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ABSTRACT
The current New Zealand Bowel Screening Programme (BSP) is inequitable. At present, just over half of bowel cancers in Māori present before the age of 60 years (58% in females and 52% in males), whereas just under a third of bowel cancers in non-Māori are diagnosed before the same age (27% in females and 29% in males). The argument for extending the bowel screening age range down to 50 years for Māori is extremely simple-in comparison to non-Māori, a greater percentage of bowel cancers in Māori occur before the age of 60 years (when screening starts). Commencing the BSP at 50 years of age for Māori with high coverage will help fix this inequity. In this paper we review the current epidemiology of colorectal cancer with respect to the age range extension for Māori.
Bowel cancer screening has been shown to be effective at preventing bowel cancer and improving survival from bowel cancers by diagnosing them at an earlier stage.12 In New Zealand, bowel cancer screening modelling studies have shown that screening is likely to improve health for Māori and non-Māori and be cost-effective.34 For these reasons, in 2017 New Zealand began a staged rollout of bowel cancer screening, with all district health boards (DHBs) expected to be involved by late 2021 (depending on the impact of the COVTD-19 pandemic). At the time of writing, bowel cancer screening had been implemented in 13 of 21 DHBs.
There are some important inequities in bowel cancer survival and treatment for Māori compared to non-Māori,56 and problems with the New Zealand bowel cancer screening programme (known as the Bowel Screening Programme (BSP)) with respect to health equity and health justice for Māori. Improving screening coverage for Māori and an adjustment to the eligible age range for Māori and Pacific peoples are two of a number of strategies proposed to address what is currently a discriminatory programme.
In this viewpoint, we review the current epidemiology of colorectal cancer with respect to an extension of the eligible age range for Māori, in the hope that we can help to demystify the numbers and encourage a broader, informed discussion on this important issue. We take a kaupapa Māori epidemiological approach, where we understand epidemiology as one of the tools...