Breast Cancer Screening age extension welcomed by Waikato surgeon

The Government has extended free breast screening to women aged 70-74.

The Government recently announced steps towards extending free breast cancer screening to women aged 70-74. Clinical lead for BreastScreen Aotearoa, Dr Adam Stewart, is an avid supporter of the age extension and talked to the Waikato Herald about why he has been advocating for this for a long time.

Stewart, who is also a Waikato-based breast surgeon, said screening was vital, because there weren’t many health interventions that had such a “profound effect” on the outcome for patients.

“Breast cancer - if it’s left untreated - is a nasty illness that affects about 4500 New Zealand women every year and sadly, about 650 of those women die.

“So it became very clear to me a long time ago, that the solution to breast cancer was not something like vaccination - cause you can’t vaccinate against breast cancer - it was not radical, morbid treatments. The solution was early detection,” Stewart said.

He has a personal connection to the topic.

“My mother had breast cancer as did my aunt and my grandmother. But they were all picked up through screening, so all their lives were saved.”

He said the early detection of breast cancer through screening had “revolutionised” outcomes for patients in the last 40-50 years worldwide.

“You can save one woman’s life as a surgeon by dedicating everything to that one case. But did you ever bother to glance at everybody else?

“Population-based programmes like screening have a benefit for the entire country, for all women.”

Currently, only women aged between 45 and 69 are eligible to receive free screening.

“Historically, women in their 70s and 80s were considered ... too old for these kinds of public health interventions. But we know that New Zealand women are getting older.

“I think there is a saying: 90 is the new 70. I believe passionately that women in their early 70s are not old. In fact, a woman who reaches the age of 69 will live for another 17 to 20 years.”

Clinical lead for BreastScreen Aotearoa Dr Adam Stewart. Photo / Danielle Zollickhofer

Stewart said he believed women in their 70s still had a long life to live, which is why extending the age for free screening was worth doing and something he had been “passionately” advocating for over a number of years.

“The advantages for this group of women aged 70 to 74 is that breast cancers are going to be detected much smaller, so it’s a simpler, shorter operation.

“Many of these women ... will avoid the complex treatments such as chemotherapy ... simply because the cancer was caught at a much earlier stage.”

Currently, the only way to get screened for breast cancer beyond the age of 69 is to pay for it yourself, “which can be upwards of $200 to $250 ... But not everyone can afford [that]... and unfortunately, some people think that after they are the age of 69, it’s not worth doing,” Stewart said.

One of the women who did think it was worth doing was Whangamatā local Valda Ritchie, 72 - and it saved her life.

“I have [been screened] for many years now, since I was ... 43.” She said no cancer was detected during her years of free screening.

Ritchie went for her last free mammogram just before the Covid-19 pandemic and it showed no abnormalities. However, because there had been a history of breast cancer in her family, Ritchie decided to continue to get screened privately.

Breast cancer survivor Valda Ritchie.

When she went for her first non-funded routine mammogram, a small abnormality was picked up. A biopsy confirmed it was cancer.

“It was a bit of a shock [when I got the diagnosis], I wasn’t really expecting that.”

Ritchie said she was just glad she lived “in this day and age”.

“I have been quite good about it, I think. My husband ... said I was very brave.

“You gotta think as positively as you can about it. I think this helps your healing process.”

She said the cancer was “so tiny” that it couldn’t be felt by a doctor’s or a surgeon’s hand.

Ritchie had an operation in January, followed by one week of radiation a few months later. She has been able to avoid chemotherapy, which can cost between $70,000 to $100,000 per patient, and was able to keep her breast.

Ritchie echoed Stewart’s sentiment about women in their 70s.

“I’m still quite young. When my mum was 70, she was an old lady. But I don’t feel it, I swim, I walk... I feel so well.

“[Thanks to the surgery] It feels like I have a new life. I’m so pleased I went and had my mammogram.”

Why extend screening to those aged 74?

Stewart said in terms of extending the screening age, New Zealand would follow the lead of other countries.

“For the last five to seven years, New Zealand has kept it at 69 while other countries have increased it to 74.”

Health Minister Dr Shane Reti said the Government had met with officials and discussed what is needed for the breast screening age to be extended. Photo / 123RF

He said international data supported the age extension.

“There is very good data [on this] from international organisations and international comparative jurisdictions such as Australia, Canada, the United Kingdom and many European countries.”

When asked if free screening should be extended beyond 74 years, Stewart said: “If we were to go beyond 74, we would be the only country that’s done that.

“I’m not confident we have the data to support that, at least at this stage.”

When will the age extension be in place?

The Government announced in February it had made the first steps.

Health Minister Dr Shane Reti said the Government had met with officials and discussed what is needed for the screening to be extended.

“Overall, our extension means women will be eligible for an average of two to three extra mammograms once the programme is fully implemented – and means around 120,000 additional women will be eligible for screening every two years,” Reti said.

“We anticipate an additional 22 lives could be saved every year.”

However, the implementation of this age extension is still a while away.

“While we want to move as swiftly as possible, we need to allow the health system to prepare for the roughly 60,000 additional women eligible each year,” Reti said.

“There’s a lot to be done in terms of preparation, both human and capital infrastructure. As well as planning for the expansion of existing screening services, Health New Zealand will need to plan for the cancer treatment services required to support the additional women [who are] diagnosed.”

Stewart added modelling was currently being done for an implementation plan.

“It will be rolled out in a phased way, so it won’t be immediate and it will be done over ... the next few years.”

Danielle Zollickhofer is a multimedia journalist and assistant news director at the Waikato Herald. She joined NZME in 2021 and is based in Hamilton.

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