During the 2023 election campaign, both National and Labour leaders, in the heat of a television debate, pledged to lower the bowel screening age to match Australia’s, which now starts at 45.
We doubt either leader had given it much thought. Nobody could deny it was, and is, a worthy goal, but changes to screening programmes are complex and deserve more consideration than politicians making up policy on the fly.
The announcement last week the starting age in the national screening programme will be lowered from 60 to 58 over four years was underwhelming. Much like some of the government’s moves on primary care, this reeked of wanting to be seen to be doing something in the face of agitation, in this case about our programme lagging behind Australia’s, and increasing numbers of people younger than 60 being diagnosed with bowel cancer.
While Mr Brown has said the long-term aim is to match Australia’s age range, there is no clear plan.
There has been understandable outrage about robbing money for the change to 58 from the scheme to offer the programme to Māori and Pasifika from the age of 50. This began in 2022 with the aim of making the programme more equitable and was supposed to have extended throughout the country by 2023. Introduced in full, it was expected to save 44 lives a year, but it was cancelled last December with only three districts covered.
Mr Brown says the scrapping of this initiative in favour of the entry to all at 58, which is expected to save 176 more deaths over 25 years than the settings with the 50 start for Maori and Pasifika, "aligns with the government’s policy of ensuring that healthcare is delivered on the basis of need".
However, this view of need has been rubbished by cancer authorities who argue Māori and Pasifika, with a significantly higher proportion of bowel cancers occurring before 60 than the rest of the population, do not benefit as much from a programme with a 60 starting age. Their cancers are often diagnosed late so their death rate is higher.
Mr Brown says he has relied on advice from the Ministry of Health on this, but at the time of writing had still not released it.
Health New Zealand Te Whatu Ora has not been forthcoming with current information on how well the country is meeting the waiting time standard for colonoscopy delivery in the screening programme or for symptomatic patients and those qualifying for surveillance procedures.
We doubt it is a happy story, given our previous coverage of these issues. The inability of the system to address colonoscopy demand has dogged the programme from the start.
The Waitemata pilot programme involved 50 to 74-year-olds and picked up more cancers than the national programme can because the testing involved a much smaller amount of blood in faeces to trigger referral to colonoscopy.
Planners realised the colonoscopy capacity across the country was insufficient to have such a sensitive test and have the age at 50. So, without fanfare, the age was set at 60, and the blood/faeces threshold in the initial faecal immunochemical test (FIT) was set much higher for the national programme. (The Australian programme has a much more sensitive test than ours).
This week HNZ would not give detailed answers about a plan mentioned by the director of the National Public Health Service Dr Nick Chamberlain in the media stand-up with Mr Brown last week.
It involves the use of FIT as a referral tool to reduce demand for colonoscopies outside the screening programme for those with possible bowel cancer symptoms.
New referrals with a negative FIT result "unless otherwise stated at triage will not require a colonoscopy", Dr Chamberlain said in an emailed statement.
Questions about what the blood/faeces threshold might be for this test, whether there would be reliance on this test given not all cancers bleed, and even which five districts will have this FIT For Symptomatic Pathway from July, remain unanswered.
The lack of transparency around all of this is unsettling.
