Harina Warbrick was 56 when she was diagnosed with bowel cancer but died three years later. Photo / Supplied
Harina Warbrick was 56 when she was diagnosed with bowel cancer but died three years later. Photo / Supplied
Harina Warbrick was supposed to be celebrating her youngest son's wedding in March this year.
Instead, her family said their final goodbyes that month as she lost her three-year battle with bowel cancer.
Warbrick is believed to be one of the hundreds of New Zealanders whose bowel cancer could havebeen picked up earlier had the screening age been dropped for Māori and Pasifika, who are considered at a higher risk of developing the disease earlier than non-Māori, a leading indigenous health surgeon believes.
The Ministry of Health says the proposal to lower the screening age for Māori and Pasifika "hadn't been ruled out" but said the priority was on rolling out the programme nationally for 60- to 74-year-olds, which was not expected to be complete until December next year.
Warbrick was 56 when she was diagnosed with bowel cancer in 2017.
She had only been taking in fluids and kept her troubles to herself until after diagnosis.
Her son Gabriel Anderson said Warbrick sought medical advice after experiencing bowel problems for months but quickly received treatment after diagnosis.
"They removed a section of her bowel, but it ended up being longer than anticipated so they couldn't reattach the bowel and she ended up having a [colostomy] bag."
Harina Warbrick was 56 when she was diagnosed with bowel cancer but died three years later. Photo / Supplied
The Whakatāne woman was soon in remission and it meant the "strong, proud Māori lady" as Anderson described his mum, was back out doing surf life saving.
However, an abnormal blood test came back in 2019 and it was later revealed that cancer had spread to her pelvis.
"Up until that point it looked pretty promising - that it was gone for good," Anderson said.
In January this year doctors realised her kidney was failing and the once strong, athletic 80kg woman began shrinking to half her weight.
What followed was a slow process, Anderson said, that eventually saw Warbrick bedridden until March 3, when she took her last breath.
Anderson's fiancee, Ashleigh Browne, said while the screening age needed to be lower, the family had to play a part in pushing and supporting whānau to be checked too.
"The screening age needs to be lowered, as well as your family being on your case to go to the doctor.
"You always hear it is the rocks of the whānau that are diagnosed with terminal cancer but I think it's because they never go and get checked. They just carry on business per usual."
Bowel cancer was the second-deadliest cancer in New Zealand after lung cancer, killing close to 1200 people each year and - with history on both his parents' side of the family - Anderson had been told by his doctor to be regularly screened.
Royal Australasian College of Surgeons Indigenous Health Committee chairwoman Maxine Ronald said lack of Government action was unacceptable. Photo / Supplied
Maxine Ronald, a Northland-based general surgeon and chairwoman of the Royal Australasian College of Surgeons (RACS)'s Indigenous Health Committee, said it was unacceptable the Government had not taken action to lower the screening age for Māori and Pasifika.
"Māori are over-represented in cancer registrations and overall mortality than non-Māori. This disparity cannot be explained away by socioeconomic status, co-morbidity or consent to treatment, as has been purported previously."
Ronald said, in her view: "Institutional racism is a known important determinant of health and is a major cause of health inequities between Māori and non-Māori in New Zealand."
The NZ National Bowel Cancer Screening Programme is being rolled out in New Zealand using an age range that, in Ronald's opinion, did not provide the same levels of health gains for Māori as it did for Pākehā.
"This is because Māori have a higher incidence of bowel cancer at ages 50 to 59, with 20 per cent compared to 10 per cent in non-Māori, and a lower rate of bowel cancer in the screening population."
Ronald said a pilot bowel screening programme at Waitematā District Health Board from 2012 to 2017 confirmed the success of the programme in detecting significant levels of early cancer and pre-cancerous polyps.
Of the cancers found in the screening pilot, 39 per cent were at an early, localised stage. This is associated with a 95 per cent five-year survival rate and is a significantly greater pick-up rate than early cancers found in the non-screened population of 13 per cent.
Diagnosis of cancers found at the most advanced stage in the screening pilot was just 8 per cent, compared with 24 per cent of the non-screened population.
These findings informed the development of the National Bowel Screening Programme, however, the minimum age was reduced after colonoscopy capacity was only deemed satisfactory to serve a screening population aged 60-74 years.
"With this knowledge, it is therefore with both shock and disappointment that RACS learns of the decision of the New Zealand Ministry of Health to not extend the minimum bowel screening age for Māori and Pasifika people to ensure equitable coverage for the entire population."
Both the Ministry of Health and Cancer Control Agency (Te Aho O Te Kahu) said it was "very aware of the issues" around the current age range for bowel screening and the concern about potential inequalities.
In a prepared statement, the Ministry of Health and the Cancer Control Agency (Te Aho o Te Kahu), said: "It was our considered view, backed up by international advisers, that the safest and most sustainable course of action is to complete the national roll-out of the programme (expected by November 2021) before reviewing the age parameters or potentially introducing an age differential."
Bowel Cancer NZ medical adviser, public health clinician and Invercargill GP, Dr Sue Crengle, said she was disappointed by the Government's "unwillingness" to fix inequity.
"Māori have less opportunity to benefit from the programme than European people and this is unfair and unjust.
"The current programme will increase inequities in bowel cancer outcomes between Māori and Europeans, meaning European mortality from bowel cancer will be reduced more than Māori."
