Health officials advised the Government "significantly" more lives could be saved if it lowered the bowel cancer screening age for Māori and Pasifika further than the rest of the population.

However, ministers didn’t go with this recommended option, which was to lower the starting age from 60 to 58 for most New Zealanders, while lowering it to 56 for Māori and Pacific peoples. Instead, they opted to lower the age from 60 to 58 for all New Zealanders.

Officials advised then-Health Minister Dr Shane Reti in August last year that their recommended option would prevent approximately 918 more cases and 678 deaths over 25 years compared with the current age.

That compared to the option chosen by ministers, that would prevent 771 more cases and 566 deaths.

Looking specifically at the effect on Māori and Pasifika, the officials’ preferred option would prevent 309 more cases and 228 deaths among them, compared to 161 more cases and 117 deaths under ministers’ option.

The Government has highlighted that its option would prevent more cases and deaths overall than a previous initiative under Labour of having the screening age at 60 for most people, but at 50 for Māori and Pacific peoples.

Health Minister Simeon Brown, who took the reins in January, said in a February Cabinet committee document, seen by the Herald, that his preferred option would deliver “the greatest modelled health gains for New Zealanders while aligning with Government health expectations”.

One of the Government’s key priorities has been to take a “needs-based approach”, which it believes its option is consistent with. Act leader David Seymour welcomed the announcement for reflecting this ‘need, not race’ view.

Brown also proposed investment in initiatives to lift screening participation rates in populations with low screening rates, such as Māori, Asian and Pacific peoples.

In a statement on Friday, Brown told the Herald that to “save as many lives as possible, we need to screen as many people as possible”.

“We are going to do that by lowering the age of eligibility for all New Zealanders, while undertaking targeted campaigns to increase screening rates among Māori, Asian, and Pacific peoples.

“We have lowered the age for all New Zealanders to access bowel cancer screening and will continue to lower it to align with Australia as capacity for colonoscopies allows.

“To save more lives among Māori and Pasifika communities, we have agreed to invest $19m to increase participation rates and bring them up to alignment with non-Māori, and non-Pasifika.”

He also highlighted advice that found achieving a 60% participation rate in Māori and Pacific communities could prevent 244 more cases and 154 deaths over 25 years compared to current participation levels. In August, officials said it was 49.1% for Māori and 38% for Pacific peoples.

Lowering the age for screening was an election commitment from the National Party. Documents show health officials have over the past year been providing advice on ways to lower the bowel cancer screening age. This would be funded by changing the scope of $36 million tagged in Budget 2022 to be spent on lowering the age to 50 for Māori and Pacific peoples.

The options presented

In August last year, Dr Reti was provided three options informed by modelling done by Erasmus University Rotterdam in the Netherlands.

These prevented the most colorectal cancer (CRC) cases and deaths, could be delivered using the tagged funding, and were in line with the additional colonoscopies expected under Labour’s initiative.

The options were to lower the age from 60 to 58 for everyone (what ministers eventually went with), to lower it to 58 for most and to 56 for Māori and Pacific peoples (what officials recommended), and to undertake an additional one-off screening at 56 for everyone, with the next screening occurring when people reach 60.

The first option would have a “positive health impact” and deemed to be feasible with the current model. It was estimated to prevent 771 more CRC cases and 566 deaths over 25 years when compared with the current eligibility age, with 161 cases and 117 deaths prevented among Māori and Pasifika.

“This option prevents more CRC cases over 25 years compared to option 3 but less than option 2,” officials said.

The risks of the option was that it would prevent “significantly fewer CRC cases and deaths among Māori and Pacific peoples over 25 years” compared to Labour’s scheme as well as option 2. It also didn’t “address underlying inequities regarding the higher proportion of CRC among Māori and Pacific peoples before the age of 60”.

“This option is likely to receive mixed reactions from stakeholders. Some stakeholders may welcome the age extension, whereas others may be unsatisfied with the 2-year age extension and advocate for the bowel screening age to be lowered further.”

Health data shows the potential impacts of the various options. Photo / HealthNZ.

The second option, recommended by officials, would add two additional screening rounds for Māori and Pacific peoples and one additional screening round for others. It was also deemed to be feasible.

“The option has potential to mitigate some of the risks presented earlier as it would acknowledge the recognised health inequity and support both improved overall outcomes and improved equity.

“This option has a positive health impact when compared to the current eligibility age. It is estimated to prevent 918 more CRC cases and 678 deaths over 25 years when compared with the current eligibility age. This is greater than both options 1 and 3.”

It was estimated to prevent 309 cases and 228 deaths amongst Māori and Pacific peoples, which is less than Labour’s initiative, but “significantly more” than options 1 and 3.

Officials noted it may receive opposition for not going as far as Labour’s initiative in terms of addressing underlying inequities.

“There may also be opposition to having differential age eligibility for bowel screening by ethnicity.

“This can be mitigated through clear rationale and communications that this is to address an existing inequity and that Māori and Pacific peoples have a higher proportion of bowel cancer diagnosed before the age of 60 years and lower 5-year survival rates compared to other ethnic groups.”

Lowering the age was an election promise. Photo / Ministry of Pacific Peoples

The third option, which was not recommended by officials, would have a “positive health impact” when compared to the currently age eligibility range.

It would prevent 679 more cases and 617 deaths over 25 years, with 147 cases and 112 deaths prevent amongst Māori and Pacific peoples. This prevents fewer cases, but more deaths, when compared with option 1.

There were several further risks, such as being hard to implement and requiring “significant public engagement to communicate this change”.

“Confusion around this messaging could result in further decreased screening participation rates, particularly among communities with low rates such as Māori and Pacific people.”

What happened next

An October briefing highlighted that Dr Reti had indicated his preference for option 1 while also investing leftover funding into initiatives to improve screening rates for populations with low rates.

It highlighted that consultation with different ministries and departments had shown “concern about the relatively lesser benefit of the proposal for Māori and Pacific peoples compared” with what the Labour Government had done. However, they “supported investment in listing screening rates amongst populations with low participating rates”.

Soon after becoming Health Minister, Brown began receiving information about the decisions.

One talking point he was provided was that he was “determined” to see change in the low participation rates for Māori and Pacific peoples and that is “why a portion of the funding is allocated to initiatives to improve screening participation rates”.

Lowering the screening age further than 58 for the entire population wasn’t viewed as possible as “colonoscopy capacity is a key pressure point and outyears funding available is not sufficient”.

Brown would want to progressively lower it as capacity and resourcing allowed.

The changes went before the Cabinet Business Committee in February. A paper presented by the Health Minister highlighted his justification for going with the first option.

“I propose to proceed with Option 1 as it delivers the greatest modelled health gains for New Zealanders while aligning with Government health expectations. In addition, I propose to invest in initiatives to lift screening participation rates in populations with low screening rates.”

The proposal was said to contribute to “delivering timely, quality healthcare, and better health outcomes by improving access to bowel screening and enabling earlier detection of bowel cancers”.

The option was also “consistent with this Government’s focus on needs-based approaches, as it will prevent more cancers and deaths compared to the previous government’s proposal”.

Cabinet agreed to the move on March 3 and it was announced a few days later.

“This is the first significant step we are taking to align our screening rate for bowel cancer with Australia as funding and access to additional colonoscopy resource becomes available,” Brown said last week.

The shift will happen in two phases. The first stage will see the age lowered in two of Health NZ’s regions from October this year. The age will then lower in the remaining two ages beginning in March next year. Which regions get the lower age first is yet to be determined by Health NZ.

People will be mailed their kit around their next birthday or be contacted by a local provider, once age extension is introduced in their area.

Act leader David Seymour welcomed the change. Photo / Alex Burton

Seymour was pleased with the move.

“Bowel cancer does not discriminate on race. Māori and Pacific peoples have a similar risk of developing bowel cancer compared to other population groups at a given age.

“It was true that a higher proportion of bowel cancers occur in Māori and Pacific peoples at a younger age, but that is because the overall demographics of those groups are younger. It has always been age that determines bowel cancer risk, not race.”

When Labour announced its initiative at Budget 2022, ministers described it as “an example of the system changing to better meet the needs of whānau”.

“A higher proportion of bowel cancer occurs in Māori and Pacific peoples before they reach 60, at approximately 21%, compared to 10% for non-Māori, non-Pacific peoples,” said then-associate Health Minister Peeni Henare.

Jamie Ensor is a political reporter in the NZ Herald Press Gallery team based at Parliament. He was previously a TV reporter and digital producer in the Newshub Press Gallery office.