Every four weeks of delay increases the risk of death by 8 percent
At Parliament in Wellington, the Breast Cancer Foundation placed before lawmakers a modest but consequential proposal: allow women with suspicious screening results to proceed directly to diagnostic imaging, bypassing the GP referral step that currently adds weeks to an already fragile journey. Behind the simplicity of the ask lies a harder truth — that in New Zealand, where a woman lives determines how quickly she is treated, and where treatment is delayed, women die at measurably higher rates. The proposal is less a revolution than a reckoning with what the system already knows but has not yet acted upon.
- In Northland, only 22 percent of women begin breast cancer treatment within 28 days of diagnosis — a figure that exposes how geography compounds delay into danger.
- Every four weeks lost between diagnosis and treatment raises the relative risk of death by 8 percent, meaning the GP referral bottleneck is not a bureaucratic inconvenience but a measurable mortality factor.
- The Breast Cancer Foundation is urging a direct-to-imaging pathway that would cut up to eight weeks from the diagnostic process and reduce the private-versus-public care divide that currently advantages wealthier women.
- A looming 11 percent pathology workforce shortage by 2030 threatens to deepen the bottleneck further downstream, with digital pathology and AI screening proposed as systemic remedies.
- The government has expanded funded screening to women aged 69–74 and increased Pharmac funding by $604 million, signalling movement — but the referral pathway reform remains unresolved.
On a Thursday morning at Parliament, the Breast Cancer Foundation made its case for a change that is structurally small but humanly significant: let women with suspicious screening results go directly to diagnostic imaging, without first returning to a GP for a referral. Chief executive Ah-Leen Rayner argued the shift could eliminate up to eight weeks of waiting, ease pressure on primary care, and close the gap between women who can afford to move quickly through private channels and those who cannot.
The current pathway is where time is lost. A screener finds something, sends the woman home, and she must book a GP appointment before imaging can be arranged. In Auckland, 60 percent of women begin treatment within 28 days of diagnosis. In Northland, that figure is 22 percent. The stakes are not abstract: international research shows that every four-week delay between diagnosis and treatment raises the relative risk of death by 8 percent — a figure that climbs to 26 percent at twelve weeks. Late-stage treatment also costs the health system four to five times more than early-stage intervention, yet 55 percent of diagnoses still follow a woman noticing her own symptoms.
A less visible bottleneck runs deeper in the system. Pathology — the analysis of tissue samples that underpins every treatment decision — remains largely manual in New Zealand's public hospitals. Workforce shortages are projected to reach 11 percent by 2030. Rayner called for a transition to digital pathology as a necessary modernisation of the entire diagnostic pipeline.
Health Minister Simeon Brown pointed to recent progress: a screening age extension to 74, now drawing in 52,000 additional women annually, has already detected 190 cancers that would previously have gone undiagnosed. Increased Pharmac funding of $604 million will expand access to advanced treatments, and community infusion services are being extended nationwide.
Survivor Andi Shirtcliffe gave the policy its human weight. Diagnosed at 57 after a routine mammogram she had delayed — "I was too busy," she said, "my country needed me" — she endured two surgeries, chemotherapy that severely compromised her immune system, and radiation. She has not yet reached the five-year milestone. The complications she carries, she reflected, might have been fewer had she acted sooner. Her story is the foundation's argument made flesh: in a disease where weeks are measurable in lives, the distance between a screening result and a treatment decision is not a procedural detail — it is the margin between cure and consequence.
On a Thursday morning at Parliament, the Breast Cancer Foundation made a case for a simple change that could reshape how New Zealand diagnoses breast cancer. The argument was straightforward: let women with symptoms skip the GP and go straight to diagnostic imaging. That single shift, the foundation's chief executive Ah-Leen Rayner said, could eliminate up to eight weeks of waiting time, ease pressure on primary care, and narrow the gap between women who can afford private care and those who cannot.
Right now, the system works like this. A woman attends routine screening. The screener finds something—a lump, a shadow, something that needs investigation. She is sent home and told to book an appointment with her GP, who then refers her to imaging. Those referrals take time. In Auckland, only 60 percent of women start treatment within 28 days of diagnosis. In Northland, that figure drops to 22 percent. The delay is not trivial. International research shows that every four weeks between diagnosis and treatment increases the relative risk of death by 8 percent. Stretch that to twelve weeks, and the risk climbs to 26 percent.
The economics matter too. Late-stage breast cancer costs the health system between $120,000 and $150,000 per patient to treat. Early-stage cases cost less than $30,000. Catching cancer sooner saves lives and saves money. Yet 55 percent of diagnoses still happen only after a woman notices symptoms herself. Of those diagnosed, 15 percent still die from the disease, despite breast cancer becoming increasingly treatable and curable.
But there is another bottleneck most people never see. Pathology—the analysis of tissue samples—is where every treatment decision flows through. New Zealand's public system remains largely manual: pathologists staining slides, counting cells one by one under a microscope. It is slow. It is constrained by workforce shortages projected to reach 11 percent by 2030. Rayner called for a shift toward digital pathology, a modernization that could accelerate the entire diagnostic pipeline.
Health Minister Simeon Brown, who hosted the event, pointed to progress already underway. Last October, the government extended funded breast screening from women aged 69 to 74. When fully rolled out by 2029, an additional 52,000 women per year will be screened, building on the 270,000 already screened annually. Since the expansion began, more than half of the 31,800 newly eligible women invited have taken up screening. Those women have already caught 190 breast cancers that would have gone undetected under the old age limit. Brown also announced increased funding for Pharmac—$604 million—to expand access to new medicines like Keytruda and Hertu for advanced breast cancer, and expansion of community infusion services nationwide.
Andi Shirtcliffe, a breast cancer survivor, spoke to the human weight of delay. Diagnosed at 57 in October 2022, she had a lump detected on screening that self-examination would never have found. She was fortunate to be within the screening age group. But she had delayed her own mammogram. "I was too busy," she said. "We're in the middle of the pandemic and my country needed me." She underwent two surgeries, chemotherapy—which triggered a severe reaction that depleted her immune system and led to repeated hospitalizations—and radiation therapy. She has not yet reached the five-year post-cancer milestone. "I still have two years to go," she said, "but so far so good." She wished she had acted faster. The long-term effects of treatment, the removal of lymph nodes, the complications that followed—these might have been avoided if diagnosis had come sooner.
The foundation's proposal is not radical. It is a reordering of existing pathways. But in a health system where weeks matter, where every delay measurably increases the risk of death, it could mean the difference between early intervention and late-stage treatment, between a woman catching cancer while it is still curable and discovering it only when options narrow.
Notable Quotes
Direct referral could remove up to eight weeks of delay, cut pressure on primary care, and reduce inequities for women least able to self-advocate or pay privately.— Ah-Leen Rayner, Breast Cancer Foundation chief executive
I was too busy. You know the story. We're in the middle of the pandemic and my country needed me. I wish I had acted faster.— Andi Shirtcliffe, breast cancer survivor
The Hearth Conversation Another angle on the story
Why does it matter that women go to a GP first instead of straight to imaging? Isn't a referral a referral?
Time. In Northland, only 22 percent of women start treatment within 28 days of diagnosis. That gap—weeks of waiting for a GP appointment, then waiting for the referral to process—compounds. Every four weeks of delay increases the risk of death by 8 percent.
So the GP is the bottleneck, not the imaging center?
The GP is one bottleneck. But there's another one almost nobody sees—pathology. Every treatment decision flows through tissue analysis. Our system is still largely manual, and we're facing a workforce shortage that could hit 11 percent by 2030.
If we fixed the referral pathway, would that solve the problem?
It would help. Direct referral could save eight weeks. But you'd still hit the pathology wall. That's why the foundation is also pushing for digital pathology—automating what's now done by hand under a microscope.
What's the cost of getting this wrong?
Late-stage breast cancer costs $120,000 to $150,000 per patient. Early-stage costs less than $30,000. But beyond money—15 percent of diagnosed women still die from breast cancer. A woman like Andi Shirtcliffe might not have needed chemotherapy, surgery, and radiation if her cancer had been caught and treated faster.
Is this a problem everywhere in New Zealand, or just some regions?
It's worse in some places. Auckland is at 60 percent of women starting treatment on time. Northland is at 22 percent. That gap is an equity issue. Women who can afford private care don't wait. Women in the public system do.
What would change if women could go straight to imaging?
The foundation says up to eight weeks of delay could be removed. That sounds abstract until you remember what those eight weeks mean—the difference between early-stage and late-stage treatment, between a 26 percent increased risk of death and a manageable one.