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Posts Tagged ‘Maori and prostate cancer’

PROSTABLOG NZ: If you’re Maori and poor in New Zealand, you have less chance of being diagnosed early with prostate cancer – and you’re got a 60% greater chance than non-Maori of dying .

These and other findings are in a major new report just released by the NZ Ministry of Health, whose researchers looked at cancer trends in the five years 2002 to 2006 and compared rates with ethnicity (Maori and non-Maori) and socio-economic status (deprivation) and where people live.

Some quotes from the report:

Prostate cancer was…more common among non-Māori men, but Māori death rates were higher than those of non-Māori men.

On average, just over 130 Māori men were diagnosed with prostate cancer each year, and around 33 died from the disease during 2002–2006.

Among non-Māori men, on average 2,495 per year were diagnosed with prostate cancer and nearly 540 per year died from the cancer.  The Māori age-standardised registration rate was about 10% lower than the non-Māori rate while the death rate was 60% higher.

Over the period 1996–2006, there were no significant changes in incidence or mortality for Māori men.  Among non-Māori men there was no change in incidence but there was a significant decrease in mortality of 2% per year.

Prostate cancer incidence was associated with increasing deprivation for Māori men but not for non-Māori.

Prostate cancer incidence was significantly lower among Māori and non-Māori rural residents compared to main urban residents.

Only a small proportion of lung, prostate cancers and around a third of stomach cancers were diagnosed at the earlier stages of disease spread.

…Māori had significantly lower odds than non-Māori of being diagnosed at a localised stage, and higher odds of being diagnosed at a distant stage for most of the key cancers (breast, cervical, colorectal, lung, and prostate cancers).

During the period 1996–2006, Māori had a significantly higher age-adjusted risk of dying from their cancer after diagnosis compared to non-Māori…The relative risks ranged from 24% higher for lung and stomach cancers to 103% higher for prostate cancer.

For prostate cancer, gaps between Māori and non-Māori are wider outside main urban centres.  Both Māori and non-Māori with prostate cancer have worse survival outcomes outside main urban centres, but the difference is greater for Māori patients.

Among non-Māori, increasing deprivation was significantly associated with poorer survival chances for breast, colorectal, lung, prostate, and uterine cancers.

Among Māori, rural residents had significantly lower survival (or higher death rates) than their main urban counterparts for prostate and uterine cancers.  Among non-Māori, rural residents had significantly lower survival from colorectal, lung, and prostate cancers.

Within each rural–urban area, Māori had higher risk than non-Māori of dying from their cancer after diagnosis.

Disparities in cancer incidence and outcomes persist in Aotearoa/New Zealand, although there is promising movement towards equity for specific cancers, such as cervical cancer.

…ethnic disparities in socioeconomic status and in other social and environmental determinants of health result from the entrenched unequal power relations that underpin and sustain a racialised society.

…there is some evidence to suggest that socio-economic inequalities in cancer mortality are growing over time.

Similarly to mortality trends, there is some suggestion of increasing socio-economic disparities in survival in recent decades.  Improvements in survival are generally larger for those people residing in affluent areas compared to those living in deprived areas for many cancers.

…participants in studies of Māori health care experiences report significant hardships resulting from the hidden costs of ‘distance deprivation’ among rural residents, particularly for those with low incomes.

For Māori, the age-sex-standardised incidence rate for all cancers combined was 220.4 per 100,000, 19% higher than the non-Māori rate of 185.2 per 100,000.  The cancer death rate for this period was 112.0 per 100,000 for Māori, 78% higher than the rate for non-Māori of 63.3 per 100,000 (Figure 2.1).

Lung cancer was the most commonly occurring cancer for Māori overall, accounting for 20% of all cancers (compared to 9% for non-Māori).  Breast, prostate, colorectal, and stomach cancers were the next most frequent.

Among non-Māori, the most common types were colorectal, prostate, breast, melanoma of the skin, and lung cancer.  These patterns were also consistent across each rural–urban area, except for non-Māori in rural areas where prostate ranked highest and melanoma third.

Among Māori males, lung cancer (20%) and prostate cancer (20%) were the most common (registrations), followed by colorectal (9%), stomach (5%) and liver cancer (5%).  For non-Māori males, prostate cancer was the most common (28%)…

Lung cancer was the leading cause of cancer death, accounting for 31% of Māori and 17% of non-Māori cancer deaths.

Female breast, colorectal, stomach and prostate cancers were the next most common for Māori. Among non-Māori males, lung, colorectal, prostate, cancers of unknown primary site, and melanoma were the leading causes of cancer death.

Among Māori, lung, breast, prostate and colorectal were the four leading cancer sites across all deprivation quintiles, with some variation across quintiles. Prostate, colorectal, breast, melanoma and lung were the five leading sites for non-Māori in all quintiles, with colorectal leading in the three most deprived quintiles.

Among non-Māori, the deprivation gradients were steepest for deaths from cervical, oral, and lung cancers.  Other cancers with a significant deprivation gradient for non-Māori included cancers of the thyroid, liver, stomach, uterus, pancreas, bladder, oesophagus and prostate.

Our results suggest that substantial undercount of Māori cancer registrations still exist, despite the improvement in the count of Māori registrations from the new ethnicity algorithm.  The undercount ranges from approximately 2% to 22% depending on age.

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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>

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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.

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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.

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