‘Overwhelmed’ cancer specialists warn of five-week delays, ‘backlog pile’

Kenwright said the pathology workforce is “at a cliff edge” with an ageing workforce, and not enough staff to process the surging number of cases that need investigating.

Kenwright said while cases where cancer is suspected are prioritised, there will still be “undiscovered cancers” that sit in piles of slides in a “traffic jam” waiting to be diagnosed.

Even urgent cases, which should be processed in 48 hours, take up to two weeks at the moment, she said.

Slides containing tissues sit in piles waiting to be examined and diagnosed.

This Wednesday, the age for free bowel screening will be lowered to 56, and in March next year an additional 786,000 women will be eligible for free cervical screening.

When a procedure like a colonoscopy is performed, that procedure alone doesn’t determine if a patient has cancer. Any suspicious tissue is sent to an anatomical pathologist who studies the sample, decides whether it’s cancerous, and reports the result.

The samples are cut into paper-thin strips and examined on slides under microscopes.

Health Minister Simeon Brown said this month the Government had “exceeded” targets with 89,039 procedures delivered across radiology, colonoscopy, cardiac and colposcopy services as a result of a $65 million boost in funding for such tests last year.

But Kenwright said pathologists have received no additional funding or resources to diagnose results faster.

“It’s just moving the waitlist. Funding extra procedures translates to more biopsies arriving at the laboratory bench, but nobody funded people at the bench,” she said.

Pathologists warn the five-week wait for biopsy results will increase without additional resources.

Kenwright supported expanding screening, including moves to lower the age of free bowel screening, but said “not one dollar” was set aside for the pathologists who are already 30 specialists short.

She said the predicament for pathologists was “distressing” because they didn’t want patients facing uncertainty, or added complications, because of delayed results.

Asked what the worst-case scenario could look like, Kenwright said there are situations overseas where patients wait up to three months for results.

“It would be disastrous to get to that stage.”

The RCPA said the minister needs to fund 23 pathology training positions “now” – which would cost $3.7m annually – to support the Government’s screening initiatives.

“It’s a relatively small investment to ensure that the diagnostic engine of our health service actually works,” Kenwright said.

The Herald sent a series of questions to Brown – most of which he did not answer directly.

He acknowledged pathologists play an “essential role”, and that lowering the bowel screening age and making cervical screening free will add to demands on labs.

Health Minister Simeon Brown has acknowledged that pathologists play an “essential role”.

Asked why specific funding for pathology had not been set aside, he said Health New Zealand (HNZ) was talking with pathologists to “understand and confirm” funding requirements.

“I expect HNZ to keep working closely with the sector, so patients receive their results as quickly as possible, and I encourage the college to continue that engagement.”

However, the RCPA’s policy and advocacy manager, Frances Cox-Wright, told the Herald the group’s costed pitch for extra staff was sent to HNZ almost a year ago.

She said the RCPA was subsequently told cash to expand pathology immediately wasn’t available, which is why it urged the minister to act.

She said Brown regularly funded new initiatives that rely on pathology but wouldn’t fund pathology itself.

“It’s within the minister’s power to allocate the modest $3.7m a year needed to train more pathologists and begin to secure the future diagnostic workforce for New Zealanders waiting on a diagnosis,” she said.

Brown did not say why he could not commit to the plan put forward by the RCPA.

No response to ‘urgent’ concerns

Diane Kenwright says pathologists want Simeon Brown to action their request to fund more pathology training positions.

Kenwright, who’s a gynaecological pathologist, wrote to Brown on September 4 to seek “urgent” clarity on the Government’s “cervical cancer elimination plan”.

The plan, which includes making cervical screening free in March, involves setting targets for vaccination, screening and treatment with the aim of cutting cervical cancer rates to fewer than four cases per 100,000 women annually by 2040.

On average, 179 women are diagnosed with cervical cancer annually and 52 die from the disease each year.

In its strategy document, Health New Zealand said increasing screening would increase demand on cytology, colonoscopies and anatomical pathology.

The document said the pathology service and capability “will need to be monitored”.

The word pathology features six times in the 46-page plan, but at no stage does it refer to expanding or funding the pathology workforce or infrastructure.

In Kenwright’s letter to Brown, written on behalf of the RCPA, she questioned how the elimination plan would succeed.

“A programme that depends on pathology at several points cannot deliver on its targets if pathology capacity is left unplanned for,” she said in the letter.

Brown is yet to respond to Kenwright’s September 4 letter.

Patient advocate Malcolm Mulholland says the pathology sector is extremely stretched and should have been given funding before the Government’s screening plan announcement. Photo / Mark Mitchell

Patient advocate Malcolm Mulholland, who is chair of Patient Voice Aotearoa, said a commitment to boost the pathology workforce should’ve happened months ago.

“It should have been front of mind before they extended the screening programme because we already knew that sector was under the pump in a big way,” he said.

He said the current situation means under pressure pathologists could make mistakes, and referred to a case where a rushed review of a biopsy led to “significant harm” of a patient.

He said delayed results also present significant risks for patients.

“The longer you leave the diagnosis, the worse the outcome for the patient, and in some instances that will mean death,” he said.

He said while the public often didn’t see or meet pathologists who are “stuck in labs” dissecting biopsies and checking blood, they played a key role.

“Our health system is dependent upon pathologists being well resourced and staffed.”

Brown said HNZ was developing a plan for how pathology is resourced, and the RCPA will be invited to contribute.

That plan is expected to be finalised in the first part of next year.

Gynaecological pathologist Diane Kenwright says her sector urgently needs more trainees.

Kenwright said with many pathologists nearing retirement, action was needed now so senior members of the profession were available to mentor and supervise trainees.

Kenwright urged Brown to visit a lab so he could see firsthand the backlog of work.

“I would really like to take him to a laboratory and show him what we do and the piles of slides waiting to be diagnosed [and to understand] what it would mean for one of his kids personally to have a delayed diagnosis.”

Michael Morrah is a senior investigative reporter/team leader at the Herald. He won the Best Coverage of a Major News Event at the 2024 Voyager NZ Media Awards and has twice been named Reporter of the Year. He has been a broadcast journalist for 20 years and joined the Herald’s video team in July 2024.