Sara was diagnosed at 27. She wanted her daughter’s generation to be spared her pain – but experts fear cervical cancer will be Covid’s legacy. Michelle Duff reports.
When Sara Corbett was diagnosed with cervical cancer, her daughter was three. Ratahi doesn’t remember much; the hospital’s bright lights, her colouring-in book on mum’s bed.
It was the most frightening time of Sara’s life. A young, single mum, she made the choice to go ahead with cancer treatment immediately, sacrificing her ovaries and any chance of having another baby.
“I just had to think of Ratahi,” she says, now. “I couldn’t leave her without a mum.”
That was more than a decade ago. Ratahi is now 16, and Sara, 40, is cancer-free. Ratahi has been vaccinated against HPV, the virus that causes cervical cancer, meaning she’ll never get it.
* As many as 21,000 children haven’t had HPV vaccinations this year
* For an increasing number of women, the first line of defence against cervical cancer doesn’t work
* Self-testing kits for HPV cervical screening could help save lives, so why aren’t we using them?
For her generation, it was hoped the preventable cancer could be eliminated. But Covid-19 has revealed gaping holes in the nationwide vaccination and screening programmes meant to be protective shields.
The number of young women receiving first smear tests has almost halved during Covid, with experts fearing a spike in preventable cervical cancer among a new generation of wāhine Māori and Pasifika, unless immediate steps are taken.
“We know we have a problem with increasing cervical cancer in that younger group, which is very concerning,” says Professor Bev Lawton, the director of the Centre for Women’s Health Research Te Tatai Hauora O Hine. “Screening rates were already dropping, and Covid has made a huge difference.
“We need to make it accessible, it needs to be free, and we just need to put our foot on the pedal.”
Overall, around 30,000 fewer smear tests were done in the year to October 2020 alone, with figures taking another dive during the nationwide lockdown in August this year.
A nationwide backlog of overdue smear tests has prompted the Ministry of Health to dish out emergency funding to district health boards to urgently find and screen Māori and Pasifika women and girls, who research shows are already more than twice as likely to die from cervical cancer than non-Māori.
Internationally, experts have warned even small blips in screening coverage can lead to more cervical cancer, especially in minority ethnic groups.
The decline in screening comes alongside a drop in HPV vaccinations in Year 8 pupils seen this year.
Those working on the frontline in Aotearoa say a new HPV self-test due for roll-out in 2023 should be fast-tracked, or offered to at least high-priority women now.
The HPV self-test, which can be administered at home by the woman herself or a doctor, would allow screening to continue during a pandemic, Lawton says.
Lawton and her colleagues are about to start an implementation trial of HPV self-testing with several thousand women in Northland. Lawton says she is trying to shoehorn as many women as possible into it, to make up for those missing out.
Ministry of Health data analysed by Stuff show cervical screening was impacted heavily by the first Covid lockdown in March last year. It picked up slightly in May, but has not returned to pre-Covid levels.
First smear tests, most common in women aged 25-30, have dropped by 46 per cent since September 2020. Around 1500 in total have been administered so far this year.
Overall Māori and Pasifika women, already underscreened, are the most heavily impacted. In Counties-Manukau DHB alone, where 88 per cent of Pasifika women were once screened, it’s now 58 per cent.
This year, only four Māori women and eight Pasifika received their first smear tests, in the entire South Auckland area.
Otago University professor and Canterbury DHB Gynae-Oncologist Peter Sykes, who has been monitoring cancer statistics in New Zealand since 2008, broke down while talking to Stuff about young women being missed.
“It is heartbreaking when you see a young woman with advanced cervical cancer. It’s horrible, when it’s a preventable disease. The ones who are missing out on screening now are at risk, now.”
New Zealand raised the first screening age from 20 to 25 in 2019, anticipating the new, more effective HPV test. But the new test has been delayed multiple times and, now with Covid, there is a higher risk of cancer going undetected, Sykes says. “These women are exposed, especially if they’re unvaccinated.”
Stuff approached Counties-Manukau, Auckland, Wellington and Canterbury DHBs for comment on how they planned to make inroads in screening backlogs. They all declined to answer questions and treated the enquiry as an Official Information Act request, allowing 20 days to respond.
Minister of Health Ayesha Verrall was approached for comment.
A generational fight
Waipukurau mum Corbett was diagnosed with cervical cancer after two misread smear tests. In hindsight there were signs – a sore back, feeling fatigued. “I was just a single mum working a couple of jobs, you know, busy, active, playing sports, doing all those things. I could probably explain all the symptoms away, I guess,” she says.
A decade on, Corbett finds it hard to think that other young wāhine Māori will have to go through what she did. “It’s still happening. I think that’s the hard thing. It’s like, ‘Yeah, this sort of stuff was big 12 years ago, and again, it’s still pretty big’.”
Corbett’s mum, Sandra, is the Kaiwhakahaere in charge of cervical screening at Hawke’s Bay District Health Board. She’s been working overtime in its outreach programme, where she tracks women down at home to test them herself. They’re often busy mothers, sometimes with multiple jobs, and that’s the only way to get it done.
But with lockdowns and DHB resources going to Covid – vaccinations, contact tracing, staff being seconded to Auckland and regular screening clinics having to close – it’s been tough.
“Our current screening rates with Covid have absolutely decreased. There’s a big drop in the amount of smears being done, so the consequences of that will be an increase in cancer,” Corbett says.
Hawke’s Bay has a shortage of GPs, and many seasonal workers or busy women don’t have a doctor. Even those who are registered often have to wait weeks for a smear.
Corbett says the HPV self-test should already be available for high priority women. “If the Ministry had got their act together five years ago when we knew about it, we wouldn’t have this problem,” Corbett says.
“You can’t help but wonder if it were males who got cervical cancer, it would be totally different. Can’t we at least just do it with the most vulnerable people, now?”
A spokesperson for the Ministry of Health said it had provided an extra $380,000 in funding to target a widening equity gap in screening, created as a result of Covid-19. The money was used to provide additional free and accessible cervical screening tests for the Māori and Pacific eligible population.
A social marketing campaign to promote a safe return to screening for wāhine Māori and Pacific women would be rolled out next year.
The cervical screening workforce was doing an excellent job given the pressures of Covid-19, they said.
“Primary health care and support to screening services are continuing to work hard to support women and minimise the impact of Covid-19 on access screening.”