being diagnosed later than they should have been.
Change to 10-year focus
The report also found delays to surgery had worsened, with over 60% of women not getting their first surgery within 31 days of diagnosis, while many women also had a mastectomy when breast-conserving surgery with radiation treatment has better survival, and a third of women who had a mastectomy may not have needed the more invasive option.
“It is worrying that Te Rēhita is demonstrating delays to surgery are increasing, as this has been shown to have the potential to negatively affect survival," Dr Eletha Taylor, a member of Breast Cancer Foundation NZ’s medical advisory committee says.
"Delays to surgery can be due to a number of factors, but raise concerns around resource constraints, particularly in the workforce and access to operating theatre time. This is likely to be exacerbated further by the impact of Covid-19. These results suggest a need to invest in our health system and its' people with some urgency.”
The report’s findings have prompted the charity to call for more prioritisation of at-risk groups by the health system, a switch in focus to a 10-year outlook to close the survival gap, hospitals to set surgical targets, and investment from the government to tackle surgery delays.
“Our vision is to have zero deaths from breast cancer. This report shows New Zealand’s five-year survival rate is comparable with other countries but it doesn’t tell us the full story. To fulfil our vision, it’s now time to focus on 10-year survival. This will show us where we have to prioritise earlier diagnosis, timelier treatment and rigorous follow-up in order to protect those most at risk of dying from breast cancer,” Dr Reena Ramsaroop, chair of Breast Cancer Foundation NZ’s medical advisory committee says.