About 300 women with breast cancer have flown the Tasman for radiotherapy because our health system cannot cope, a problem blamed largely on staff shortages. The move has cost New Zealand taxpayers more than $2.4 million to date.
The Auckland District Health Board, the only one to send patients to Australia for radiotherapy this year, has sent about 20 women a month since January.
When our ability to nurture our nurturers fails, something is seriously wrong at the heart of our health system. The plethora of statistics includes:
2001, 615 women died of breast cancer and in 2002, 2345 cases were diagnosed.
Numbers are predicted to rise 10% by 2011.
What is going wrong?
Cancer Society medical director Dr Peter Dady says cancer simply is not given the focus it needs at a government level.
"Cancer is our major health problem - it's the commonest cause of death. It just hasn't been on their radar - it still isn't.
"I don't think hospital management have also seized the fact of how important cancer is."
In 1990, cancer experts started developing a cancer control plan, but the government shelved it in the mid-1990s. New Zealand lost traction while other comparable countries advanced their cancer plans. "We are way behind countries who have focused on it earlier," says Dady, a Wellington oncologist.
The plan was resurrected in 1999, funded by the Cancer Society and the Child Cancer Foundation. In August last year, Health Minister Annette King finally launched the New Zealand Cancer Control Strategy.
It says New Zealand has traditionally provided a high standard of cancer care. However, funding and staff shortages have caused delays in some patients getting the best treatment, including forcing some to travel to Australia for radiation therapy.
The strategy highlights the fact that cancer care varies nationally, calling for a more consistent approach. It also states standards are needed to ensure people are assessed, diagnosed and treated in good time.
A taskforce was set up to develop an action plan for its 25 objectives, which aim to reduce cancer's incidence, impact and the inequalities related to it. The action plan is due out by January.
Dady, who was elected to the Capital Coast District Health Board last weekend, applauds the strategy and hopes it is urgently implemented.
"Things must happen and happen soon, otherwise it will wither and die."
He fears the stop-gap measure of sending patients to Australia has become accepted practice.
"They've been saying for two years that it's going to get better in six months, but it never does. It's become institutional that patients get sent to Australia and wait 12 weeks for treatment."
A lack of workforce planning has had a major impact, he says, something the cancer control strategy agrees with. It notes staff shortages across all areas of cancer treatment and wants the issue solved.
So far, radiotherapy training at Otago University has been boosted from 16 students in 1999, to 36 this year. The first batch of students from larger classes graduated last year.
Auckland Hospital is pinning its hopes on filling all eight radiotherapy vacancies with students by December, which may end the need to send patients to Australia.
Some hospitals have new equipment for radiotherapy, although staffing shortages are causing problems with their use in some areas, particularly Wellington.
In 1998, free biennial mammograms were introduced for women aged 50-64 to screen for breast cancer. In July, it was expanded to include women aged 45-69.
BreastScreen Aotearoa announced last week that more than 8000 extra women were screened in the first three months since the extension, an increase of 28% on the same period last year.
But the move came only after concerted public pressure on the government. Breast Cancer Action Trust, set up by Tauranga woman Debbie Short, handed a 124,000- signature petition to parliament last November, demanding mammography eligibility be widened to include those 40-plus.
Short, who was 44 when she discovered she had breast cancer in 2001, says women aged 40-45 should be screened.
"If I had had a $120 mammography at 40, they could have picked up my cancer early and nipped it in the bud. I would have had a lumpectomy and avoided much of the expensive treatment I've had since - so far, it's cost $60,000. They don't seem to consider that they can save women's lives and money."
Australia screens women for free from age 40.
However, BreastScreen Aotearoa says evidence is unclear about whether screening women under 50 is effective because breast tissue becomes thicker, and mammograms less accurate, missing about 25% of cancers.
Short believes funding for breast cancer is disproportionate compared to spending on other diseases or issues, including a $200m meningococcal vaccination strategy, when only 25 people die of it a year.
In February, the trust will start a pilot project in Tauranga, paying half the cost of mammography for women aged 40-45 years with a community services card.
Numerous women call Short to complain about the long waits for breast cancer treatment.
"Many women are paying for their own oncology treatment because of the long waiting times. Women are dying because they're not getting it early, but no one seems to care."