Andrew Dickens: Is there a magic age before we start worrying about peoples health?

I want to start with the story of Jacquie Kidd. Jacquie's a former nurse who's spent more than 20 years researching Māori health inequities. She is the AUT professor of Māori health and she is now facing her own terminal cancer diagnosis. She's got a touch of the bowel cancer, which has now spread to her lungs. She is 62 years of age. 

Since she's found out about this cancer, she's penned a memoir called ‘Ngākaurua: My experience of cancer, identity and racism in Aotearoa’. Because of her work, obviously she's concentrated in her memoir and in her thoughts on how hard it is for Māori to get screened, how important it is for Māori to get screened for cancer. She's written that the system is too complex and that Māori also loathe to investigate symptoms because they don't want to be a burden to their whānau. 

While all of her work means that she is concentrating on the issues for Māori, there is one particular sentence in her story that rang true for me, for all New Zealanders. She said there is a magical age of 60 when free screening begins in New Zealand. Jacquie first thought that something was wrong with her when she was 58 years of age, so she went along to her doctor and said, look, I'm not right, can I get some of this free screening? And he said, there's no way you'll get it. And he just said no. He only relented when she said, look, I've got health insurance that will pay for it. And he went, oh okay, off you go, you know, go and find out about it. Guess what? She found out about it. She had it. Now, this is a question we've dealt with before. We've seen the free bowel screening eligibility test age lowered from 60 to 58 now. However, that came too late for Jacquie to get a free screening test, so she had to pay for it herself. 

The question is, do we have some magical age, some limit of 60 before we start caring about people's health? What is the situation in New Zealand? Well, New Zealand has three national screening programmes with defined free screening age ranges. So the first is cervical cancer. We have free screening available for Māori aged between 25 and 69 and for everybody else from 30. From 30 you can get screened for cervical cancer. Why there is a difference, I don't know, but we'll talk about that later. 

Breast cancer, there are free mammograms every two years for people with breasts who want to get it checked. And I can say with breasts because you can get breast cancer if you're a man as well, but how many men go for a breast cancer screening service? But you get a free mammogram every two years if you've got breasts, if you're aged between 45 to 69. And of course, bowel cancer, which I've already mentioned, free home test kit every two years for men and women from 58 to 74 – why you can stop at 74 I don't know. Of course that change to 58 might have helped Jacquie if it came in earlier. 

The thing about that, that's what we're doing now. How does that compare with overseas? In Europe and Australia, free screening for cervical cancer starts for everyone from the age of 25. For breast cancer screening, that starts at the age of 40 in the States and in Australia, compared to 45 here. And for bowel and colorectal cancer, Australia starts free screening at 50 while we start at 58. 

And looking at all the figures that I managed to pull out, on average, wealthy countries worldwide start free screening for cancer earlier than here in New Zealand. And not only that, they screen for more types of cancer too. So my question for you is how important is screening and why is our medical community not pushing for screening to come in sooner? Why did Jacquie go along to her doctor and say, I'd like to have the screening right now, and he says, well they won't give you a free one, and he tried to put her off? Why did that happen? She was 58 

Apparently, there's a magical age of 60 when people start to worry about you. Are they not pushing this purely because of cost? Most found their symptoms in their early 50s, but all were diagnosed purely because they had health insurance, which is all well and good if you can afford that. But on the question of the cost to the state of the screening programmes, you've got to remember that the later you're diagnosed, the more expensive your treatment becomes. So earlier diagnosis means a greater chance of success, obviously, but it also means for the state that more late-stage cancers do not become a burden. 

And the treatment for cancer is hideously expensive, isn't it? And everybody who's being treated takes up a hospital bed. Again, that's a burden to the state. Is it more expensive to start free screening later in age than it is to start it earlier in age? And how do you feel about this? Is it time to move the perception in this country of the magical age of 60 being when things might start falling apart to something younger? And could I even suggest 50? 

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