David Farrar: On clinical need, not ancestry....

Bowel cancer screening should be based on clinical need, not ancestry

Simeon Brown announced:

The Government has agreed to progressively lower the age of eligibility for bowel cancer screening tests to align with Australia.

“Today, I am pleased to announce that we are taking the first step by lowering the age to 58, with redirected funding of $36 million over four years.

“This means free bowel screening will become available to all New Zealanders from the ages of 58 to 74,” Health Minister Simeon Brown says.

“Lowering the age of eligibility from 60 to 58 will see 122,000 Kiwis eligible for free tests in the first year and save hundreds of lives over the coming decades.

“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.

“The changes announced today are projected to prevent an additional 771 bowel cancers and an additional 566 bowel cancer deaths over the next 25 years.

“Advice from the Ministry of Health clearly states that lowering the age to 58 for all New Zealanders will save even more lives than the previous government’s approach to lower the age to 50 for Māori and Pacific Peoples only.

“Under our approach, we will be able to prevent 218 additional cancers and 176 additional deaths over 25 years in comparison to the settings proposed by the previous government.

“This also aligns with the Government’s policy of ensuring that healthcare is delivered on the basis of need.

Labour’s policy was close to evil. Their policy was that your ancestry would determine if you get free screening for bowel cancer. People aged 58 and 59 with the wrong ancestors could die because of that.

Bowel cancer is almost 100% preventable with regular screening.

Now it is true that more Maori and Pacific NZers get bowel cancer than other NZers. But this is correlation not causation. As the definition of Maori is one ancestor no matter how far back, that means that a 50 year old David Seymour would get free screening from Labour while a 59 year old Chris Bishop would not.

The major risk factors in bowel cancer are lifestyle. You are more likely to get bowel cancer if you:

• Eat little fruit or vegetables
• Are obese
• Don’t exercise often
• Drink excessively
• Smoke
• Have diabetes

There is a degree of genetics. If family members have had bowel cancer, you are more likely to. And some ethnic groups can have higher rates – in fact globally Ashkenazi Jews have amongst the highest rates in the world.

But here’s why you don’t need to screen on race. There already is free screening for under 60s if you have risk factors such as a family history or have diabetes etc etc. This is going off clinical need, not race. If you go off race or ancestry then you are saying a 50 year old with no risk factors at all (but happens to have a Maori ancestor 180 years ago) should have higher priority than a 59 year old (and age is a large factor).

An interesting paper found in NZ that bowel cancer mortality rates for Maori and Pacific increased massively from 1980 to 2000. The authors (including the current DG of Health) concluded:

In the absence of some other constellation of unrecognised risk factors of overwhelming importance, it must be presumed that there has been a change in diet over time among Mäori and an even more dramatic change among Pacific people.

If it was genetics, then the rates would not have skyrocketed.

So having universal screening of everyone aged 58+ , and targeted screening below 58 based on actual risk profile is the right thing to do.

David Farrar runs Curia Market Research, a specialist opinion polling and research agency, and the popular Kiwiblog where this article was sourced. He previously worked in the Parliament for eight years, serving two National Party Prime Ministers and three Opposition Leaders.