May 18, 2021

Maori News & Indigenous Views

Question mark over Maori prostate diagnosis rates

2 min read

GPs can make a difference to health inequalities by diagnosing prostate cancer early, according to mens health champion Lannes Johnson.

image_previewI think we have to do a lot more for Maori [men], Dr Johnson says, in the wake of newly published findings confirming inequalities in prostate cancer testing in primary care.

Dr Johnson is the clinical director of Waitemata PHO and leads work on its prostate cancer decision tool for GPs.

An in-depth 2010 study on prostate cancer screening of men over 40 in 31 Midlands general practices was reported this week in the online journal BMC Family Practice (26 August online).

Maori screened at half the rate

It says the screening rate for Maori men was 11.2 per cent, compared with 22.6 per cent for non-Maori, but the researchers are unclear as to the reasons.

A seven-fold variation in screening rates across practices was revealed. When tested, the Maori men had twice the rate of an elevated PSA result.

Similar levels of cancer

Of those biopsied, about the same rate across Maori and non-Maori had a positive result (57.1 per cent vs 62.2 per cent respectively).

The study suggests the apparently lower incidence of prostate cancer among Maori can, in large part, be explained by the lower numbers tested.

The researchers were from the University of Auckland Waikato Clinical School, led by assistant dean and clinical professor Ross Lawrenson.

Metastatic disease risk

Earlier this month, Professor Lawrenson pointed to his teams wider study of prostate cancer care in the Midlands DHBs. This showed Maori men were less likely to be diagnosed with the cancer and, when diagnosed, twice as likely to have metastatic disease.

Survival after diagnosis was 40 per cent below non-Maori peers.Almost all these men died from their cancer, Professor Lawrenson said in a Prostate Cancer Foundation media release.

In this weeks article, the authors say, With the knowledge that screening is mainly GP-driven it is unclear why GPs are less likely to initiate prostate cancer screening for Maori men.

They say more research is needed.

Dr Johnson says its not known whether GPs are simply not testing, or the patient is not requesting, or is refusing a test.

We need to sort these problems out, so practices that have high Maori populations can deal with it.

Decision tool ready for next minister

Prostate cancer requires multivariate assessment, Dr Johnson says. The decision tool encapsulates five variables and the latest version goes to 30 Waitemata PHO practices for a further trial next month.

An education meeting on the tool recently drew 52 doctors and most were enthusiastic.

The GPs want this tool, Dr Johnson says. It will be ready for the next health minister.

Related links

Prostate-specific antigen (PSA) screening and follow-up investigations in Maori and non-Maori men in New Zealand BMC Family Practice

The Midlands Prostate Cancer Study: Understanding the Pathways of Care for Men with Localised Prostate Cancer Auckland UniServices Ltd

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