Sweet Louise joined Breast Cancer Aotearoa Coalition (BCAC) representatives in Wellington recently to meet with Minister of Health, Hon. Andrew Little and Prof. Diana Sarfati, CEO of Te Aho o Te Kahu (Cancer Control Agency) to discuss some of the key issues affecting New Zealanders with breast cancer.
The three key issues BCAC raised with the Minister and Prof. Sarfati were: risk management and targeted screening for early detection and prompt treatment; improving access to medicines for longer healthier lives; and introducing precision genetic testing to accurately match treatments to those who will benefit.
The BCAC team included Chairperson Libby Burgess, Deputy Chair Emma Crowley, Secretary Fay Sowerby, and committee member and Sweet Louise CEO Catrin Devonald.
Prior to the meeting, BCAC consulted its members and clinical advisors to ensure we captured the issues experienced at the breast cancer ‘coalface’. Many members outlined difficulties they have experienced in the health system. We provided a full list of concerns and were able to raise some of these in their discussions with the Minister and Prof. Sarfati and others at the recent clinical specialist meeting of the Breast Special Interest Group.
BCAC Chairperson Libby Burgess said: “We shared our perspectives on the actions we believe are needed to resolve the issues. We asked that the focus and investment shown in the Government’s Covid-19 response be applied to cancer control and that the health system embrace a strategy for early adoption of innovation.”
In response to our outlining of New Zealand’s low investment in medicines and resulting poor access to modern treatments, Diana Sarfati responded that Te Aho o Te Kahu is planning an international benchmarking exercise to compare cancer services provided to New Zealanders with those in similar countries. We are hopeful that the results from this will drive a more aspirational approach to cancer control in Aotearoa.
Below is a brief summary of the information BCAC presented to the Minister, and the actions BCAC is calling on the Government to take.
Risk management and targeted screening
Currently all women aged 45 – 69 are offered 2 yearly mammograms. The Government has committed to extending this to 70 – 74 and we ask that this be done with urgency. The current screening programme is based on a woman with average risk and we could do much better by using a more tailored approach. This would allow those at high risk to be more closely watched than those at low risk and identify cancers earlier. For example, Māori and Pasifika women tend to be diagnosed younger and with more aggressive disease, and could be screened from age 40.
There are some very good risk assessment tools that take many risk factors into account and could now be used to good effect in primary care.
Access to medicines
BCAC is grateful that a handful of medicines were recently funded for breast cancer but there are many more. With an inadequate and capped budget PHARMAC is continually declining to fund medicines that people and their doctors know will make their lives better. Many of these have been recommended as priorities for funding by PHARMAC’s own specialist advisory committees.
It’s incredibly concerning that PHARMAC’s annual report predicts a lower budget over the next three years. There are huge benefits to be gained from providing effective, targeted medicines to breast cancer patients. Early breast cancer is curable when effectively treated but we fall short of the global standard of care. Advanced breast cancer is fast becoming a chronic treatable disease that can be lived with for many years but we need the medicines that can accomplish this. Oncologists need a toolkit that can be used to treat individuals depending on subtype and response. One size does not fit all – if something isn’t working other medicines should be available, but in New Zealand we are left with very few options.
Introducing precision genetic testing
Breast cancer is a complex disease, with an increasing number of subtypes being identified through research. Therapies that target specific molecular features of a subtype have been largely responsible for the reductions in mortality from breast cancer in recent decades (e.g. those targeting oestrogen-driven and HER2-driven cancers).
New medicines for breast cancer are almost exclusively based on the concept of targeting particular subtypes with ever greater accuracy and effectiveness. To take advantage of the benefits these treatments can bring, patients and their doctors need to be able to know precisely which subtype they are dealing with and how aggressive the disease is.
This knowledge is derived from genomic tumour sequencing that accurately defines the subtype, which identifies the most effective treatments. Sequencing can also be used to track changes in the tumour over time so treatment can be adjusted.
Gene expression profiling shows how active or aggressive the cancer is and, for instance, whether cytotoxic chemotherapy is needed in addition to anti-oestrogen therapy. Identification of low-risk breast cancers that don’t need chemo would allow some to avoid unnecessary toxicity and reduce disruption for patients, whānau and communities, while conserving cancer treatment capacity.