Breast Screening

Problem Statement

The Ministry of Health target for participation in the BreastScreen Aotearoa programme is 70 per cent.

Breast Screen Counties Manukau is the contracted lead provider for the BreastScreen Aotearoa programme for the CM Health area. CM Health also has a contract for Screening Support Services to provide extra support for a priority group women who experience barriers to accessing breast and cervical screening services.

Breast Screen Counties Manukau is exceeding coverage targets for the total population and for Pacific women, but there is still a disparity for waahine Maaori. As at 31 August 2019, total coverage by CM Health for 50 to 69 year olds is 72 per cent; coverage for Pacific women in that age bracket is 84 per cent; and for Maaori women is 65 per cent.

Regular breast screening reduces breast cancer morbidity and mortality through early diagnosis, by allowing for treatment before the cancer grows and spreads. Maaori women have a higher incidence of breast cancer and are twice as likely to die from it as Pakeha women, mainly due to later diagnosis. Therefore, Maaori women can benefit most through participation in the programme and increasing Maaori coverage is a priority for Breast Screen Counties Manukau.

What are we trying to achieve?

Our goal is to achieve 70 per cent coverage for Maaori participation in the BreastScreen Aotearoa programme for women aged 50 to 69 years by 30 June 2020.

What have we done?

To achieve this goal, Breast Screen Counties Manukau and the Screening Support Service have been providing an integrated service and working together on the following strategies.

• Data matching with primary care practices and the DHB’s patient system to enable follow-up for women who are not enrolled in the BreastScreen Aotearoa programme, and to update contact details for women who are enrolled but not screened or overdue for screening.
• Tailoring services to support women in the priority group, through providing help to attend screening, including transport.

• Holding regular Mana Waahine days on one Saturday per month. The days are combined breast and cervical screening clinics for waahine Maaori.
• Targeting promotional activities, including working with marae and whare oranga, and attending poukai.
• Locating the mobile unit on marae and in areas with high Maaori populations.

Providing intensive follow up for women who do not respond to invitation letters or do not attend appointments.

What did we find?

The above strategies have seen small incremental increases in the programme’s coverage (see graph below).

We believe that to further improve coverage for Maaori women, new innovative strategies will need to be implemented, in addition to those described above.

Total BreastScreen Aotearoa coverage (%) of women aged 50–69 years in the two years ending June 2017, June 2018 and June 2019, by ethnicity.

How did we make a difference?

Coverage has increased, but an inequity still exists for Maaori women.

Where to from here?

In addition to the strategies already implemented, we have the following strategies planned for the 2019/2020 year.

• Maaori 500 project – this is an Auckland regional project, led by the Waitemataa and Auckland DHBs. A data match has been carried out between primary health organisation and national BreastScreen Aotearoa data. This has identified Maaori women who are enrolled in primary health organisations and living in the Auckland region, but who are not enrolled in the BreastScreen Aotearoa programme, or are enrolled and have never been screened or are overdue. Following up with these women started on 1 October 2019.
• Breast Screen Counties Manukau sponsored a project – Barriers and Enablers to Waahine Maaori Attending Breast Screening in Counties Manukau –that was carried out through the DHB’s Emerging Leaders Programme. It is planned to start implementing the recommendations from this project in the 2019/2020 year.
• Review the invitation letters sent to women.
• Develop links with Maaori communities and stakeholders, with a view to designing and testing new approaches for engaging with waahine
• Continue holding Mana Waahine days and investigate ways to develop this model further.