Women’s health is being “held together by fax machine,” with Jacinda Ardern’s Government rejecting three years of funding requests to bring New Zealand’s cervical screening programme into the 21st century.
Documents obtained under the Official Information Act reveal the Government has known the nationwide cervical screening programme – that is, cytology testing, or the pap smear test – is not the best way of saving lives since at least May 2016.
Doctors have had the physical ability to carry out a better test, known as the HPV viral DNA test, with at least 15 per cent more effectiveness at detecting cancer and reducing deaths, since 2008.
At least 30 cancers each year could have been prevented with a new programme using this test. A 2019 external review said the risks to women grew greater with each delay.
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But the improved test has never been funded on a national scale, despite multiple attempts.
The National Cervical Screening Register (NCSR) was built in 1990 to receive results through fax, and doctors still have to call or fax to check on patients. Both the technology and the law currently prohibit GPs from looking up results in a centralised system.
Sources spoken to by Stuff say the ministry’s register is commonly referred to as being “held together by fax machine,” and doctors and district health boards are angry at the programme’s continual delay.
Some DHBs have offered to roll out their own self-testing programmes, recorded on Excel spreadsheets.
On Tuesday, Cabinet Minister Kiritapu Allan revealed her shock diagnosis of stage 3 cervical cancer. “To be honest, I’m one of those gals that hates anything to do with ‘down there’. And have taken a ‘see no evil, hear no evil’ type approach to that part of my body,” she wrote, in a heartfelt statement.
Allan noticed pain in her back, stomach and legs late last year and then began bleeding constantly in January. Within two months a smear returned an abnormal result, a full colposcopy was done, and she was diagnosed with cancer. “In hindsight, there were lots of opportunities to go touch base with a doctor. But I didn’t. I put it down to work, and was on the go, and ‘that stuff usually sorts itself out’,” Allan wrote.
Since then, advocates like Victoria University’s Bev Lawton have called for the Government to prioritise a new HPV screening programme, which was due to begin in 2018.
In June 2018, its delay was announced by the ministry’s National Screening Unit director Dr Jane O’Hallahan, who said a “fit-for-purpose IT solution,” was needed.
But sources spoken to by Stuff say attempts to get the programme funded in 2018, 2019 and again in 2020 were rejected, with those close to the process told it was because there was no money left after $197m went into bowel cancer screening.
In early 2018, the ministry told then Associate Minister Julie Anne Genter the new register would take 18 months to develop and implement once it had been funded. It was projected it could be finished by 2021.
It has still not been funded. Sources say projected costs sat between $60-$160m.
The ministry did not answer questions about cost or the bidding process, saying it remained committed to introducing HPV primary screening and self-testing. “International evidence convincingly shows it is the most effective test. Government funding will be required.”
Associate Health Minister Ayesha Verrall said she was not in previous cabinets so could not speculate on why it had not been funded.
Cabinet minister Kiri Allan’s shock cancer diagnosis has highlighted the need for Māori women to get a cervical smear – that could save their life, and reverse the terrible statistics.
The longer we wait, the worse it gets
The HPV viral DNA test would need to be done once every five years, instead of three, and could be done either by smear or self-sample of the vaginal wall using a swab.
Ministry documents make it clear that the longer the new HPV screening programme is delayed, the less effective the current smear test is at detecting cancer.
This is because as more young people since 2008 have been vaccinated against HPV – the virus that causes cancer – the fewer samples are seen by the laboratory, and higher the chance the abnormal cells are not picked up.
Massey University molecular microbiologist Collette Bromhead said data already showed a decline in efficacy and if the switch to the better HPV test was not made soon, the accuracy of the current test would fall below 50 per cent. “It declines enough to make the test worse than flipping a coin.”
The HPV viral DNA test is currently used as a secondary test when a smear is inconclusive.
The cervical cancer death rate for Māori women is more than twice that of Pākeha. Ethnic minorities, poor, disabled, obese and trans and gender diverse people are under-screened.
The Ministry of Health’s modelling has found that making the test easier, free, and more accessible would save more lives. While the current testing programme has reduced cervical cancer in New Zealand by 60 per cent, this has plateaued since 2005.
”The evidence is absolutely irrevocable that this [HPV screening] is a life-saving, cost-saving programme,” Bromhead said. “We have the people to do it, we have the ability, and we have the need.”
Falling further behind
A parliamentary review of the current programme in late 2018 led by Australian public health expert Gail Ward said changes to a modern system were critical, or more women would needlessly suffer.
“Primary HPV screening, including self-sampling, should be funded and implemented as a matter of urgency. Delays in implementing the primary HPV screening programme will result in a significant number of otherwise preventable cervical cancers in New Zealand women and continuing inequities.”
Australia has been screening with the HPV test since 2017.
Among the review’s recommendations were that a national cervical screening register be developed at the same time as a $15m bowel screening register, instead of waiting until afterwards. The bowel screening register is now complete.
Because of the protections established after the Cartwright Enquiry, a law change is necessary to allow doctors to access centralised information on a new register.
The National Cervical Screening Amendment Bill is currently still in its second reading.