Document One TE AHO 0 TE HAHU CANCER CONTROL A. AGENCY MANATU HAUORA Health Report Update on the National BoweE Screening Programme ?nc?uding equity considerations Date clue to M0: Action required by: Security level: IN Health Report number: 20201036 Hon Dr David Clark Contact for telephone discussion Name Position Telephone f" Deborah Woodley Deputy DirectOI? ngertl Population 3 Health and Pigmemtteh .. Diana Sarfati Chief Executive Te Aho 0 Te Kahu Cancer Q9ntr0 Agency f-I -- Action for Pl?vdte' Secretaries 1? .13 Return the report to the Ministry and Te Aho 0 Te Kahu. Withthe Minister? 5 agreement forward this briefing to the Pglr?eMmIster 5 Of?ce and to the Office of the Associate Minty? of Health (Hon Peeni Henare). Date dispatched to M0: Document One TE AHO . 0 TE KAHU CANCER CONTROL AG IMUOM Update on the National Bowel Screening Programme including equity considerations Purpose of report This report responds to advice requested by the Prime Minister, Rt Hon Jacinda Ardern and Associate Minister of Health, Hon Peeni Henare, regarding the National Bowel Screening Programme, including: roll?out and funding a equity considerations inciuding the issue of lowering the screening age f?rMaori from 60 years to 50 years i 9 options to improve heaith equity through cancer screening. Key points . Screening is an important part of taking action on cancer- - improving cancer outcomes through prevention a?gg?l?fearly intervention is vital to population health improvement and delivering equitable for Maori and other groups. The national cancer screening programmes (eraser, cervical and bowel cancers) are an important part of the early intervention approachr National Bowel Screening Programme rofifout and funding a The roii?out of the National BoweiS?fcigeening Programme (the programme) to all DHBs is a key Government priority and towns part of the New Zealand Cancer Action Plan (2019?2029). *4 0 Once the programme isnf?hy rolled out around 700,000 New Zealanders aged 60-74 years will be invited to be Edger-awed every two years. At present: .- ?54: ten DHBs?i?e?part of the programme 0 four are funded tojoin the programme in 2020/21. 5 EH2 it'il'ii'ivi a 9i2'H'fJiivJ Health Report: 20201036 OTE KAHU CANCER CONTROL AGENCV MINISTRY OF EALTH IMUORA Equity impacts of lowering the screening age for Maori Age?standardised incidence rates of bowel cancer per 100,000 population for Maori (37.6) are similar to those of non?Maori (39.7). Bowel cancer incidence rates for Pacific peoples are lower at 28.8 per 100,000 population. . Experts in Maori and Pacific Health, the National Screening Advisory Committee, the Bowel Screening Advisory Committee and Te Aho 0 Te Kahu, Cancer Control Agency Advisory Council have considered the possible impact of lowering the screening age for Maori and Pacific peoples from 60 to 50 years. These groups advocate lowering the age of screening from 60 years to 50 years for Maori and Pacific peoples to improve health equity givenntl'i'e younger age structure of these populations and the proportion of bowel cancers occunri-ng below the current screening eligibility. While lowering the age for bowel cancer screening has been identified as an option for consideration, in practice it will have a minimal equity impact reiative to other interventions where inequities for Maori and Pacific are high. This is an important consideration when seeking to achieve better cancer outcomes within available resources. - Within the current bowel screening programme, DHBs are experiencing higher than forecast demand (based on modelling of overseas experience and the New Zealand pilot) and this is placing pressure on colonoscopy capacity and clinically acceptable wait times for screening. . The Ministry and Te Aho 0 Te Kahu, Cancer Control Agency consider the priority for equity, particularly given current capacity and capability constraints, is to complete the programme roll- out to the remaining DHBs, as well as focus on equitable screening uptake for Maori and Pacific populations (which are below those of the non- Maori non? ?Pacific population) In some DHBs that have rolled out the programme to date. . This will ensure the programme reach?s national coverage including in DHB communities with high Maori and Pacific populations Piloting a tower age of eligibility for bowel screening could be Ievisited completion of the pIogramme roll out in the context of overall screening priorities, workforce and service capacity. Options to increase equity Wbugh cancer screening a improving equity in pmcemes from cancer is a pIiority for the Ministry and Te Aho 0 Te Kahu. There are a miner of options to achieve this In the view of the Ministry and Te Aho 0 Te Kahu, it is imwrtant to particularly focus on cancers where the most stark inequities exist. The Wm 15 working to improve the current national screening programmes for 5 Ivll 6 Improving lung cancer outcomes is also an area for potential additional focus. Lung cancer is the leading cancer associated with health loss in New Zealand (from premature death and morbidity) and is also a significant driver of inequities for Maori who experience much higher incidence rates of lung cancer than non-Maori (4.3 times higher for Maori females and 3.0 for Maori males) due to ongoing higher smoking rates. Health Report: 20201036 .iir .nl in on ACHOE CANCER CONTROL AGENCY MANATU - Thus, in addition to preventing lung cancers through tobacco control and smoking cessation programmes we should consider introducing targeted lung cancer screening, initially through a well-designed pilot study. Recommendations The Ministry and Te Aho 0 Te Kahu, Cancer Control Agency recommends that you: a) note that the Ministry and Te Aho 0 Te Kahu consider the priority for the National Bowel Screening Programme (the programme), within current constraints, is to complete the programme roll?out to all DHBs (to ensure national coverage) and to increase equitable screening coverage for Maori and Pacific peoples within the existing programme parameters 5 c) note that lowering the age of bowel screening from 60 to 50 years for Maori and Pacific peoples in the first instance (and piloting this approach) be could be revisited following completion of the programme rollwout in the context of overall screening priorities, workforce and service capacity that support improved cancer outcomes for Maori and Pacific peoples d) forward this briefing to the Prime Minister, the Rt Hon Jacinda Ardern and Yes/No Associate Minister of Health, the Hon Peeni l-lenare e) indicate whether you would like to meet with officials from the Ministry and Yes/No the Te Aho 0 Te Kahu to discuss. Deborah Diana Sarfati Hon Dr David Clark Deputy Dir?syf General Chief Executive Minister of Health Popu 3f? Health and Te Aho 0 Te Kahu, Date: Prove Cancer Control Agency Health Report: 20201036 emits OTE KAHU CANCER CONTROL AGENCY up IAUDRA improving cancer outcomes 1. Screening is an important part of taking action on cancer 4-. A strong focus on prevention and early intervention is vital to improving population health, increasing health equity for Maori and other groups, and achieving Pae Ora: healthy futures for all New Zealanders. Improving cancer outcomes is central to these aims. Cancer is the leading cause of health loss (early death and morbidity) in New Zealand and its impact is felt across society, in our communities, and families/whanau. Each year, around 23,000 people are diagnosed with cancer and 10,000 die from cancer-related illnesses. Cancer outcomes are not equitably distributed in the population and are an important driver of health inequities. For example, Maogi are overrepresented in total cancer registrations (430.3 per 100,000 population) ind Overall cancer mortality (188.5 per 100,000 population) compared to non?Maori (320.8 registrations and 110.3 mortality).1 2.: Taking action on cancer is a key Government priority. The lgew Zealand Cancer Action Plan (2019? 2029Kahu, the Cancer Controi Agency, and supported by the Ministry and sector partners, guides the overalltapproach to improving cancer outcomes and increasing health equity in relationg?i??Eer. Cancer screening forms an important part of this-loverall picture. The Ministry's National Screening Unit currently operate three natIomlbancer screening programmes for breast, cervical and bowel cancers (the. latter Is currently being rolled out). in 1? Investing In these programmes recognises that early detection coupled with prompt access to treatment offers the beist opportunities to save lives, increase health equity, and' Improve the quality of lifegpr those living with canceI. a it; . is The NatIonaI Bowel Canceriw?ScreenIng Programme 7. 10. Bowel cancer is the fetond leading cancer associated with health loss In New Zealand (behind lung cancer)? Screening is an effective population intervention for bowel cancer and the a bowel screening pilot between 2012- 2017. a . . Of the pgople diagnosed during the leot, the cancer was at an early localised stage for 39 premietid participants, compared with 13 percent in the non?screened population. Dia?iapsis at the most advanced stage, where cancer has spread to other organs, was graificantly lower In the pilot, at 8 percent compared with 24 percent of the non- iffsEreened population. Having fewer advanced?stage diagnoses shows the screening is effective in early detection, which results in better participant outcomes. Those with localised disease at diagnosis have a 95 percent chance of a five-year survival compared with a 10 percent chance for those with the most advanced-stage cancer at diagnosis. Findings from the pilot informed the development of the national cancer bowel screening programme (the programme). However, the age of eligibility for the 1 National collections cancer registrations 2017; cancer mortality 2016 Health Report: 20201036 MINISTRY 0i 0 TE KAHU EALTH cancer: CONTROL. AG ENC programme was narrowed in the national rollout from years. This reflected a number of factors with a key driver being scaling the programme to meet available colonoscopy capacity while achieving the most health gains. Progress on the national rollout 11. The implementation of the programme is a key priority for the Government. Once the programme is fully rolled out about 700,000 men and women aged between 60 and 74 years will be invited for screening every two years. 5 91'2ilfili?u?i 13. A purpose designed information technology solution (the National Screening Solution) has also been developed to?support efficient operation of the service, improved data flow and to monitor promises and outcomes. The further rollout of the National Screening Solution has' peen paused due to the impact of ?19. The impact of on programme rollout 14. In March the programme was paused in the ten district health boards (DHB) while the country vent Into ocl