Cancer strikes by postcode

Tony Dalton fought an aggressive cancer for nearly two years before dying just three days before Christmas.

His father, Graham, scoured the world's best hospitals before spending a "significant six-figure sum" on cutting-edge stem-cell treatment available in Melbourne to try to save his son.

Before crossing the Tasman, Tony, 23, had already undergone public and private chemotherapy, radiotherapy and surgery in New Zealand to try to beat the germ cell cancer.

Mr Dalton understands that a small country such as New Zealand cannot be expected to offer every new cancer treatment, such as those Tony needed.

But, he says, "if you can't have the treatment here, there should be a tax writeoff or a grant. Most people could not afford to do what I did and I don't think that's right".

Kay Wilson worked as a sawmiller in Greymouth on the West Coast before being diagnosed with breast cancer a little over a year ago.

The 43-year-old was lucky her former employer provided health insurance that offered private breast screenings.

"It was a bit of a fluke they picked it up because I wasn't sick," Ms Wilson says. "To be perfectly honest, I probably would've been a bit slack otherwise."

After urgent surgery in a private Christchurch hospital the following week, the mother-of-three chose chemotherapy in Christchurch rather than on the Coast, despite a three-hour drive.

Peace of mind was the determining factor. "I had a choice and there's nothing wrong with the hospital here, they've been great.

"But Christchurch was doing chemotherapy all day, every day. Greymouth is only once a week."

After beating cancer, Ms Wilson is back on her feet and working in a pharmacy. "I've swapped my steel caps for high heels," she says.

Both Tony Dalton and Ms Wilson travelled long distances to get the cancer treatment they needed.

Early diagnosis and access to treatment are thought to be two factors in the varying cancer rates and deaths in different parts of the country.

The geography of the disease was revealed by Ministry of Health research, which has mapped these differences in the Atlas of Cancer Mortality in New Zealand 1994-2000. The report shows regions with high or low mortality for 26 types of cancer, the second-biggest killer of New Zealanders, behind cardiovascular disease.

The atlas divides the country into 21 district health boards and reveals striking differences between districts.

People living in Wellington, Otago, Canterbury and Waitemata, for instance, have significantly lower death rates for several cancer types.

With the exception of Counties-Manukau, the larger centres seem to do better, raising the possibility the differences may relate at least in part to how easy it is to get treatment.

Ethnic disparities

The report also reveals serious ethnic disparities - Maori are about three times as likely to die of lung, stomach and liver cancers as non-Maori but are less likely to die from colorectal cancer.

Over the seven years covered by the report, more than 53,000 New Zealanders died of cancer - with lung, colorectal, breast and prostate cancer and non-Hodgkin's lymphoma the top five killers.

Among men, cancer of the trachea, bronchus and lung, bowel and prostate claimed the most lives.

For women, breast, trachea, bronchus and lung, and bowel cancer were the most common causes of cancer death.

The atlas was published partly to encourage further investigation into the causes of specific cancers in different regions and to try to explain the differences.

The report does not pinpoint what causes the variations, but poverty, treatment quality and availability, access to doctors and ethnic makeup have all been raised as possible factors.

Associate Professor Brian Cox heads the epidemiology unit at Otago University and also heads the Cancer Control Trust.

He says cancer mortality rates vary in parts of the country because of fluctuating population sizes, but various forms of the disease are more common in some areas.

"Melanoma is far more common in the North Island because the population is closer to the harmful ultraviolet light of the equator.

"Likewise, primary liver cancer is more prevalent in the North Island because of greater numbers of hepatitis B carriers."

The number of melanoma deaths in the Bay of Plenty, Hawke's Bay, the Coromandel and Waikato is significantly higher than the national average, according the map.

And bowel, colon and kidney cancers are rife in the farming heartland of Southland, the West Coast and South Canterbury.

Dr George Ngai is a bowel cancer surgeon with nearly 30 years' experience working in Southland hospitals.

The region has the highest bowel cancer rate in New Zealand, particularly involving the lower bowel, which is harder to operate on.

Dr Ngai's research shows that the ethnic make-up of the population affects the incidence of cancer.

"There are few Maori in Southland, who are proven to have lower rates of bowel cancer. Most Southlanders have Celtic origins, a caucasian genetic makeup," he says.

That doesn't mean all fair-skinned Southlanders should blame their ancestry.

Research suggests a diet rich in red meat increases the odds of bowel cancer. New Zealand, Australia, Scotland, Argentina and the United States have the highest bowel cancer rates in the world.

"They have one thing in common: They are big producers of meat, especially beef and sheep," Dr Ngai says.

"There are many different arguments. But the general consensus is to eat more fruit and green vegetables and less red meat."

Spikes

Breast cancer, the biggest killer of women, occurs relatively evenly across the country, with just a few spikes in Auckland and Counties-Manukau.

Dr Cox says breast cancer is linked to child rearing and breast feeding but it will soon be overtaken as the worst killer of women by the fallout from a generation of smokers.

"The explosion of women smokers 20 years ago means lung cancer will become more common than breast cancer in the next 15 years. It's absolutely predictable."

Tairawhiti residents on the East Cape are stricken with 11 of the 26 cancers the researchers studied.

More are dying of cervical, head and neck, liver, lung, pancreatic, prostate and uterine cancer, leukaemia and non-Hodgkin's lymphoma, than the national average.

Dr Bruce Duncan from Tairawhiti District Health says the numbers of people diagnosed with cancer are no higher than elsewhere, but more people die.

Early detection can help catch tumours but many on the East Coast are diagnosed too late because they cannot afford to visit the doctor.

"Socio-economic status is a factor and people are deprived of access here," Dr Duncan says. "But it's a different lifestyle too. There's a lot of smoking, which has an impact on cancer."

Although the total number of deaths is rising, the survival rate is climbing too, not least because of improved treatments and early detection.

Several years ago, women with breast cancer were flocking to Australia for radiotherapy treatment because New Zealand clinics were booked up.

Karen Lloyd, of the New Zealand Breast Cancer Foundation, says radiotherapy treatment for patients is improving.

"We don't hear of that any more but a few years ago it was horrendous for women to fly to Australia at a very vulnerable time of their lives."

Although women no longer need to cross the Tasman for lifesaving help, many drive long distances across country for radiotherapy.

"Is it fair that people in rural areas like Hawke's Bay or Taranaki have to drive three or four hours to Palmerston North for radiotherapy when they're already stressed?"

The good news is that in 1972, 261 out of every 100,000 cancer cases were fatal but this number is expected to drop to 180 in 2012, when cancer is predicted to claim about 9000 lives.

Cancer Society policy adviser Betsy Marshall says New Zealand's growing population is ageing, which is partially to blame for rising cancer deaths.

"Cancer numbers will continue to increase for the next 15 years as our population gets older.

"But it's not the whole story," she says.

Some forms of cancer, such as stomach cancer, are becoming rarer, while others are becoming increasingly common.

"We're not exactly sure why that's happening," Ms Marshall says.

She recommends quitting smoking, staying out of the sun, eating healthy foods and exercising regularly to help prevent cancer.

Regular cervical smears also save lives, she says. "But life isn't that simple, is it?"

- HERALD ON SUNDAY