Region tops cancer rates in New Zealand, sparking fight against inequities

Professor Jason Gurney from the University of Otago says lung cancer screening is one way to turn around health inequities experienced by Māori.

Northland has the highest rates of cancer in the country. Northlanders diagnosed with cancer are more likely to die than patients in almost every other region. The “postcode lottery of cancer care” has inspired homegrown cancer control champions. Northern Advocate reporter Denise Piper caught up with them for World Cancer Day.

Northland had the highest rate of new cancer diagnoses out of 20 health districts in 2022, according to latest Health NZ cancer data. It also had the second-highest rate of cancer deaths, behind only Tairāwhiti (Gisborne).

The region also had the highest death rates for bladder, breast and cervix cancer, and the third-highest rate for lung cancer, from 2018 to 2022.

Professor Jason Gurney (Ngāpuhi), who leads the University of Otago’s cancer and chronic conditions research group, said the high rates were due to inequities experienced by the population, particularly Māori.

He cited the example of lung cancer, which Māori are three times more likely to develop and 30% more likely to die of, once diagnosed, than Europeans.

That was due to the social determinants of health, such as being poor and having less access to higher education — which were both linked to greater rates of tobacco smoking. Poor housing was another factor in poor lung health, Gurney said.

But surviving lung cancer was also about getting an early diagnosis, and Māori were more likely to first present with symptoms at their ED than at their GP, leading to delayed diagnosis, he said.

Northland’s spread and high numbers of rural patients also contributed to the stark statistics, leading to both late diagnosis and the difficulty of accessing care once diagnosed, Gurney said.

“The bigger story here is the postcode lottery of cancer care — it does matter how easy or difficult it is to get to care.”

Gurney said Northland’s poor health statistics inspired his career and he particularly enjoyed providing public health advice to the Minister of Health.

“Coming from Northland — being Māori and growing up in Whangārei — was an absolute golden ticket in terms of understanding what the key challenges are facing Māori, in particular, and our health system in general.

“It gave me a sense of responsibility: I saw that Māori were doing worse than Pākehā and I started thinking, why is that happening?”

Gurney was optimistic there were ways to turn around the inequities in the health system, such as introducing lung cancer screening for early diagnosis, using a low-dose CT scan of the chests of high-risk patients without symptoms.

“The Government is very interested in rolling out a lung cancer screening programme. It would absolutely save Māori lives.”

Sasha Webb from Cancer Control Agency Te Aho o Te Kahu says she often thinks how patients from Whangārei or Kawakawa or Mitimiti might be impacted by health system changes

Access to a GP, plus cancer screening and access to cancer treatment are all hugely important to better cancer outcomes, said Sasha Webb (Ngāuhi, Ngāti Kahu, Pākehā), director of equity and whānau-centred care at the Cancer Control Agency Te Aho o Te Kahu.

The fellow Northlander, who attended Kamo High School about two years behind Gurney, said wanting to improve outcomes for a patient from the likes of the Far North was an important part of what she does.

Webb does not have a clinical background but loves helping drive change after speaking with people going through the cancer journey.

She said Northland had high cancer rates for particular cancers, such as breast cancer, bowel cancer, leukaemia, melanoma and lung cancer.

While Webb said it was hard to pinpoint what caused inequities, they could be reduced with access to cancer screening, plus cancer care closer to home. Pushing for chemotherapy in Kaitāia and Bay of Islands helps with the latter, as will radiotherapy in Whangārei, she said.

Alex Pimm from Health New Zealand says cancer rates in Northland will be improved by a focus on smoking cessation, immunisation and cancer screening. Photo / Denise Piper

Health NZ said rates for cancer registrations and deaths varied between areas due to factors such as age and the level of exposure to common cancer risk factors such as tobacco, alcohol, insufficient physical activity, poor nutrition, excess body weight and certain long-term infections.

Alex Pimm, Te Tai Tokerau group director of operations, said ethnicity, socioeconomic status and rurality could also impact a person’s exposure to the cancer risk factors, as well impacting access to protective factors such as healthy food and health services.

All of these are a factor in Northland, he said.

Smoking cessation, immunisation and cancer screening were a key focus to help drive cancer prevention in Te Tai Tokerau, Pimm said.

Patients with a high suspicion of cancer are actively monitored, to ensure diagnosis and treatment happens as quickly as possible, he said.

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