Elsevier

The Lancet Oncology

Volume 9, Issue 6, June 2008, Pages 585-595
The Lancet Oncology

Review
Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia

https://doi.org/10.1016/S1470-2045(08)70150-5Get rights and content

Summary

An assessment of recent data on cancer in Indigenous Australians (Aborigines and Torres Strait Islanders) 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. Inadequate identification of Indigenous people in cancer registers precludes reporting for some parts of Australia, but sufficient information is available to identify priorities and inform appropriate remedial action. Health-risk factors, especially smoking, and inadequate health-system performance largely explain the patterns of cancer incidence and mortality in areas with adequate data. Effective tobacco control programmes, improvements across a range of health services, and meaningful Indigenous engagement are all needed to decrease the burden of cancer in Indigenous Australians.

Introduction

Indigenous Australians (Aborigines and Torres Strait Islanders) have a range of socioeconomic and health disadvantages compared with other Australians, consistent with the ongoing legacy of colonisation, dispossession, and social disruption. Indigenous life expectancy is about 17 years less than for other Australians,1 with only slow progress in closing this gap. Health problems, such as poor maternal and child health, infectious diseases, injury, diabetes, and heart disease are areas of major concern, as are high rates of smoking, obesity, and other behavioural risk factors (figure 1).1

Cancer has only recently been regarded as an important health issue for Indigenous Australians. Although other health problems might have more focus, cancer is a leading cause of death for Indigenous Australians, as for all Australians (17% and 30% of all deaths, respectively, in 2005).2 The availability of information about cancer is much more limited for Indigenous people than for Australians generally, mainly as a result of the shortcomings in the quality of identification of Indigenous people in administrative data collections.1, 3

A previous review on cancer in Indigenous Australians4 reported the limited information published up to 2001, which related mostly to risk-factor prevalence and to mortality statistics from South Australia, Western Australia, and the Northern Territory. At that time, there was little information on cancer incidence, diagnosis, treatment, and survival, or on time patterns in this population.

Since then, there have been considerable improvements in the availability of information relevant to cancer control in Indigenous Australians. In particular, there have been improvements in information on cancer incidence, diagnosis, treatment, and survival; information for Indigenous people in other states, especially Queensland and New South Wales; and information for time patterns in certain aspects of cancer, especially in the Northen Territory. Although important gaps remain in our current knowledge, and national statistics on cancer in Indigenous people are still not available, a more complete picture of cancer occurrence, causation, and control in Indigenous Australians can now be presented.

The aim of this Review is to provide an up-to-date assessment of cancer in Indigenous Australians, including the demographic and socioeconomic context; patterns of incidence, mortality, treatment, and survival; key risk factors; screening participation; and the views of Indigenous people on cancer and cancer treatment. This information is intended to strengthen the evidence base for improving prevention and control of cancer in Indigenous Australians.

Section snippets

Demographic and socioeconomic factors

A reason for why cancer might be less prominent in Indigenous Australians than other health conditions is the age of this population, with a median age of 20·5 years and only 3% of people aged 65 years or more in 2001.5 These data contrast sharply with the non-Indigenous population (median age 36·1 years, 13% aged ≥65 years in 2001).5 The median age of Indigenous people is similar across Australia, ranging from 19·5 years in Tasmania to 21·8 years in the Northern Territory.5

Most Indigenous

Incidence

There are currently no national data on cancer incidence in Indigenous Australians due to poor data quality in several jurisdictions. Of primary concern are Indigenous patients who are registered, but not correctly identified as Indigenous. The three cancer registers of the Northern Territory, Western Australia, and South Australia have long been known to collect data on Indigenous status that are of sufficient quality to allow publication; however, a formal assessment of data quality has only

Behavioural factors

Data on behavioural risk factors, including smoking, alcohol consumption, obesity, and dietary quality, are available from the 2004–05 National Aboriginal and Torres Strait Islander Health Survey.41 After adjusting for age, Indigenous Australians were 2·2-times more likely to be current daily smokers; 1·1-times more likely to consume alcohol at dangerous levels; 1·2–times more likely to be overweight or obese; twice as likely to report no daily fruit intake; and 6·6-times more likely to report

Barriers to cancer prevention, detection, and appropriate care

People's perceptions about cancer can have an important effect on their association with preventative, diagnostic, curative, and palliative services. Several studies have explored Indigenous people's views relating to cancer. Most of this work has been done in Queensland and the Northern Territory and has focused on breast and cervical cancer.

A persistent finding is the fear of cancer as a death sentence beyond the control of medical intervention.56, 57, 58 Although this fear is consistent with

Conclusion

Despite the limited available data on cancer in Indigenous populations, and the varying quality of such data, cancer is clearly an important health issue for Indigenous Australians. Although Indigenous people are less likely to have some types of cancer, they are significantly more likely to have cancers that have a poor prognosis, but that are largely preventable, such as lung and liver cancer. Indigenous patients with cancer are diagnosed later, less likely to receive adequate cancer

Search strategy and selection criteria

Several databases, including PubMed and the various databases in the Australian Health Databases (INFORMIT). Key search terms included alternative expressions and open terms for “Australia”, “Indigenous”, and “(pre-)cancer” in combination. Additional references were obtained from the Australian Indigenous HealthInfoNet on-line clearinghouse, the Australian Institute of Health and Welfare, and the Australian Bureau of Statistics. All Australian State and Territory cancer registers were

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