Breast cancer survival laid bare in new report

Breast cancer remains deadlier for Māori, Pasifika, and younger women despite significant improvements in overall survival rates, according to a new report published on World Cancer Day (4 February) by Breast Cancer Foundation NZ.

In its first ever report analysing data from Te Rēhita Mate Ūtaetae - Breast Cancer Foundation National Register, the charity has revealed that, beneath the impressive overall improvements in survival, there are many women who haven’t benefited to anywhere near the same extent. Te Rēhita provides the most comprehensive and up-to-date picture of breast cancer in the country, holding information about more than 40,000 patients since 2000. The report covers 30,000 patients diagnosed from 2003 to 2019.

Some of the key findings highlighted in the report, titled 30,000 voices: Informing a better future for breast cancer in New Zealand, include:

• The five-year risk of dying of breast cancer has halved since 2003, but 10-year rates expose the drastic differences that exist for the most vulnerable groups and those with high-risk cancers;
• Wāhine Māori were 33% more likely to die of breast cancer within 10 years than Pākehā and more likely to have higher-risk HER2+ breast cancer;
• Pacific women were 52% more likely to die of breast cancer within 10 years than Pākehā. They had the highest rate of stage 3 and 4 breast cancers and of HER2+ cancers, and more grade 3 tumours than all other ethnicities;
• Younger women (under 45) had much lower 10-year survival than the 45-69 age group: 82% compared to 89%;
• For women with grade 3 or stage 3 breast cancer, and those with triple negative breast cancer, the survival difference widened sharply by 10 years;
• Of all breast cancers diagnosed in 2020, 7% fewer were found by mammogram than in 2019 (likely as a result of paused and reduced screening during the Covid-19 lockdown), meaning they were diagnosed later than they should have been.

The report also identifies areas where treatment practices are falling short:

• Delays to surgery worsened: over 60% of women didn’t getting their first surgery within 31 days of diagnosis;
• Too many women had a mastectomy when breast conserving surgery with radiation treatment has better survival: a third of women who had a mastectomy probably didn’t need this more invasive option.

The report’s findings have prompted the charity to call for more prioritisation of at-risk groups by the health system, a switch in focus to a 10-year outlook in order to close the survival gap, hospitals to set surgical targets, and investment from Government to tackle surgery delays.

Ah-Leen Rayner, chief executive of Breast Cancer Foundation NZ, says: “The improvements in survival are a tribute to our dedicated cancer specialists and the BreastScreen Aotearoa screening programme. But we need to stop talking about five-year survival. That’s no longer an acceptable measure of success.

“We’re still losing more than 650 women to breast cancer every year, and our comprehensive review of the Register data shows our Māori, Pasifika and younger women, and those with larger or more aggressive cancers, are being left behind. On top this, Covid-19’s devastating impact on breast screening is putting even more women at risk. We can’t allow the pandemic keep pushing other health issues to the side-lines, as our most vulnerable women will be the ones to suffer.”

Dr Reena Ramsaroop, chair of Breast Cancer Foundation NZ’s medical advisory committee, says: “Our vision is to have zero deaths from breast cancer. This report shows New Zealand’s five-year survival rate is comparable with other countries, but it doesn’t tell us the full story. To fulfil our vision, it’s now time to focus on 10-year survival. This will show us where we have to prioritise earlier diagnosis, timelier treatment and rigorous follow-up in order to protect those most at risk of dying from breast cancer.”

Dr Eletha Taylor, member of Breast Cancer Foundation NZ’s medical advisory committee, says: “It is worrying that te Rēhita is demonstrating delays to surgery are increasing, as this has been shown to have the potential to negatively affect survival. Delays to surgery can be due to a number of factors, but raise concerns around resource constraints, particularly in the workforce and access to operating theatre time. This is likely to be exacerbated further by the impact of Covid-19. These results suggest a need to invest in our health system and its' people with some urgency.”

Dr Paul Samson, member of Breast Cancer Foundation NZ’s medical advisory committee, says: “Deciding on a type of surgery can understandably be difficult for patients, who may have concerns around survival outcomes, greater recurrence rates, the need for radiotherapy and further surgery. The up-to-date information in te Rēhita allows us to reassure patients that breast-conserving surgery is standard of care in up to 80% of cases and results are as good as, and often better than, mastectomy.”

Te Rēhita Mate Ūtaetae - Breast Cancer Foundation National Register has been collecting breast cancer case data since 2000 for use in research and audit to help improve diagnosis and treatment. It began as four regional registers funded by Breast Cancer Foundation NZ, and by 2021 it had been consolidated and expanded into one national register covering all 20 District Health Boards.

Te Rēhita is used by clinicians, researchers, service managers, health planners, funders and policy-makers to generate evidence-based information to drive changes and improvements in breast cancer outcomes.

Click here to download a copy of 30,000 voices: Informing a better future for breast cancer in New Zealand.