Cancer in Northland: Stark figures show postcode lottery for cancer care

Northland has some of the highest cancer rates in the country, including high death rates for bladder, breast, cervix and lung cancers. Photo / 123RF

Cancer is a devastating diagnosis received by about 1300 Northlanders each year. Northern Advocate health reporter Denise Piper investigates cancer patients fundraising for better treatment, how Northland compares with the rest of the country and what is being done to improve cancer treatment in the region. Here, she takes a look at our cancer rates, and how they compare.

Northland’s rates of cancer diagnoses and deaths are among the highest in the country, and the reason why is unclear.

The latest data from Health New Zealand - Te Whatu Ora shows in 2021, Te Tai Tokerau had 366 cancer registrations, or new diagnoses, per 100,000 people - the third-highest rate in the country out of 20 areas.

In the same year, Northland had a cancer death rate of 129 per 100,000 people, the fourth-highest rate in the country.

The north also has high numbers of diagnoses and deaths for certain cancers: bladder, breast, cervix and lung.

The region had the highest registration rates in the country for bladder, breast and cervix cancer from 2017 to 2021. It also had the second-highest rate of lung cancer registrations.

Northland also had the highest registration rates for rarer cancers - including connective tissue, hypopharynx, mesothelioma, thymus and vagina cancers - although the numbers are so small, one or two diagnoses could impact the rates.

From 2017 to 2021, the rates of Northlanders dying from bladder, breast and cervix cancer was the highest in the country.

The north also had the fourth-highest death rate from lung cancer, with 558 people dying from lung cancer over the five years - the same number as all of Auckland over the same time period.

The reasons for the disparity between regions is unclear, with Health NZ unable to answer why Northlanders fare so poorly with bladder, breast, cervix and lung cancers.

But the impact on Northlanders facing a terminal cancer diagnosis is stark and often means they need to turn to fundraisers to help fund treatments.

Whangārei mother of three Jacqualine Findlater is fundraising for Avastin to battle an aggressive colorectal cancer - stage-four adenocarcinoma spread to her stomach lining, lungs, spine and lymph nodes.

Jacqualine Findlater, 38, is among Northlanders feeling the impact of the region’s stark cancer figures as she uses funded and unfunded treatments to give her the best chance of survival.

Before the 38-year-old was diagnosed in August, she was in and out of hospital, with clinicians unable to find what was wrong. They later admitted to her they could have done better.

Whangārei former hairdresser Brenda Johnson also has stage-four colorectal cancer and is also fundraising for Avastin to extend her life. Her diagnosis was delayed by two years after doctors at her general practice and Whangārei Hospital’s emergency department (ED) misdiagnosed her symptoms as piles.

Patient advocate Malcolm Mulholland, from Patient Voice Aotearoa, said people living in far-flung regions are more likely to have delayed cancer diagnoses - which can lead to a worse health outcome - than those in major cities.

“I am aware that there is a particular issue in the north, particularly with delayed diagnosis with breast cancer, but also there are issues down in Southland with bowel cancer and issues in places like the West Coast,” he said.

The reason for this is likely linked to the health workforce crisis, which has resulted in a lack of pathologists to help diagnose cancers and oncologists to help treat them, Mulholland said.

“There is a lack of oncologists in New Zealand and the majority of them are Auckland-based. Once you start getting out of Auckland, it becomes slim pickings,” he said.

The difficulty regarding seeing a GP in Northland could also be having an impact, Mulholland said, as that is normally a patient’s first port of call if something goes wrong.

“A patient would first see their GP, who would then order a series of tests or a specialist appointment - without a doubt it’s also playing a role with delayed diagnosis.”

Northland general practices have long been saying their funding model is unsustainable and have called on the Government to support them more.

Practices have now cut back their overnight services and patients can wait weeks - and have to jump through hoops - just to get an appointment.

A study published in the New Zealand Medical Journal on September 27 found lung cancer patients have a much poorer survival rate if they first present to an ED with symptoms as opposed to seeing their GP.

The study looked at 10 years of data from Waikato and found those attending the ED were less likely to survive the first 12 months after diagnosis than those who did not need to visit an ED.

General Practice Owners Association of Aotearoa NZ chairman Dr Angus Chambers said the study clearly shows surviving lung cancer could depend on access to a GP, as a GP visit is usually done when symptoms are less severe, leading to an earlier diagnosis and better treatment options.

“That patients are choosing not to go to their GP because they cannot get an appointment, cannot enrol [at] a local GP, or cannot afford to pay for a visit, [which] means they put up with less serious symptoms. But eventually the symptoms get so bad they go to an emergency department. By this time, it is often too late.”

Lung cancer is New Zealand’s single biggest cause of cancer deaths, Chambers said.

“The study shows that there is health inequity in New Zealand - those who can access and afford to visit a GP are advantaged over those who cannot, which is wrong. We need to ensure everyone can access a GP for an earlier diagnosis which could save lives.”

* This story has been updated to add in the number of former district health board areas Northland is compared with (20).

Cancer in Northland series

• Mum’s fight for life and disappointment in health system
• Figures show postcode lottery for cancer care
• What are plans to improve access and care in Te Tai Tokerau?
• Dad with rare cancer spending $165k for expert surgery

Denise Piper is a news reporter for the Northern Advocate, focusing on health and business. She has more than 20 years’ experience in journalism and is passionate about covering stories that make a difference.