Introduction

Introduction

Overview

Prevention and early detection of cancer

Although accurate and current data on the true impact of cancer on Aboriginal and Torres Strait Islander people are limited, available data highlight the stark inequities that exist within Australia.

In 2017, cancer overtook circulatory diseases as the leading cause of death among Aboriginal and Torres Strait Islander people, with lung, breast, bowel (colorectal), prostate and head and neck cancers the most commonly occurring.¹ In 2018, cancer was estimated to account for 9.9% of the total burden of disease for Aboriginal and Torres Strait Islander people.² This is 1.7-fold higher than for non-Indigenous Australians,² and the gap in mortality rates continues to widen between the two populations.

The evidence suggests specific, strategic and sustained efforts are required to redress inequities. Survival rates associated with screening-detectable preventable cancers (eg lung, breast, bowel, cervical, liver and head and neck cancers) are lower for Aboriginal and Torres Strait Islander people than for non-Indigenous Australian people.^3,4 Likewise, secondary and tertiary prevention initiatives are vitally important to achieving equity. Even where incidence rates of some cancers are lower for Aboriginal and Torres Strait Islander people (eg some childhood cancers and prostate cancer), survival rates are still lower, reflecting the systemic barriers to effective preventive and health promotion initiatives, as well as access to high-quality and timely care, including screening, early diagnosis, treatment, rehabilitation and palliative care.⁵

Aboriginal and Torres Strait Islander communities are best placed to identify priorities and lead community actions to prevent and manage cancer. Guided by the National agreement on Closing the Gap and four Priority Reforms,⁶ the Australian Government has committed funding to the Aboriginal and Torres Strait Islander Community Controlled Health Organisation (ACCHO) sector to lead efforts to redress the cancer equity gap and improve health outcomes for those most at risk of, and affected by, cancer. Holistic, strengths-based, life course approaches that address the full spectrum of cancer care and control are needed. Trauma-informed approaches to care that acknowledge the fear, stigma and complexity associated with cancer prevention and care are essential to promoting the social, cultural, economic and emotional wellbeing of those living with and affected by cancer.

The foundations for a paradigm shift in cancer prevention and treatment among Aboriginal and Torres Strait Islander people and communities have been laid with the recent release of the Aboriginal and Torres Strait Islander cancer plan.⁷ This plan has been co-designed with the ACCHO sector following extensive engagement and should inform all future efforts to meaningfully change and improve cancer outcomes for Aboriginal and Torres Strait Islander people.

This guide outlines the evidence base and makes recommendations for the prevention and early detection of six common cancers, and seeks to ensure all primary health practitioners have ready access to the latest body of evidence to inform clinical advice to community members and support locally adapted preventive initiatives. Aboriginal and Torres Strait Islander health workers, practitioners and hospital liaison officers have a particularly vital role to play in cancer prevention, management and care and are essential partners in cancer planning, implementation and evaluation initiatives at all levels.