Breast Cancer Aotearoa Coalition Update: April/May 2007 

Contents

Member News

Updates on the Five Initiatives

Other News

Member News

Herceptin Hero Chris Walsh leads a Judicial Review of PHARMAC process
On Friday April 27, eight women revealed their intention to file for a Judicial Review of PHARMAC’s decision-making process not to fund Herceptin for 52 weeks for women with early stage HER2 positive breast cancer (it is currently funded in NZ for women with advanced, or metastatic, HER2 positive breast cancer). BCAC has sponsored the Herceptin Fighting Fund donations page.

The eight women (seven pictured here with The Topp Twins), led by Herceptin Hero Chris Walsh, are funding their own Herceptin treatments and are ineligible for the 9 week funding PHARMAC has proposed. The women are raising funds to cover the estimated $30,000 to $40,000 that will be needed for legal costs. A very successful show and auction hosted by The Topp Twins on May 20 in Levin raised over $20,000 towards the Herceptin Fighting Fund. Full details on donating to the Fighting Fund, the eight women and the Review can be found on the BCAC website at: http://www.breastcancer.org.nz/TheHerceptinFightingFund.htm Updates on the progress of the Judicial Review will also be posted there.

John Billington QC said on Radio New Zealand (April 27) that a successful Review for the women could have wider implications for decisions on other expensive drugs. ‘It's an interesting case because it could well affect a whole raft of other people who have similar funding issues,’ he said. It is expected that the High Court will consider whether the required processes were followed by PHARMAC and only relevant considerations were taken into account.

BCAC welcomes 18th member, The Waikato Breast Cancer Trust
The Waikato Breast Cancer Trust was established in 2000 to support research and education into breast cancer diagnosis, prevention and treatment in the Waikato region.  The Waikato is one of the most active New Zealand centres for breast cancer research and the Trust currently supports more than 17 different studies/clinical trials including radiotherapy, drug trials and new surgical treatments for breast cancer. In addition to local studies the Waikato research team works collaboratively with many international groups actively participating in international research protocols. For further information on the Trust and its work, please contact us or visit our website at www.wbct.co.nz

Postal Address:             Jenni Scarlet (Secretary), PO Box 97, HAMILTON
Physical Address:          36 Clarence Street, HAMILTON
Telephone:                    (07) 8398726 Ext 7916 or 8343665
Fax:                              (07) 8343657 or 8343660
Email:                           scarletj@waikatodhb.govt.nz

.. and welcomes 19th member, Kenzie’s Gift
Kenzie’s Gift is the vision of BCAC Steering Committee member and Herceptin Hero Nic Russell. It is inspired by the life of her daughter Kenzie and the cancer journey they shared together. The vision of Kenzie’s Gift is to establish a specialist team of community based family therapists, play/youth therapists and art/music therapists to provide support for families and children affected by cancer from the point of diagnosis through treatment and beyond, which may encompass either bereavement or survivorship. Further information about the charity can be viewed on the BCAC website, by visiting www.kenziesgift.com, by emailing kenziesgift@kenziesgift.com or by contacting Nic directly on 027 345 2514 or (09) 446 1100.

The Breast Cancer Research Trust Achievement Party, May 15 2007
The BCRT Achievement Party was held on Tuesday 15 May to celebrate the considerable achievements of the Trust over the last year. Invited guests joined BCRT patron Trelise Cooper and the BCRT Board of Trustees at Fables Restaurant in Parnell, Auckland. There was even more to celebrate as two new research grants were announced at the cocktail party event. The two research grants were awarded to Professor Peter Lobie and to Dr. Chelleraj Benjamin. The grant to Professor Lobie will support his work towards the identification and characterisation of a trefoil factor (TFF) receptor. The award to Dr Benjamin (pictured) will be used to support his Accelerated Partial Breast Irradiation Study (APBI Study). The duration of the project is 3 years commencing June 2007. This study trials targeted radiotherapy using external traditional  radiotherapy machinery to deliver a dosage of radiotherapy to the post operative breast in 10 doses over one week

New website for BCRT
BCRT has launched its recently upgraded website, at www.bcrt.org.nz.
‘At The BCRT we are all very proud of our new website,’ said Jo Ramsey, BCRT Administration. ‘We believe it now represents everything that The BCRT stands for and contains new and updated information about our history, events, sponsors and research projects. It is a true ‘blueprint’ of our charity organisation and all we represent. It is the dedicated mission of The Breast Cancer Research Trust to find a cure for breast cancer in our lifetime and in achieving this we will create a new brighter breast cancer-free future for everyone to live in. We do hope you will visit us at www.bcrt.org.nz very soon!’

BCS Weekend Training Programme May 5 and 6
Breast Cancer Support Inc (BCS) held a two day training programme for their volunteer group facilitators and telephone support people on Saturday and Sunday May 5 and 6 at the Auckland Cancer Society. The programme aimed to provide the volunteers with helpful skills enabling them to give emotional and practical support to women affected by breast cancer. Techniques covered in the course were based upon a one to one contact scenario between a BCS volunteer who has had breast cancer and another woman who has requested support. BCS had not hosted a comprehensive training course for some time so the two-day programme was intended as a pilot. Feedback from participants and tutors alike was actively encouraged and will be used to help shape future courses. BCS course organiser, Joan Kerr (pictured, with Marie Goudge on right), said the main objective of the two day course was to 'establish an excellent benchmark for the future' by providing an effective model for further training programmes. The weekend, whilst intensive, was a great success and participants felt well informed, upskilled and prepared to offer their support to other women coping with breast cancer.

Pink Dragons Dragon Boat Team
This update comes from Robin Gamble, Team Head.

We are the second breast cancer dragon boating team in Auckland, and the sixth team in New Zealand.  We began as a mixed team in 2005 with the help of a number of non-breast cancer survivor paddlers, but became 100% breast cancer survivors for the 2006-07 season.  We participated in a fun festival at Takapuna Beach, and competed in the Tauranga Super Twelves, but it was at the Auckland Festival and the Nationals in Christchurch where we rewarded our coach and ourselves by achieving our best times yet.  We also found travelling together as a team a great bonding experience.  We had so much fun, and ended the paddling season on a high note.
We suffered some withdrawal pangs once our regular contact with each other was put on hold, but we heeded coach Graeme’s advice that, for the success of the team, we really needed to take a break over winter.
Our mission is to show our fellow breast cancer survivors that life is for living!  After being swept along in the process of diagnosis, surgery, treatment, medication and supervision, we could feel rather helpless.  Participation in this physically demanding sport has been empowering.  We have benefitted from learning new skills, improving our fitness, feeling positive, and being part of a wonderful support group working together to achieve a goal. Graeme has made a special award for Team Member of the Year, and the inaugural recipient was Lindsay Scott (pictured), who exemplified all that our team aspires to.  She never let the tribulations of her treatment get in the way of her commitment to the team. We are looking ahead to the next season, starting in October.  Our team is still growing, so we would like to hear from anyone who wishes to join us.  Please phone Robin on 630 6423 (home), or 021 146 8381.

Busting with Life Dragon Boat Team
This update comes from Linley Rivers, Team Secretary
Since the end of their summer paddling, Busting With Life Dragonboat team members have celebrated a successful year with an end-of-season dinner at the Kingsgate Hotel. The evening was also an opportunity to acknowledge the efforts of all paddlers, our coaches and sweep.
Team members have taken part in the Orca Women’s Walk, and the YMCA Women’s Walk, and during the off season will be joining with friends and supporters for monthly Sunday walks and coffee. All are welcome to join us.
We are also looking forward to meeting with our supporters in mid July - a chance to socialise and show appreciation of their involvement.
Foranyone wanting further information about joining the team, as a paddler or supporter, please contact Marcia Fraser (president) at tel. (09) 833 9353.

Updates on the Five BCAC Initiatives

1.To ensure consistent, high quality detection and treatment of breast cancer throughout New Zealand by promoting the development and implementation of evidence-based best practice guidelines.
NZGG researchers are gathering the latest information on key topics with the next meeting of the Guidelines Group scheduled for August. Libby’s team is researching the use of complimentary and alternative therapies (CATs) to define any benefits or risks involved with using these strategies. Information on CATs was requested by GPs involved in the Guidelines Advisory Team as they are often asked by patients about their appropriate uses.  This information may be included as an appendix to the guidelines. Libby has also agreed to assess existing guidelines on access to clinical trials and will search for evidence on impacts of access to trials on patient outcomes.
Northern Region Cancer Network (NRCN)
BCAC continues to campaign for consumer representation on the Network Executive Group of the NRCN. Consumers were excluded from this top level when the structure for the NRCN was determined late last year. BCAC wrote a letter of reply to a communication from CEO Garry Smith, March 30, stating: ‘Disappointingly, your reply of March 30 indicates that you … continue to show a genuine lack of concern and understanding for the important role of the consumer in the Regional Cancer Control Strategy. High level consumer input is recognised worldwide as essential to the effective planning and consequent delivery of health services and BCAC believes that the failure to establish such input is neither appropriate nor efficient.’

2. To support the prompt and effective implementation of the extended age breast screening programme (45 to 69)
MercyAscot announces plans for private radiotherapy clinic.
MercyAscot plans to develop NZ’s first private radiotherapy clinic at Mountain Rd in Epsom, Auckland, a joint initiative with Southern Cross Hospitals. BCAC issued a supportive press release May 28, stating ‘The proposed clinic will offer the option of a more timely provision of treatment for some women with breast cancer,’ said BCAC Chair Libby Burgess, ‘ and this will take pressure off the public system, hopefully reducing the waiting time for access to treatment.  We hope this facility will eliminate the need for New Zealand women to travel to Australia to have radiotherapy within the recommended time frames.’
New Zealand Breast Cancer Foundation spokeswoman Belinda Scott said it was about time something was done to alleviate unacceptable waiting times for cancer patients needing radiation therapy. ‘The problem with waiting times has existed since early 1990... And since 2001 we have been sending New Zealand patients to Australia for treatment, with little relief in sight. This has been a serious problem for far too long, with patients’ lives seriously compromised.’
Dr Scott said the new centre was fantastic news. ’At long last we are seeing some positive movement to help alleviate what's become a heartbreaking and frustrating situation, ‘ said Dr Scott. ‘We hope the new centre will not only provide timely treatments for those who don't want to wait, but also be able to work in with the public sector to help when needed.’

3. To inform and advocate for improved access to breast cancer treatment drugs
a. Herceptin (trastuzumab) Update
Following a consultation period on its proposal (as outlined in last month’s update), PHARMAC announced on May 3 that it would fund Herceptin for early stage HER2 positive breast cancer for a 9 week treatment period instead of the ‘gold standard’ internationally accepted 52 week period.

BCAC offered the NZ public a chance to ‘have their say’ during the consultation process by placing an online submission form on our website. Over 200 submissions were received and forwarded to PHARMAC and the Minister of Health, Pete Hogdson.

The BCAC press release (May 3) branded the PHARMAC decision as ‘unintelligent’ and showing a ‘reckless disregard’ for the lives of New Zealand women who have the aggressive HER2+ form of breast cancer. Libby went on to say, ‘The decision to fund 9 weeks of Herceptin with chemotherapy clearly illustrates the need to separate the functions of drug purchase and determination of effectiveness and cost benefit, processes currently combined within the drug purchasing agency. This leads to confused, compromised decisions such as the one announced today.’

The 9 week regime PHARMAC intends to fund from July 1 is based upon results of a controversial Finnish study called FinHer, an unproven treatment regime designed by a Finnish researcher to test other chemotherapy agents. Only 54 women were given Herceptin in this study. PHARMAC has declined to fund the 52 week regime, the international standard, which was based on studies involving over 12,000 women throughout the world and has proven survival benefits.

The 9 week Herceptin regimen which PHARMAC has announced it will fund has not been evaluated or approved in New Zealand by drug regulatory body Medsafe. Women wishing to access the funded treatment will be asked to sign a consent form to indicate their understanding that they will be receiving an unapproved treatment. The absence of Medsafe approval means women who suffer any adverse events as a result of the treatment will not receive ACC cover.  Herceptin Heroes Chair Anne Hayden had this to say in a press release (May 3) ‘Although patients routinely consent to medical and surgical treatment, does this disclaimer divorce Pharmac from any responsibility for the administration, success, side-effects or any thing else that might crop up relating to this treatment? It seems they are being very careful to cover their backs rather than care for women with an aggressive disease.’

Responses to the announcement were swift. Dr Pippa MacKay, Chair of RMIA (Researched Medicines Industry Association) said: ‘Today’s announcement that PHARMAC is to help fund a ‘trial’ to assess the short term use of Herceptin for breast cancer is the clearest example yet that New Zealanders are continually denied access to the modern medicines that people in other developed countries are prescribed as of right. It is an outrage that a procurement agency should involve itself in this sort of activity as a way of reducing rising public concern about the ad hoc and random way of approving medicines in New Zealand.’

Internationally, 23 of 28 OECD countries now offer 52 weeks of funded Herceptin treatment. New Zealand is the only country globally to fund 9 weeks.

Roche Products (New Zealand) spokesperson Svend Petersen (Managing Director) said the NZ public should not be surprised by the decision due to the severe financial Government imposed constraints PHARMAC operates under. ‘Although the government has significantly increased its investment into health over the last five years, the medicines budget has not kept pace,’ he said. ‘Today's announcement on Herceptin clearly reflects that.’ Nor does he accept PHARMAC’s assertion that that evidence for the efficacy of the nine week regime is comparable to that for 52 weeks. ‘Four international clinical trials, involving more than 12,000 women have shown a clear survival benefit when treated with Herceptin for 52 weeks… the nine week trial … showed no survival benefit.’

b. The Karolinska Report details access to medicines in 25 countries
Sources: NZPA Friday 11 May 2007; Stuart Knight, Roche Products (NZ)
Report published in Annals of Oncology 18, 2007(Supplement 3)
On May 24, BCAC met with Stuart Knight and Felicity Bonham of Roche Products (NZ) to view their presentation on the Karolinska Institute Report which details comparative access to medicines in 25 countries. The report's Swedish authors Dr Nils Wilking, of the Karolinska Institute and Dr Bengt Jonsson, of the Stockholm School of Economics did not rate New Zealand well.

Stuart noted that the extra $14 million announced in the recent budget for cancer drugs brings NZ’s level of spend from 6 Euro to 7 – this is compared with the 12 Euro spent by Australia, 11 by UK and 15 being the European average (page 11, Table 4 of the Report).

The report said that Austria, France, Switzerland and the US are the leaders in the use of new cancer drugs, with France replacing Spain among the top four since an earlier report was published in 2005.

Uptake of new cancer drugs was "low and slow" in New Zealand, Poland, Czech Republic, South Africa and Britain. “In many countries new drugs are not reaching patients quickly enough and this is having an adverse impact on patient survival," said Dr Wilking. ‘Where you live can determine whether you receive the best available treatment or not. To some extent this is determined by economic factors, but much of the variation between countries remains unexplained.” The authors recommended reducing the review time for the marketing authorisation of new cancer drugs and ensuring that any economic evaluation or health technology assessment was done quickly to aid patient access. Appropriate and adequate funding for new, innovative cancer drugs should also be made available in the health care system by planning ahead. Dr Jonsson said the inequalities between countries in patient access to cancer drugs should not continue. “Cancer patients will not accept that a standard of care available in one country is not available in other countries," he said.

Main points from the report are as follows:

• The uptake of cancer medicines is ‘low and slow for many drugs in New Zealand, Poland, Czech Republic, South Africa and the UK’ (Report Summary)
• In relation to health technology assessments determining medicine availability they highlight that ‘it is obvious that the impact of PHARMAC on the access to new cancer medicines in New Zealand is significant, but the main effect comes from the fixed budget, not from the impact of economic evaluations.’ (Report Summary)
• Based on the sales of the 67 cancer medicines studied, our low comparative investment in cancer medicines is also highlighted at 6 Euro (NZD$12) per capita versus 12 Euro for Australia and 11 Euro for the UK.
• Only Poland invests less in cancer medicines. (Section i, Table 4, Section iii, Figures 3 & 4).
• Note the Karolinska's analysis of NZD $12 (6 Euro) per person for NZ is appropriate as NZ invests $50 Mio per annum for cancer medicines.
• There is also a considerable time delay in access to new cancer medicines, with New Zealand not showing use/sales until an average of 3.2 years after the first introduction of a new medicine in a country (Section iii, Table 3). This ranks NZ as 22nd out of the 26 countries studied. The main driver of this appears to be the PHARMAC appraisal timeline as opposed to regulatory assessment. Such information is useful when put into the context of the Ministry of Health’s Cancer Control Strategy 2003 which highlights in goal three that in order to reduce the mortality and morbidity associated with cancer there should be timely access to treatments currently recognised as providing optimal outcomes as well as systematic assessment of new treatment approaches

A recent editorial in The Lancet has this to say (excerpts below) about the report:

However, in an in-depth report published last week as a supplement to the Annals of Oncology, Bengt Jönsson, an economist from the Stockholm School of Economics, and Nils Wilking, a clinical oncologist from the Karolinska Institute, Stockholm, Sweden, assessed access to new cancer drugs in 25 countries. They then linked differences in availability to differences in cancer mortality. Of five major European countries, France had the highest overall 5-year cancer survival rate with 71% for women and 53% for men, and the UK had the lowest, with 53% for women and 43% for men. The UK, together with New Zealand, Poland, the Czech Republic, and South Africa, had the lowest and slowest uptake for many new drugs, whereas Austria, France, Switzerland, and the USA had the highest uptake. This is in stark contrast with the finding that the UK is, together with Sweden, the European country that spends most public money per head on cancer research.

Yes, the authors did compile their report with an unrestricted grant by Roche Pharmaceuticals, which is clearly acknowledged, and some—but by no means all—of the drugs they assess in detail, such as trastuzumab for breast cancer and bevacizumab for colon cancer, are made or marketed by Roche. But to dismiss this very detailed report that looks beyond pure usage data and tries to assess outcomes in three different ways is premature and petulant.

All countries with publicly funded health care need to decide on comprehensive national plans and strategies to achieve the maximum possible gain in survival and quality of life for cancer patients. If costs are the predominant consideration, health systems are failing their people.

The Lancet2007;369:1665 DOI: 10.1016/S0140-6736(07)60755-7. See the whole editorial, Cancer treatment: not just a question of costs, at:

http://www.thelancet.com/journals/lancet/article/PIIS0140673607607557/fulltext

National Party associate health spokeswoman Jackie Blue said the report showed PHARMAC was failing to give New Zealanders access to drugs and Health Minister Pete Hodgson should step in. She said over the past five years PHARMAC underspent its budget upwards of $50 million and when it did decide to spend money on drugs it took too long. ‘The time for a drug to get funding approval in New Zealand takes an average of two years, which is far too long,’ she said. ‘The delays and stalling involved in getting approval in itself functions as a rationing strategy.’

c. Government increases cancer pharmaceuticals budget, May 17
Health Minister Pete Hodgson announced in the 2007 Budget that PHARMAC will receive a permanent increase of $20 million per year, $14 million of which is tagged for funding cancer treatments. ‘Drugs for the treatment of cancer is an area where things are constantly developing and changing and New Zealanders can be assured their health system is keeping up with those changes,’ Pete Hodgson said.

d. Tykerb (lapatinib) Update
BCAC has posted a Tykerb Fact Sheet on the website. This is a general guide only and women interested in finding out more about Tykerb should consult their medical specialists.

e. Access to Medicines Coalition
The ATM coalition (http://www.atmcoalition.org.nz) consists of 27 organisations that collectively advocate on behalf of New Zealanders for better access to medicines. BCAC is a member of ATM and regularly attends meetings.

Steering Group member Anne Hayden attended the special meeting on March 21 where two major issues were discussed: the ATM response to the Pharmac consultation document on High Cost Medicines and the upcoming submission to the Ministry of Health (MOH) Consultation on a Medicines Strategy for New Zealand.

ATM spokesperson John Forman submitted a response to the Pharmac consultation (March 19) in which it was stated that it is unacceptable for Pharmac to decide whether to fund an essential medicine on the basis of an operational decision-making framework.  It was also felt that Pharmac lacked specificity to NZ values. Equal priority should be given to cases of equal seriousness, political input should be expected when essential medicines are denied to any segment of the population and Pharmac should actively seek guidance from the MOH, the government and other stakeholders regarding a more strategic approach to the funding of high cost medicines.

The main point of ATM’s submission to the Ministry was, “Equal access to medicines for all people.” It was suggested that a broader government policy would align effectively with the proposed medicines strategy. ATM suggested public consultation with Maori, disadvantaged groups and other parties would lead to the development of a sound policy for the New Zealand public and would also identify priorities in improving access to medicines. A national budget for Pharmaceuticals should be developed which takes into account Pharmac’s current role conflicts.

ATM recommended a thorough review of structures and decision-making processes, thus separating medical and scientific decisions from funding and procurement.

4. To research and promote the provision of psychosocial services for breast cancer patients, their whanau, family, friends and supporters
Breast Cancer Support Inc. training weekend Libby Burgess and Jane Bissell attended this training course for one to one support volunteers and support group facilitators (please see item in Member News). The weekend was a great success and enjoyed by all who participated.

New Zealand version of Breast Cancer Network Australia’s ‘My Journey Kit’ Nic Russell continues to work on the development of this kit for women newly diagnosed with breast cancer. The sample Kit from BCNA is being reviewed by oncologists from Auckland and the Waikato.

Kenzie’s Gift new charity Kenzie’s Gift has joined BCAC as the 19th member group. Kenzie’s Gift will help to provide psychosocial and support services to children with cancer and their families within the public system.

BCAC representatives met with members of the New Zealand Association of Cancer Specialists (NZACS - visit their site at http://www.nzacs.org.nz) on May 24. These members are hoping to establish a breast cancer subgroup within NZACS and would also like to work with BCAC to improve access and information to clinical trials for those patients who may wish to participate. The area of access to clinical trials is one the BCAC Steering Group is researching as a possible initiative/project for the future. 

5. To identify and promote breast cancer issues for Māori and Pacific women
In May, Libby and Carlene Wolfgram met with Tracy Walters, CEO of Tihi Ora, a Māori health organization mandated by Ngati Whatua for the ADHB area. The issue of education of Māori re: breast cancer was discussed. Mr Walters felt that a strong connection with the community is vital for the effectiveness of such initiatives.BCAC continues the ongoing process of building relationships with Maori health providers, establishing contacts within the Maori community and gathering information. It is hoped that Mr Walters may be able to guide BCAC towards further contacts.

Other News

1. NZ Researchers Seek Cancer Survivors
Cancer survivors are being asked to tell their stories. The Life After Cancer Study at University of Auckland’s School of Nursing is asking long-term cancer survivors to identify any issues they may have faced (or are still facing) once surgery, radiotherapy or chemotherapy treatment has ended.  The questionnaire covers topics such as physical and emotional wellbeing, persistent symptoms of cancer treatments, effects on social life and family members, effects on employment and finances, and experiences with healthcare services.

“Improved cancer treatments have resulted in a growing number of survivors who live many years beyond their cancer diagnoses,” Associate Professor Jill Bennett (pictured) says.  “This project will be an important study of cancer survivorship issues in New Zealand as most cancer research to date has focused on issues evolving around biomedicine, prevention or treatment.”

“By getting information directly from the survivors, we can create more awareness of the needs of cancer patients and the problems they face.  Most survivors feel they changed in many ways after they were diagnosed and are keen to share their experiences in the hope of helping others.”

The study team is looking for cancer survivor volunteers who were aged 18 or older when first diagnosed with cancer and who are at least six months beyond their last surgery, chemotherapy or radiotherapy treatment.  Maori and Pasifika are especially encouraged to participate.  Volunteers are asked to spend one to two hours completing a written questionnaire at home and to then post it back in a supplied freepost envelope.

To take part in the Life After Cancer Study or for more information, contact the study’s Project Manager Tanja Ottaway on 373 7599 ext 89752 or from outside Auckland: 0800 333 227.

2. The discovery of four new genes linked to breast cancer could lead to a new blood test for women at risk.
Source: Kelly Schicker, Waikato Times, May 28
Scientists working on an international study have discovered four new genes that increase the chance of developing breast cancer, raising hopes that a blood test to determine individual women's risk of the disease may be within sight. The genes - three of which are related to cell growth - go some way to explaining why breast cancer is about twice as common in the daughters and sisters of women who have the disease. Each of the new genes increases breast cancer risk by only a small degree - about 3.6 per cent altogether, according to the Cambridge University-led study, which is published today in the journal Nature. But they supported the prevailing theory of breast cancer as a "polygenic" disease in which small increments of genetic risk could accumulate to determine a woman's overall susceptibility.

Two other genes, BRCA1 and BRCA2, discovered a decade ago, confer an exceptionally high likelihood of breast cancer if they are affected by particular mutations, but they are implicated in only a minority of familial cases. It could take five to 10 years to develop a blood test that could meaningfully characterise a woman's breast cancer risk.

3. Breast cancer risk on the rise in NZ – see projections in this latest MOH report where the breast cancer burden is expected to rise by at least one third:
http://www.moh.govt.nz/moh.nsf/indexmh/cancer-incidence-projections-1999-2003?Open

4. MoH Consultation Presentation May 29
BCAC’s Anne Hayden attended this presentation by the Ministry regarding its consultation on establishing a national medicines strategy.
The 3 objects of the consultation were: Safety and quality of use of medicines,ensuring all New Zealanders have access,ensuring optimal use of those medicines.

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