"Racism and bias exist across the programme," the report said. Photo: 123rf.com
About 50,000 women have missed out on breast cancer screening in the past two years because of Covid-19 disruptions that could create more problems for years.
The figure is part of a damning report into breast screening that calls the system racist, and says improvements recommended 12 years ago have not happened.
The independent Quality Improvement Review for Breastscreen Aotearoa was prompted by delays in the Wellington region that a separate review found could have harmed some women, meaning their cancers may have been in a more advanced stage when they were discovered.
The new, national review found the Covid-19 backlog could create a long tail of problems, because all the extra women screened in the catch-up phase would come up for routine screening again every two years until they reached the maximum age.
Modelling was needed to look at whether the delays could have an impact on cancer death rates because the whole purpose of screening was to lower them, it said.
The biggest fall in screening rates during the pandemic were for Pasifika women. In general, Māori and Pasifika women had much higher death rates from the disease and were screened less than other groups.
"Racism and bias exist across the programme," the report said.
Breast cancer was the biggest cancer killer for Māori, behind lung cancer.
Timely screening had a big impact on survival rates, but Māori women lacked a voice at the table when it came to shaping how best to reach people, the report said.
"If there is too long an interval between screens, new cancers have a longer time to develop beyond the early stages and screening is less effective at preventing illness and death."
Te Whatu Ora has announced a new $55 million national screening register in response to one of the 26 recommendations made in the review.
And, along with the Māori Health Authority / Te Aka Whai Ora, it will implement a breast screening action plan overseen by Nina Scott from the National Māori Cancer Leadership group.
Scott said "mana-enhancing" screening experiences were critical for all women.
"Our action plan will focus on co-designing services for wāhine Māori and Pacific women, including developing tailored programmes to increase access to all screening programmes.
"We'll also be looking at improving access to cancer screening for those who are finding it difficult to get into these services, such as disabled women and those living in rural and remote communities."
The review said many of the problems identified existed in the last review in 2011 and meaningful change was needed.