A series of Reviews published in the June edition of The Lancet Oncology discusses the health inequalities faced by the Indigenous population of Australia when receiving cancer care.

Dr Joan Cunningham and Dr Alice Rumbold (Menzies School of Public Health Research, Casuarina, Northern Territory, Australia) and colleagues begin the review by noting the range of socioeconomic disadvantages that Indigenous Australians (Aborigines and Torres Strait Islanders) have compared with other Australians – the continuing legacy of colonization, dispossession, and social disruption. Indigenous Australians are also expected to live about 17 fewer years than other Australians.

“An assessment of recent data of cancer in Indigenous Australians shows that, although they are less likely to have some types of cancer than other Australians, Indigenous people are significantly more likely to have cancers that have a poor prognosis, but are largely preventable, such as lung and liver cancer. Indigenous people with cancer are diagnosed at a later stage, are less likely to receive adequate treatment, and are more likely to die from their cancers than other Australians,” write the authors.

In addition to inadequate health-system performance, the higher prevalence of risk factors (most notably smoking) provide possible explanations for the Indigenous population’s higher cancer incidence and mortality rate. In order to monitor patterns, identify regional variations, and assess control programs, improvements in data quality and availability are still needed. “However, there is already sufficient information to identify priorities and inform appropriate remedial action. A decrease in tobacco use is crucial for decreasing the burden of cancer (and other chronic diseases) in Indigenous Australians. With half of Indigenous adults being daily smokers, and no evidence of any measurable decrease in smoking over the past decade, it is apparent that tobacco-control programmes up to now have been inadequate and ineffective. Such programmes need to be designed to be effective in the context of social disadvantage, and need to address the social and cultural role of smoking in Indigenous people,” suggest the writers.

The authors recommend that Indigenous Australians in both remote and urban areas receive across-the-board health-service improvements, such as health education and health promotion programs; screening, immunization, and other public health programs; improvements in primary care; and specialist curative and palliative services. These service improvements should specifically keep the Indigenous population in mind, according to the authors.

“Effective mainstream services can be adapted to be culturally appropriate for Indigenous people, as shown, for example, by the Northern Territory Well Women’s Screening Programme. The resultant decrease in cervical cancer in the Northern Territory suggests that rapid change is possible, at least for some cancers,” they conclude.

Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia
Joan Cunningham, Alice R Rumbold, Xiaohua Zhang, John R Condon
The Lancet Oncology (2008); 9[6]: pp. 585-595
DOI:10.1016/S1470-2045(08)70150-5.
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Written by: Peter M Crosta