Tongan-led solutions needed to overcome barriers to bowel cancer screening

Bowel screening is available to Māori and Pacific people from the age of 50 to 74. Photo / Waitemata District Health Board.

The National Bowel Screening Programme is failing to deliver screening equitably to Pacific New Zealanders, but there are ways to improve it, research led by the University of Otago, Wellington has found.

The researchers held two talanoa focus groups in 2021, asking Tongan-born New Zealanders over 60 how the programme could be made more effective and equitable. They also talked to four Pacific experts working for the screening programme.

Bowel screening is available to Māori and Pacific people from the age of 50 to 74. A higher proportion of bowel cancer occurs in Māori and Pacific people before they reach 60 (approximately 21% compared to 10% for non-Māori non-Pacific peoples).

The researchers are some of the first to ask Tongan New Zealanders about their experiences with the bowel screening programme. The results of their study are published in the New Zealand Medical Journal.

Lead researcher Dr Viliami Puloka.

Lead researcher Dr Viliami Puloka, from the university’s department of public health, says the participants overwhelmingly supported a “by Tongan, for Tongan” approach to screening.

“Many Tongans die unnecessarily from bowel cancer because the programme, while available, isn’t accessible to them. Taking a Tongan approach was recommended by all the participants and experts involved in the study.”

Puloka says only 35 per cent of Tongan people are screened, compared with 58 per cent of New Zealanders overall. Pacific peoples are 60 per cent more likely to die from bowel cancer compared to New Zealanders of European heritage.

The study found Tongans were very motivated when it came to looking after their health, but that the programme was not meeting their needs, he says.

“It was important for us to understand what the roadblocks are and how to empower people. Tongans stressed the collective nature of their society and the need to deliver the programme to the community, something that would only really be effective from a Tongan provider.

“The programme can be delivered equitably if there is the will to do so. What is required is courage and the political will to shift the power and resources necessary to ensure equitable outcomes.”

He says the recently announced lowering of the age at which bowel screening starts, to 50-years-old for Pacific peoples, is an essential step in increasing the accessibility of the programme.

But he says it does not take away the need to reimagine the programme from a Tongan and a Pacific perspective.

While the study focused on the Tongan community, Puloka says the findings may also provide valuable insights into the needs of other Pacific peoples.

The research was independently funded by the Cancer Society of New Zealand.