Cervical cancer screening programme a failure: audit

11.00am

A national women's screening programme for cervical cancer is failing to reach women, particularly Maori women, an audit has revealed.

The Cervical Cancer Audit released by the Ministry of Health today said the programme was not reaching women and making sure they were adequately screened.

It said Maori women were screened for cervical cancer less often than non-Maori women and when abnormalities were found, they waited longer for investigations such as biopsies.

The ministry said the national screening programme was "failing to effectively engage Maori women in screening."

Maori women were twice as likely to develop cervical cancer and four times as likely to die from it than non-Maori women, said auditor and Maori public health physician, Dr Sue Crengle.

The independent audit team reviewed the screening histories of 371 women diagnosed with cervical cancer between January 2000 and September 2002, including 75 Maori women.

In a statement today the audit team said women with invasive cervical cancer were being denied the opportunity to have cervical abnormalities diagnosed before they became cancerous.

Dr Crengle said only 50 per cent of Maori woman had a smear test in the past three years.

"Ideally this figure would be closer to 80 per cent," she said.

The audit also said ethnic data held on the National Cancer Registry was inaccurate.

It 20 per cent of the Maori women on that database were not identified as Maori. That meant the number of Maori women with cervical cancer was underestimated which prevented accurate planning and monitoring of screening services for Maori.

The audit team recommended the formation of a population based database and a "nationally consistent pro-active recall system" which would improve screening for all groups of women.

It also said there should be more innovation to increase screening of Maori women.

The National Cancer Screening Programme should also investigate why more Maori women developed and died from cervical cancer than non-Maori women.

It said a significant effort was needed to increase the number of women having cervical cancer smears every three years.

It said only 20 per cent of women with cervical cancer had been regularly screened and only half had had smears in the three years before their diagnoses.

Cervical cancer accounts for three per cent of all cancer registrations in New Zealand women. In 2000 the death rate for Maori women was 8.1 for every 100,000 but for non-Maori women the death rate was 1.9 for every 100,000.

The audit team said without regular cervical smears, one woman in 40 would develop cervical cancer and one woman in 85 would die. With regular screening one women in 250 would develop cancer and one woman in 770 would die.

The audit followed a ministerial inquiry after a high level of under-reporting of positive smears at a Gisborne laboratory.

That inquiry said there were systematic problems in the design, configuration and operation of the National Cancer Screening Programme between 1990 and 1996. It recommended the audit to find out what further systematic problems existed in the programme.

- NZPA

Full report [PDF 211p 735kb]