Feeds:
Posts
Comments

Archive for the ‘Maori mortality’ Category

WHITIREIA journalism student CARL SUURMOND went to the Chatham Islands with the Prostate Cancer Foundation last weekend. Here’s his first report (see below for his SLIDE SHOW):

Chathams 8

FLYING PROSTATE TEAM: from left, Carl Suurmond, Dene Ainsworth, Daniel Marshall, David Mason, Ash Zoias, Kelvin McDonald and Joe Tapara.

PROSTABLOG NZ: The men of the Chatham Islands are a tough  breed of fishermen and farmers whose work environments have shaped their hardwearing demeanour – but it’s the women of the island who are really tough.

Without the support and encouragement of wives, partners and mothers, many of the male inhabitants of the island may not have turned up at the presentations on prostate cancer held over the weekend.

Chathams 10

Prostate Cancer Foundation board member Dene Ainsworth (left) and Joe Tapara.

That’s the view of Joe Tapara (Ngāti Ruanui),  cultural adviser for the Hao Te Ora o Wharekauri Trust and member of the Chatham Islands Māori Community Health.

“The wives and the partners were the reason why so many men turned up,” he said. “Without them nagging, I’m not sure how many would have bothered.”

Chathams 15

Dene (right) in the jump seat behind the pilots.

The weekend presentations aimed to raise awareness of prostate cancer and promote early detection, with a focus on reducing fatalities amongst Māori men.

Maori are less likely to be diagnosed early and suffer a death rate after diagnosis that is twice that of non-Māori.

The trip was funded and organised by the NZ Prostate Cancer Foundation, in conjunction with Māori Community Health and Chatham Island Health Care.

Chathams 13

David Mason (right) and Daniel Marshall get checked out on a boat at Port Hutt.

Chathams 19

ISLAND FOOD: The team is spoiled at Kaingaroa.

The team included the expertise of urologist Dave Mason and trainee urologist registrar Daniel Marshall, both from Hastings.

Otaki’s Dene Ainsworth (Te Āti Awa Iwi), a board member on the foundation, and prostate cancer survivor, shared his own experience during four well-attended presentations to several communities around the island, which is 800km off the coast of Christchurch.

Chathams 11

Dene speaks to one of the Chathams gatherings.

In total, 40 men out of 135 over the age of 40 – and a few women – turned out, and in small communities like Kaingaroa Harbour, Owenga and Port Hutt just about all the male population was there to have their questions and concerns answered.

The tour round the main of the Chathams group was organised by Mr Tapara, with plenty of help from other locals.

Mr Ainsworth said the weekend was a great success and the desired outcome had been achieved.

“It was a bloody awesome weekend.  I think we achieved more than we could have ever hoped for.  The reaction from the islanders was first class and they’re really keen to get us to go back and do this on a regular basis.”

Chathams 17

Mr Mason and his colleague were there to address medical concerns and provide advice.

“I think the turnout has been amazing,” said Dave Mason.  “Each place that we’ve been to, the guys have come out and talked about things in different ways and brought up different concerns.

“There was a good bit of interest and a good spread of age groups.”

Mr Marshall said the men were not shy about asking questions.

“From talking to them afterwards it seems they’ve got a lot out of it.  They certainly haven’t been shy in asking questions and finding out what they want to know, which is what it’s all about.

“Seeing the island, seeing the style of life here, the way everyone gets on so well in the community here – it’s been brilliant.”

ChathamsPano1

The waterfont at Waitangi, the main settlement.

The weekend came about through a serendipitous meeting between Dene Ainsworth and Joe Tapara at the first-ever Māori men’s health conference, Tane Ora, held in Blenheim earlier this year.

Chathams 9

MAORI TV: Kelvin McMcdonald (left) & Ash Zoias.

Dene spoke about prostate cancer in a presentation at the conference and was heard by Joe Tapara.

The two talked about men’s health and prostate cancer and Joe told Dene that his presentation was needed on the Chatham Islands.

“I agreed that Chatham Islands men should have the same access and opportunity to these sorts of presentations as ‘mainland’ New Zealanders,” said Dene.

The trip, which was funded by the Prostate Cancer Foundation, was filmed by a crew from Maori Television, which will show it on its top current affairs programme, Native Affairs.

VIEW THE CHATHAM ISLANDS TRIP SLIDESHOW HERE

Read Full Post »

PROSTABLOG NZ:  A chance meeting between two Maori men may affect the future well-being of 135 males living on the Chatham Islands.

DENE AINSWORTH  (Dominion-Post picture)

DENE AINSWORTH DomPost pic

The meeting has led to a NZ Prostate Cancer Foundation-funded initiative, which will soon see the island’s over-40 male population offered health checks and prostate cancer screening tests.

More than half the island males have Maori and Moriori ancestry, and while they have no proven genetic pre-disposition, statistics show they are less likely to be diagnosed early, and suffer a death rate after diagnosis that is twice that for non-Maori.

Earlier this year, the Foundation helped Kapiti Coast man Dene Ainsworth get to Blenheim to attend Tane Ora, the first-ever Maori men’s health conference, so he could make a presentation.

One person who heard him was Joe Tapara, a representative of the Chatham Islands Māori Community Health.

Later, the pair talked about men’s health in general, and prostate cancer in particular, and Joe reckoned a talk along the lines of Dene’s presentation was needed on the Chathams.

“I agreed that Chatham Islands men should have same access and opportunity to these sorts of presentations as ‘mainland’ New Zealanders,” says Dene (Te Ati Awa), who is a prostate cancer survivor and now a member of the PCF Board.

He put the idea of a Chathams visit to the PCF in August and it was approved for the last weekend in September.

Dene will be accompanied by Napier urologist Dave Mason, who is donating his time and insists on paying his own travel costs, and who will offer free health checks to those men who want them.

The two will work with island health workers, and will be guided by their advice about the island’s needs.

chathamsMAP

According to the last census (2006), the 10-island Chatham Islands group (800 kilometres east of New Zealand) has a population of 609, whose ethnic origins are European (66%), Maori (57%) and Moriori (the first settlers).

Some 22% of the population (135) are men 40-plus, the milestone age when prostate cancer risks begin to rise.

The main island, Chatham, has a hospital and resident doctor, but no ready access to a specialist like Dave.

The islands are connected to NZ by regular air service, but fares cost many hundreds of dollars.

Julian-Wilcox

Julian Wilcox

Along to cover the trip will be Maori Television presenter Julian Wilcox, who will report it for the channel’s flagship current affairs programme, Native Affairs.

Also covering the three days – checkups by Dave and four presentations by Dene – will be Whitireia Journalism School student Carl Suurmond (Tainui), who will shoot video and still photos, and write articles.

Dene is Business Manager for a research and policy company, Mauriora-ki-te-Ao/Living Universe Ltd, which offers products and services that concern the development and communication of ideas, particularly as they relate to the creative potential of Māori knowledge, people and resources.

Owae Marae

Owae Marae

Dene: “Nō Waitara ahau, engari inaianei e noho ana ahau ki Ōtaki. Ānei toku pepeha: Ko tokomaru te waka, ko Taranaki te Maunga, ko Waitara te Awa, ko Te Āti Awa te iwi, ko Ngāti Rahiri te hapu, ko Owae te marae.

“I come from Waitara and am currently living in Otaki. I whakapapa to Te Āti Awa iwi and the hapu of Ngāti Rahiri and my turangawaewae (home place to stand) is Owae marae in Waitara.

Read Full Post »

mohPROSTABLOG NZ: Maori and Pacific people living in NZ suffer big disparities in the way cancer is detected and treated, and how well they survive it. READ MORE>

This has been known for some time, but the problem is newly highlighted in the Ministry of Health-funded cancer guidelines for GPs that have just been released.

For example, it reminds us that as many as 17% of Maori cancer cases and 6% of deaths are never reported.

It also points out that health statistics tend to be five years old before they are published, which suggests that in the rapidly changing detection/treatment environment for prostate cancer, decision-making on how best to screen and treat is seriously hampered by lack of knowledge.

While the overall, 174-page report, avoids discussion of population-based screening, it does touch on the issue in the ethnicity section:

Cormack et al. noted that national screening programme data have identified that equitable screening for breast and cervical cancer has not been achieved for Mäori women.

However, BreastScreen South Limited’s results (70% of eligible Mäori women screened in 2005) suggest that the inclusion of focused efforts and leadership are the key to achieving equity in screening.

The report analyses available data on ethnic disparities in cancer detection and treatment, and makes a number of suggestions, including more “cultural competence” training for health workers.

For the full report, CLICK HERE>

Read Full Post »

mohPROSTABLOG NZ: New guidelines for general practitioners on how to handle men presenting with possible symptoms of prostate cancer (and other cancers) were released today by the NZ Ministry of Health.  READ MORE> and HERE (summary)>

The advice is contained in a 174-page report from the Ministry-backed NZ Guidelines Group called Suspected Cancer in Primary Care – Guidelines for investigation, referral and reducing ethnic disparities, which sets out background data and guiding principles on a range of cancers.

The report avoids getting into population-based screening – a major issue in detecting prostate cancer – saying:

Cancer screening, health promotion and prevention, case-finding in asymptomatic people, recurrence of a previous cancer and metastatic cancer were beyond the guideline scope and therefore are not included.

However, it does relent a little in the section on ethnicity and cancer treatment disparity:

Addressing the issue of cancer screening is outside the broad scope of this guideline. However, because of the impact that screening uptake can potentially have on disease outcomes, it is briefly included as part of this disparity chapter.

In the section on prostate cancer, it outlines the following advice for GPs seeing patients:

  1. A man presenting with macroscopic haematuria (blood in urine) should be referred urgently to a specialist;
  2. A man found to have an enlarged, smooth prostate on digital rectal examination and a normal PSA should only be referred to a specialist if they have macroscopic haematuria;
  3. An older man presenting with lower urinary tract symptoms (frequency, hesitancy, nocturia) should be recommended to have a digital rectal examination and a PSA test.

Men with erectile dysfunction are excluded from the referral guidelines.

The report also contains the latest data on cancer trends and explores in some depth the detection, care and mortality disparities between Maori, Pacific people and European Kiwis.

On the page listing organisations that endorse the report (so presumably have seen it already), the Cancer Society of NZ (which opposes population-based prostate cancer screening) is included – but not the Prostate Cancer Foundation of NZ (which supports it).

The report comes just a week before the Government’s Parliamentary inquiry into prostate cancer detection and treatment, which will hear its first submissions on Wednesday.

Read Full Post »

PROSTABLOG NZ: A new $20 million “Maori health innovations fund” has been announced by the Associate Minister of Health, Tariana Turia – but it makes no mention of one of the biggest killers of Maori men, prostate cancer.

The press release says:

The Fund is a significant step toward realising the aspirations of He Korowai Oranga (the Māori Health Strategy) and advancing whānau ora by supporting Māori service providers to develop and implement initiatives that effectively meet the health needs of whānau, hapū, iwi and their wider communities.

Over the next four years the Fund will invest a total of $20 million in the design, development, promotion and delivery of innovative whānau ora driven health services.

Check this site now for more information about the Māori Health Innovation Fund.

Download the Guide to Te Ao Auahatanga Hauora Māori from this site to find out more about application criteria and how your organisation might apply.

Read Full Post »

JUNE 4: PROSTABLOG NZ: Any hopes the NZ Prostate Cancer Foundation and some top urologists may have that the government will change its mind  any time soon about promoting prostate cancer screening among men are not helped by a new NZ Medical Journal article. READ ARTICLE HERE>

There has been world-wide  renewal of the debate about population-based screening campaigns since publication in the New England Journal of Medicine in March of the results of a couple of long-term studies into whether PSA testing saves more lives.

The authors of the NZ article think the results support a long-held fear that PSA testing leads to “over diagnosis” and unnecessary treatment of slow-growing prostate tumours that were never going to do any harm.

The Otago University researcher and epidemiologist say:

“The results of the randomised controlled trials might optimistically be considered to indicate that: eventually there will be a reduction in prostate cancer mortality from PSA testing of asymptomatic men 55–69 years of age; the considerable harms from such testing are bearable by patients and the health care sector, and; PSA testing of asymptomatic men should be facilitated.

“Another view would be that we now have inconclusive evidence from randomised controlled trials of any decrease in prostate cancer mortality and unequivocal evidence of major harms, mainly from over-diagnosis and consequent overtreatment, so much so, that good health care should involve advising asymptomatic men against PSA testing at this time.”

The article is timely, since the Ministry of Health is due to release an updating statement on its prostate screening policy.

Its stance has been that a campaign like those for cervical and breast cancer screening is not appropriate for prostate cancer, given widely held views that it may do more harm than good.

This is a view shared by the Cancer Society, but not the prostate cancer foundation, whose president, Barry Young, has called the stance scandalous.

His opinion appears to be backed by statistics showing the death rate among Maori men from prostate cancer is twice that for non-Maori. The cervical and breast cancer campaigns feature TV advertisements clearly aimed at Maori and Pacific Island women.

Recent US studies show poorly educated men in lower socio-economic groups fare worst from prostate cancer, as do black Americans.

The NZ Medical Journal article seems at odds with the American Urological Association’s recently updated guidelines, which urge men of 40 to be PSA-tested so a baseline for later comparison can be established (level change and speed of change are significant).

However, the AUA is equivocal about what the two studies reveal and stops well short of recommending population-based screening. It advises “well-informed” men to seek individual assessment by their physicians, a view held by the NZ Ministry of Health.

The ministry has been reviewing the studies. One of its committees discussed them on May 18 and has made a recommendation on screening to the Director General of Health, who is expected to make a statement as early as Monday.

This will undoubtedly assist the new Minister of Health, Tony Ryall, who contradicted himself when he announced new health targets in May. He made no mention of prostate cancer, despite his January statement that it would be a top priority for the new Government.

NZ Medical Journal, June 5, 2009:

PSA testing in asymptomatic men to diagnose prostate cancer remains experimental

By Brian Cox, Mary Jane Sneyd

The recent reductions in prostate cancer mortality seen in some countries have been attributed to earlier detection of the cancer by PSA testing.

However, the randomised controlled trials show that if any benefit from PSA testing exists it would not be seen within 7 years of its introduction.(1,2)Therefore, the mortality reductions observed are likely to be due to more cases being offered curative therapy or the availability of better treatment.

In 1996, PSA testing of asymptomatic men was considered experimental and the major potential for over-diagnosis and subsequent overtreatment with major sideeffects was highlighted3 and now the results of two studies have become available.

These results provide conflicting evidence of the effectiveness of PSA testing in reducing mortality from prostate cancer.

The results of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial in the United States were published because, at this time, the study’s monitoring board raised concerns about the harms they identified from PSA testing in asymptomatic men,(2) whereas the European Randomized Study of Screening for Prostate Cancer (ERSPC) study protocol precipitated publication when a statistically significant result was obtained from analyses conducted at regular intervals.(1)

A summary of the design of these two studies is shown in Table 1.

The ERSPC study was conducted in 7 countries, used various PSA cut-off points for recommendation for biopsy, varying screening intervals, and different age eligibility, with screening ceasing when the upper age of eligibility was reached.

In the PLCO trial, men aged 55–74 years were offered annual PSA testing for 6 years, combined with digital rectal examination for 4 years, or in the control arm received usual care.

Active annual follow-up by questionnaire and linkage to the National Death Index was undertaken with a median duration of follow-up of 11.5 years (range
7.2–14.8). The PSA assays for each PLCO trial centre were performed by one laboratory. A cut-off of 4ng/ml was used to recommend referral to their usual doctor.

Table 2 summarises the main results of these studies.

The results of the ERSPC study suggested a 20% reduction in prostate cancer mortality from PSA testing, along with other screening tests such as digital rectal examination (DRE) and transrectal ultrasonography (TRUS), in asymptomatic men after a median of 9 years of follow-up (RR=0.80, 95%CI 0.65–0.98).

Table 1. Summary of the design of the PLCO trial and the ERSPC study

Screening 1

The PLCO trial observed a non-significant 13% increase in prostate cancer mortality in those offered annual PSA tests (RR=1.13, 95%CI 0.75–1.70) after 7 years of follow-up for all subjects.

This was not significantly altered by inclusion of available data to 10 years of follow-up (67% of subjects) or if confined to those with one PSA test, or 2 or more tests, in the previous 3 years at baseline.

The chance of a diagnosis of prostate cancer increases with the number of biopsies taken.

In the ERSPC study the number of biopsies after a positive screening test varied between countries, but standardisation was recommended in 1996, whereas in the PLCO trial the decisions about biopsy and treatment were left to the man’s usual health care provider.

This meant that, in the PLCO trial, any further assessment procedures and treatment were expected to be similar for both the intervention and control group.(4)

Table 2. Summary of the PLCO trial and ERSPC study results of PSA screening for prostate cancer

Screening 2

In Finland, Sweden, and Italy, randomisation of the offer of screening occurred after selection from population registers – a study of the effect of the introduction of prostate screening in the general population (the effectiveness of screening).

In the Netherlands, Belgium, Switzerland, and Spain, randomisation occurred after acceptance of the invitation to participate—a study of screening in those who accept it (the efficacy of screening).

Efficacy is greater than effectiveness and effectiveness measures the overall benefit of offering PSA testing to asymptomatic men in the population.

Therefore, the ERSPC study estimate of benefit is greater than would be achieved from population-based PSA testing in asymptomatic men.

In the PLCO trial 40% of the control subjects had at least one PSA test by the second year of follow-up (contamination of the controls) and this increased to 52% by the sixth year of follow-up.

The contamination of the control group in the ERSPC study was not reported in the recent publication but varied from 6.7% to 36.6% among centres during 1996–2001.(5)

This resulted in a smaller relative increase in prostate cancer diagnoses between intervention and control groups in the PLCO trial (22%) compared to the ERSPC study (71%).

Detailed analyses of both the similarities and differences among the different trials included in the ERSPC study are likely in the future.

The beneficial effects from randomised controlled trials of screening almost always exceed what is obtained when the technology is introduced into routine health care, as the tight controls for the decision making process and management protocols of trials tend to be lost.

A greater length of follow-up of the trials will be required before more conclusive results are available. However, the contamination of the control groups in both studies may not have occurred equally among different risk groups for prostate cancer death, resulting in unresolvable bias.

What is now unequivocal from these two trials is the magnitude of over-diagnosis and subsequent overtreatment resulting from the PSA testing of asymptomatic men.

Overdiagnosis is the detection of prostate cancer that would not become clinical disease in a man’s natural life.

This is sometimes referred to as indolent prostate cancer and has been known for a long time to be very common.

This over-diagnosis has been estimated to be 48% (95%CI 44%–55%) for annual screening and 50% (46%–57%) for 4-yearly screening in men aged 55–67 years.(6)

The treatment of prostate cancer by either radical prostatectomy or radiotherapy carries significant risks such as chronic incontinence (urinary or faecal), impotence, or, in some instances, death.

In addition to significant side-effects, the treatment of many men who will not benefit produces increased waiting times and reduced accessibility to radiotherapy and surgery for other patients who may benefit from them.

For example, if we accept the ERSPC study results, 1480 men would need to be screened and 48 additional cases of prostate cancer treated for each death from prostate cancer prevented over a 10-year period.

Moreover, about 24 of the additional cases treated would receive treatment for a condition that would not have become clinical prostate cancer in their lifetime, and of these about 4 would have chronic incontinence or impotence.

The decision about the value of PSA testing in asymptomatic men is not solely determined by the magnitude of any reduction in prostate cancer mortality but by the balance of harms versus benefits.

Despite previous claims of effectiveness,(7,8) it now appears that if there is a reduction in prostate cancer mortality from PSA testing in asymptomatic men, it is likely to be small.

The current results of the trials assist in resolving the controversy regarding the value of PSA testing of asymptomatic men.

The results of the randomised controlled trials might optimistically be considered to indicate that: eventually there will be a reduction in prostate cancer mortality from PSA testing of asymptomatic men 55–69 years of age; the considerable harms from such testing are bearable by patients and the health care sector, and; PSA testing of asymptomatic men should be facilitated.

Another view would be that we now have inconclusive evidence from randomised controlled trials of any decrease in prostate cancer mortality and unequivocal evidence of major harms, mainly from over-diagnosis and consequent overtreatment, so much so, that good health care should involve advising asymptomatic men against PSA testing at this time.

It is easy to understand the belief that the early detection of cancer must result in a reduction in the mortality from the disease.

Historically, many clinicians and patients have been seduced by this idea many times for a variety of cancers.(9)

However, the current randomised controlled trial evidence suggests that claims of benefit from PSA testing in asymptomatic men have probably been overstated and that, as indicated by the authors of one of the trials,2 the recognised harms must be more rigorously considered to protect many men from iatrogenic illness.

Author information: Brian Cox, Associate Professor; Mary Jane Sneyd, Research Fellow; Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin.

Acknowledgement: Associate Professor Cox and Dr Sneyd were funded by the Director’s Cancer Research Trust.

Correspondence: Brian Cox, Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. Fax: +64 (0)3 4797164; email: brian.cox@otago.ac.nz

References:
1. Schroder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine. 2009;360(13):1320–8.
2. Andriole GL, Crawford ED, Grubb RL, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. New England Journal of Medicine. 2009;360(13):1310–9.
3. Cox B. Prostate cancer screening is experimental. The New Zealand Medical Journal. 1996;109(1017):63–4.
4. Barry MJ. Screening for prostate cancer – the controversy that refuses to die. New England Journal of Medicine. 2009;360(13):1351–4.
5. Ciatto S, Zappa M, Villers A, Paez A, Otto SJ, Auvinen A. Contamination by opportunistic screening in the European Randomized Study of Prostate Cancer Screening. BJU International. 2003;92 (Suppl. 2):97–100.
6. Schroder FH. Detection of prostate cancer: the impact of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The Canadian Journal of Urology. 2005;12 (Suppl. 1):2-6.
7. Lamb DS, Slaney D, Smart R, Nacey JN, Russell G, Scott B, et al. Prostate cancer: the new evidence base for diagnosis and treatment. Pathology. 2007;39(6):537–44.
8. Smart R. PSA testing and DRE, TRUS scanning with sector biopsy, improved histology, curative treatments, and active surveillance for prostate cancer: asuccess story for men’s health. New Zealand Medical Journal. 2008;121(1287):57–68.
9. Richardson AK. Prostate cancer screening: is it possible to explain diametrically opposed views? New Zealand Medical Journal. 2005;118(1209).

Read Full Post »

MAY 31: PROSTABLOG NZ:  Here’s a question that doesn’t seem to have been addressed for a while – how come fewer Maori than non-Maori are registered as prostate cancer sufferers, yet the death rate among Maori is twice that of non-Maori?

Maori deaths 2

MaoriDeaths 1

And why is nobody apparently concerned?

No media coverage has been accorded the problem in the last couple years, and the Ministry of Health’s Maori Health Directorate Newsletter did not mention prostate cancer in its three issues in 2008.

A search of research and academia would no doubt find papers explaining in technical and inaccessible language what’s happening, but what is being done to alert the public?

Why is there no TV marketing campaign to match that being aimed at Maori and Pacifica women to promote cervical cancer screening (aside from the argument that cervical cancer testing is more accurate and less prone to so-called “over-diagnosis” and “over-treatment”)?

Here’s what the Maori Health Directorate’s current website says about Maori male cancer rates in general (Maori comprise about 16% of the NZ population): 

  • Māori male lung cancer registration and mortality rates were three times those of non-Māori males.  
  • Although Māori males had a lower colorectal cancer registration rate than non-Māori, colorectal mortality rates for both Māori and non-Māori males were similar.
  • For Māori males, the liver cancer registration rate was five-and-a-half times that of non-Māori males, and the liver cancer mortality rate was six times that of non-Māori males.
  • Prostate cancer registration was lower for Māori males than for non-Māori males. However, Māori males had a prostate cancer mortality rate twice that of non-Māori males.
  • Rates of stomach cancer registration and mortality were almost three times higher for Māori males than for non-Māori males.
  • For many cancers the rate ratio for Māori compared with non-Māori is higher for mortality rates than for registration rates. This suggests that Māori with cancer may be more likely to die from their cancer than non-Māori.

Read Full Post »

Follow

Get every new post delivered to your Inbox.

Join 26 other followers