Cabinet Minister Kiri Allan's shock cancer diagnosis has highlighted the need for Māori women to get a cervical smear, which could save their life and reverse the shocking statistics.
The 37-year-old Minister of Conservation and Emergency Management has stage 3 cervical cancer, and admitted in a Facebook post she delayed getting checked because she wasn't comfortable with the invasive test.
She got a smear test over three years ago, in response to the Smear Your Mea campaign, started by Talei Morrison to encourage Māori to get checked.
Morrison's own cancer diagnosis gave her the impetus to launch the campaign. She lost her battle with the disease in 2018.
Her brother Eruera Keepa, who's carrying on his late sister's legacy, was deeply saddened to hear about Allan.
"I'm sending all my wishes and all of my strength to Kiritapu and to her whānau with their battle ahead."
He has been an advocate for women having access to self-testing swabs to see if they have the Human Papillomavirus or HPV, which can lead to cervical cancer, as he said there were cultural reasons Māori were reluctant to get the conventional smear test.
"When you apply a Māori worldview to that, it's the protection of tapū and that's been a barrier for many of our wahine Māori, the intrusive nature of getting your smear and how that impacts on the tapu of the whare tangata [uterus] so any solution that mitigates that is something we support wholeheartedly."
Anna Adcock from Victoria University of Wellington's Centre for Women's Health Research - Te Tātai Hauora o Hine - said self-swabbing could help Māori women overcome whakamā, or reservation about having a smear.
"We associate that with a desire for bodily autonomy so these are people who do not feel like the current cervical screening system is sensitive enough to their needs or they may have had a bad experience in the past where they don't want anyone interfering with them."
She co-lead a study on why Māori women were not screened regularly, and whether the new self-test would change that.
Most cervical cancer occurs in women who don't get screened, and Adock's research revealed 34 per cent of Māori women - compared to 21 per cent of Pākehā women - don't get regular screening, resulting in mortality rates two and a half times more than non-Māori.
This was even more startling for Māori women aged between 25 and 44 who are three times more likely to die from cervical cancer than Pākehā women that age.
Adcock said the self swab test could be a game changer in a system that must do better.
"It's devastating when you hear about people who are being harmed by this preventable cancer, like Minister Allan.
"We need a screening system that works for us where all people with cervixes who need to screen feel comfortable and confident to do so, and HPV self-testing will be game-changer in that regard," she said.
Te Tātai Hauora o Hine director Bev Lawton was frustrated there was still no movement on a new screening programme using the self-swab test.
"It baffles me - does that mean women, particular wāhine Māori, aren't worth it?"
The Ministry of Health said it was committed to introducing HPV primary screening and self-testing as international evidence showed it was the most effective.
It said the main barrier was adapting the national screening register to accommodate a new test and it needed government funding to make the changes.
When asked on Morning Report whether she now regretted that the self-swabbing cervical cancer programme wasn't rolled out three years ago, Prime Minister Jacinda Ardern said Allan's case was a separate issue.
She wouldn't rule out introducing the programme as a priority, but said a screening regime already existed and that people should be encouraged to use it.
"We have to overcome a range of barriers that are leading to those perhaps not being part of the screening that is already available," Ardern said.
"This is something that I would be interested in understanding for our experts."
Ngāti Pāhauwera in Wairoa and Ngāti Porou on the East Coast were doing the self-swabbing as part of research pilot programme. About 600 tests are to be processed over the next few years.
But Lawton said the national programme needed to get started now as it would take 18 months to two years from initiation for the rollout to reach women.
Meanwhile, the cervical smear screening programme is behind schedule because of Covid-19, with 22,000 women - including 3000 Māori - still waiting for test.