In a five-part series, the Herald investigates controversies in cancer testing and treatment and reports on the moving stories of people afflicted with cancer.

We've come a long way, with a 30 per cent drop in breast cancer mortality in the past twenty years, thanks to our top-notch screening programme and improved treatments. But we're still losing more than 600 women a year to breast cancer. To fix that, there are several areas where we need an attitude adjustment.

First, access to drugs. New Zealand spends less per capita on healthcare than Australia, and that's not good enough. Our women are missing out on drugs that are standard therapy in Australia and the UK. Some, like Perjeta, used with Herceptin to treat advanced HER2-positive breast cancer, have prolonged survival dramatically.

Drug access will become even more challenging with several promising but very expensive immunotherapies coming through. So it's important for our DHBs to be more proactive in securing pharma-funded clinical trials and recruiting patients nationally, giving as many women as possible access to new medicines. The pharmaceutical companies also have a responsibility globally to get real about their prices. Some of the newer breast cancer medicines look set to cost hundreds of thousands of dollars per patient. Breast cancer is not a rare disease, so there's no excuse for rarity pricing.

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On the positive side, there's increasing call for research into how we might use our older drugs better, which will prove highly relevant in New Zealand.

The second major issue is our support for women with advanced breast cancer. New evidence suggests they may live longer with assertive treatment and new techniques like stereotactic radiosurgery. We need to focus on doing everything we can to keep our women not only alive, but living well.

Issue number three is mammograms for our older women. Few 70-year-olds consider themselves written-off, yet free mammograms stop at age 69, while a woman's breast cancer risk is higher at 70 than it was at 50. The NZBCF will be petitioning Parliament to extend free screening to age 74.

We sit down with Tracey Eising who tells of the breast cancer that has been with her for nine years and how without state funding she can’t afford the one remaining medicines that could help her once her current drugs fail.

Lastly, while we have a fantastic public health system, inequalities mean that where you live can make a huge difference to your breast cancer outcome and your quality of life. Treatment guidelines suggest all medically eligible women should be offered breast reconstruction after mastectomy - but women in some areas are being declined even a space on the waiting list.

Their distress is real and justified. Post-operative lymphoedema has a major impact on quality of life, but services are patchy and inadequate. Our Maori and Pacific Island women are more likely to die of breast cancer, and important research is underway to assess what part treatment inequalities play.

We've come a long way...but there's still a long way to go.

Evangelia Henderson is chief executive of The NZ Breast Cancer Foundation
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