Te Whatu Ora – Health New Zealand has today released a Quality Improvement Review of Breast Screening Aotearoa, which sets out the pathway to improve breast screening services for women across New Zealand.
The review, conducted by a panel led by Dr Dale Bramley that was independent of the National Screening Unit, contains 26 recommendations to help improve access to screening along with experiences and outcomes for women. The recommendations relate to governance; monitoring, research and evaluation; workforce; consumer involvement, clinical and quality safety; and identification and reporting.
The review found that breast screening services continue to play a critically important role in helping to improve outcomes, reduce recovery times, and prevent women from dying from breast cancer. Women who access the national breast cancer screening programme have a 34% reduction in their risk of breast cancer death.
The review team recommended a strengthened focus on improving cancer screening access and experiences for wāhine Māori and Pacific women.
Te Whatu Ora has announced a new national breast screening register to support the response to the review. This additional funding of $55 million committed over the next four years will enable women to be directly invited to participate as soon as they are eligible, as well as receive follow-ups when they are due for their next screening appointment. The register will also allow for tailored approaches based on the needs of local communities.
A Breast Screening Action Plan will be developed by Te Whatu Ora and Te Aka Whai Ora to respond to the recommendations, with a focus on improving access to screening and experiences for Māori and Pacific women.
Coming together as one health system will provide new opportunities to capitalise on data and technology, such as the new national screening register, pilot new approaches, share best practice and better integrate different types of cancer screening services.
A Pae Whakatere has been appointed by Te Whatu Ora and Te Aka Whai Ora to oversee the finalisation and implementation of the new Action Plan. This will be chaired by Dr Nina Scott (Waikato, Ngāti Whātua and Ngāpuhi), who is co-chair of the Hei Ahuru Mowai – National Māori Cancer Leadership Group. Dr Scott was a member of the review panel and is currently a public health physician in the Waikato.
Dr Scott says: “Breast screening is so important and continues to be one of the best ways we can help to reduce the impact of cancer on women and their whānau, and enable women to live longer, healthier lives.
“We know that well designed cancer screening services that provide mana-enhancing experiences for all women are critical.
“Our action plan will focus on co-designing services for wāhine Māori and Pacific women, including developing tailored programmes to increase access to all screening programmes.
“We’ll also be looking at improving access to cancer screening for those who are finding it difficult to get into these services, such as disabled women and those living in rural and remote communities.”
The Action Plan will also include a focus on:
- a dedicated workforce recruitment and retention strategy for Māori, Pacific peoples and people with lived experience of disability
- co-designing bespoke services for whānau and Pacific peoples, including targeted programmes and a new whānau and consumer panel
- broadening the focus of the screening programmes to include wellbeing and hauora health gain for individuals, whānau and the community
- better integrating different types of cancer screening services, so that cancer screening is a better experience and women can access all cancer screening programmes
- co-design of a kaupapa Māori accreditation programme for breast screening providers
- new research to improve access to screening for wāhine Māori, Pacific women, tangata whaikaha and consumers with lived experience of disability, and other groups at increased risk of breast cancer death who are underserved by the screening programme including rural and lower socio-economic communities.
The independent panel also commissioned an epidemiological review to support the Quality Improvement Review. The epidemiological review found that Aotearoa’s programme compares well to breast screening programmes in other countries, but we need to do much more to improve access to breast cancer screening for Māori and Pacific women, particularly following the impact of COVID-19.
Access to breast cancer screening is lower for wāhine Māori and Pacific women compared to non-Māori/non-Pacific women. The COVID-19 pandemic led to a reduction in screening for all groups.
Wāhine Māori and Pacific women had the highest death rate from breast cancer for the 45-69 year screening age group at 68 deaths per 100,000 women. In comparison, non-Māori/non-Pacific women had a breast cancer death rate of 42 deaths per 100,000 women.
The review was commissioned in May 2022 by Te Whatu Ora CEO, Margie Apa, to help ensure that the BSA programme was equitable and effective. This followed the discovery that a number of women in the Wellington region had been waiting longer than the 60 working day target from enrolment to offer of an appointment for their first screening mammogram. This incident was subject to a separate review by Capital, Coast and Hutt Valley, which has also been released today.