Retrospective analysis of National Bowel Screening Programme outcomes in Hawke’s Bay: The need to achieve equity

Abstract

BACKGROUND: Bowel cancer is one of the most commonly diagnosed and also one of the deadliest cancers in the world. New Zealand’s bowel cancer rates are one of the highest in the world, particularly for females. Both Māori and Pasifika populations are more likely to have a more unfortunate health outcome following a diagnosis of bowel cancer compared with other ethnicities in New Zealand.

AIMS This research had four goals. Firstly, to quantify the number and types of patients currently using Hawke’s Bay bowel screening services. Secondly, to analyse the collated data for evidence of gender and ethnicity equity. Thirdly, to identify trends to predict future demand for labour-intensive colonoscopy services. And finally, to provide recommendations for Hawke’s Bay bowel screening based on the evidence from the first three aims.

METHOD: Data was collected from the medical records of bowel screening participants from 9 October 2018 to 9 April 2019. Gender and ethnicity of participants who returned a negative, positive or spoilt faecal immunochemical test (FIT) kit were compared. Regression models were to identify current and future trends for colonoscopy services. The number of histology samples taken were analysed by gender and ethnicity. Findings: Pasifika returned a more significant proportion of spoilt FIT kits than Europeans (P<0.0001, Chi-square=50.51) or Māori (P<0.0001, Chi-square=38.83). For colonoscopy, while Māori are not currently under-represented (p=0.7954), they are likely to be under-represented in the next six months (p=0.0001) from the study end date. Males had a more significant (p=0.0060) number of histology specimens sent to the laboratory than females.

CONCLUSION: For FIT kit participation, Pasifika may be disadvantaged compared to other ethnicities. Although colonoscopy participant rates are increasing overall, the current service may not be benefiting Māori compared to other ethnicities. Recommendations are suggested to facilitate a more equitable Hawke’s Bay bowel screening programme.