7. Dr JACKIE BLUE (National) Link to this
to the Minister of Health
Is he satisfied that women are receiving consistent breast cancer care throughout New Zealand?
Hon PETE HODGSON (Minister of Health) Link to this
Women across New Zealand receive a high standard of breast cancer care but there is variation in clinical practice, which deserves closer scrutiny.
Can the Minister explain why 74 percent of women with breast cancer who live in Nelson-Marlborough have a mastectomy, compared with only 30 percent of women who live in the Waikato?
I welcome the member’s interest in this important matter and I saw the figures she released yesterday. She will be aware that one of the figures she released yesterday, the highlighted figure, is in fact wrong. The MidCentral figure is about a third of that which she had initially thought it might be. Furthermore, the member requested what each district health board provided, rather than the rate of treatment based on where people live. She is therefore, inadvertently, unable to compare one population in a district with another, which is how comparisons of this ilk are usually made. I would make one last point. These decisions are, of course, clinical, not political.
How will the Minister explain to the woman with breast cancer who lives in Rotorua that she has double the chance of having her breast removed, compared with a woman who lives less than an hour away, in Tauranga?
I will say again to the member that the figures she has quite carefully collected in her research are to do with where the surgery is provided. She is, therefore, unable to take into account any effects from intradistrict flows, where there are any.
Sue MoroneyAre there variations in surgical services other than mastectomy; if so, what is the Government going to do about them?
Yes, there are. Variations across the country exist for every surgical activity. Last year we began a process of making sure that data on intervention rates are as accurate as possible—itself a significant task, which will be completed in a few weeks. From 1 July this year we will then use the extra surgical electives funding to address low levels of intervention in this or that surgical procedure, where discussions with clinicians indicate that that is appropriate. I appreciate that mastectomy is a procedure where the optimal rate may be lower, not higher, than the existing rate.
Does the Minister understand that breast cancer surgery, with the exception of breast cancer reconstructive surgery, would not normally require referral to another district health board, and however he wants to spin the data and make excuses, the fact is some women may be getting their breast removed unnecessarily because they are simply living in the wrong part of New Zealand?
I just say to the member that I agree with her that significant variation in intervention rates for anything is a measure of quality and that reduced variation means higher quality. The member, however, should reflect on this: New Zealand’s intervention rate for mastectomy is 32.5 percent. That is lower than the average across all of Europe and it is lower than that of the United States of America.
Does the Minister agree that there is an urgent need to investigate why there are such differences in surgical practice and to update the current breast cancer surgical guidelines, which are well over a decade old, so women can be reassured that they will be getting the best surgical treatment for their breast cancer and not this current haphazard surgery by postcode?
The member will be interested to learn—I am sorry she did not already know—that as part of the Government’s cancer control strategy, guidelines are currently being updated for all breast cancer treatments, including of course the surgical options. [ Interruption] The member has asked me whether I would like to do something; I am just replying and explaining to the fellow over there that we are already doing it. I say again to the member that she is right—variations in intervention rates for any surgical procedure perhaps indicate a lower quality than is ideal.