Published: 4 September 2020
Authors: Jason K Gurney, Bridget Robson, Jonathan Koea, Nina Scott, James Stanley, Diana Sarfati
Source: This abstract has been sourced from NZ Respiratory Research Review Issue 181
Cancer is an important cause of morbidity and avoidable mortality for Māori, with more than a quarter of all deaths among Māori attributable to this disease. There is substantial evidence of enduring disparities in cancer incidence, mortality and survival between Māori and non-Māori, with cancer making an important contribution to the life expectancy gap between these groups.
Our country’s new Cancer Action Plan for the years 2019–2029 aims to address inequities in the burden of cancer experienced by Māori New Zealanders. In the plan, the Ministry of Health stated that the plan would be equity-led, achieve equity by design, and included as a primary outcome that “New Zealanders experience equitable cancer outcomes”. These objectives are important and signal a commitment from central Government to closing the cancer gap for Māori.
Given the substantial inequities in cancer outcomes experienced by Māori, the prioritisation of initiatives to close this gap is congruent with the objectives of the new Plan. However, in the presence of finite capital (both fiscal and political), there is a need to carefully set priorities that reflect the reality of the cancer burden faced by Māori. While many initiatives will have pan cancer impact—such as renewed investment in the Māori cancer care workforce—there is value in understanding which cancers cause the largest burden on Māori, before we prioritise and invest in new initiatives that may increase inequities, or only impact one or two cancers (such as screening programmes).
In this manuscript, we present current evidence on the most commonly diagnosed cancers among Māori between 2007–2016, the decade immediately following on from the 1996–2006 period presented in the landmark Unequal Impact II report. We also present the most common causes of cancer death for Māori over this period. Alongside these absolute cancer death data, we present a relative cancer survival comparison between Māori and non-Māori. Finally, we summarise the factors that link these cancers, and discuss how to reduce their occurrence and the overall cancer mortality burden for Māori.
In this manuscript we have presented the most commonly diagnosed cancers for Māori, the most common causes of cancer death, and contextualised survival disparities between Māori and non-Māori against the actual mortality burden of each given cancer. If our primary objective is to reduce the overall cancer burden for Māori, then our top priority may be preventing the majority of lung cancers via tobacco eradication while simultaneously detecting lung tumours early (possibly via a targeted lung CT screening programme). Population-based initiatives aimed at the prevention of cancers related to infectious diseases, diet, obesity and diabetes will also result in a substantial reduction in the incidence and mortality cancer burden for Māori. Likewise, overall improvements in early detection and the provision of best-practice timely treatment for Māori patients will close the survival gap between Māori and non-Māori in the short- to medium-term, leading to a further reduction in Maori cancer deaths.