The cost of breast cancer treatment is on the rise.
Waikato University research shows on average each patient with breast cancer is now costing the country almost $45,000 in treatment.
And it's Pasifika women who are being left behind.
Aucklander Miriam Fuimaono thought she was too fit, young, and healthy, to get breast cancer.
"I kind of thought everything was fine, and then I got diagnosed at 40. So yeah, go figure, I got the roll of the dice there," she says.
With Level 4 lockdown looming last year, Fuimaono faced delays getting a screening and diagnosis in the public health system. So she went private.
The dimple on her left breast turned out to be a cancerous tumour.
"I'm glad I got it diagnosed early, only because I would've been for however long just sat there waiting to see when I would be having a mammogram and an ultrasound."
She knows many other Pasifika women aren't as fortunate in having the opportunity to go private, or as proactive in getting screened.
"Pacific Island women tend to look after everyone else. Everyone else tends to come before their own wellbeing. I suspect that would be the same for a lot of women," she says.
The Breast Cancer Foundation says early detection is vital.
"If you catch it by screening and mammogram, your chances of surviving the ten-year rate are significantly higher," explains CEO Ah-Leen Rayner.
But the number of Pasifika women being screened has dropped off dramatically.
"Obviously screening has been impacted by COVID, like everything else. But what we've seen is screening has declined since 2019. So for us, that's actually a real concern," Rayner says.
It's a concern because Waikato University research has found the most aggressive breast cancers are in young women, and Pasifika women.
"We know that Pasifika women are more likely to have more comorbidities. But we suspect that there may be other barriers that are meaning that they're not receiving the treatment that is going to help improve their outcomes," says Professor Ross Lawrenson, lead author of the study.
The research, published in the New Zealand Medical Journal, also found that while Pasifika women are twice as likely to have HER2+ disease, they're less likely to get access to certain treatments.
"They are less likely to be treated with chemotherapy, and more importantly, less likely to be treated with what we're calling immunotherapies. They're the treatments, particularly for women with HER2+ disease, which initially was treated with Herceptin, but now there are some other options," explains Professor Lawrenson.
The cost of treating breast cancer is rising. Thanks to drugs like Herceptin, and improved diagnostic tools, it’s now one of our most treatable cancers, with 80 percent of patients surviving for more than 10 years.
But it means it’s also one of the most expensive.
"We're getting really good at targeting what is the best treatment for individual women, but the cost of some of those individual treatments can be quite expensive," says Professor Lawrenson.
Around 23,000 Kiwi women have breast cancer, and the mean cost of treating them is $44,954 each, over four years of treatment.
That cost decreases with age, from $69,121 if you’re under 45 years old, to $23,805 for those aged 80 or over.
Fixing inequities in the health system won't just save money. It'll save lives.
"If we screen earlier and identify people earlier, then it's cheaper to treat people with early-stage disease than to treat them with late-stage disease when the outcome's much worse," says Prof Lawrenson.
Ah-Leen Rayner wants to see more funding for some of those early interventions, such as more radiographers, and an increase in BreastScreen Aotearoa’s budget.
"Early detection is the key, and if we catch breast cancer early, we’re also ensuring a sustainable health system."
While some women may be put off screening by the clinical environment in COVID times, Rayner is reassuring them it's safe.
"Precautions are in place, like at level 3 they're running reduced screening capacity to ensure physical distancing," she says.
Miriam Fuimaono says Pasifika women may also be disillusioned by the costs and lack of access.
"It is that fear of getting it checked out and finding out it's probably nothing to worry about, and then finding out later on it really was something to worry about, it's really disheartening to hear about cases where it could have been picked up a lot sooner."
She's currently gearing up for her first bodybuilding competition since her diagnosis and mastectomy, grateful her cancer was caught early.
She's encouraging all women to get themselves checked.
"I still do have treatment, but it's a drop in the ocean compared to what I was last year. I'm a lot stronger than what I was, physically and emotionally. It's only going to get better, this is the new normal I have to live with. I'm grateful."
