Introduction
The Australian health care system is failing to adequately prevent, diagnose and treat cancer among Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) Australians, a situation which is being confirmed by a growing body of research evidence1-2. Cancer survival is lower for Indigenous Australians than other people. It is the second leading cause of death among Indigenous people, accounting for a greater number of deaths each year than diabetes and kidney disease3-6.
The burden of cancer for Indigenous Australians has only recently begun to be fully appreciated. Compared with other Australians, Indigenous people have a similar or lower incidence of all cancers combined 1,6,8, but a higher incidence of rapidly fatal cancers (e.g. lung, liver) and a lower incidence of cancers with better survival (e.g. melanoma, breast) 1,2,8. In addition, many cancers that are amenable to prevention through reduction in exposure to risk factors or that are detectable early through screening programs are more common among Indigenous people1,2.
Advanced cancer at diagnosis1,4,6, reduced access to/uptake of treatment5, higher rates of co-morbidities amongst Indigenous patients6, and language barriers5 are some of the factors that may lead to poorer cancer outcomes. However, these factors only partly explain the disparity. Indigenous people with cancer have poorer survival compared to non-Indigenous people even after taking into account stage at diagnosis, cancer treatment and presence of co-morbidities5. Further complicating the picture is that many Indigenous cancer patients are not identified as such in the state/territory cancer registries that are the key sources of data on cancer patterns1,2,7, this means that the burden of cancer among Indigenous Australians continues to be underestimated.
The need to improve cancer-related health services for Indigenous Australians is apparent however the available evidence is currently inadequate to effectively direct efforts. Limited access to cancer care services, including radiotherapy services, continues to have a detrimental impact on cancer outcomes of Aboriginal and Torres Strait Islander patients.
Radiation oncology plays an important role in the treatment of those cancers that are most common among Aboriginal people. Access to radiation oncology services for Indigenous patients warrants additional research and a greater emphasis.
Demographics
Over half of the estimated resident Indigenous population reside in either1 New South Wales (29%) or Queensland (28%); 15% in Western Australia and 13% in the Northern Territory. Over a third of the population was located in Major Cities (32%); 21% lived in Inner Regional areas; 22% in Outer Regional areas; 10% in Remote areas and 16% in Very Remote areas.
Socioeconomic factors
Indigenous Australians have a lower life expectancy, higher unemployment rate (16.5%) and a significantly lower weekly income compared to non-Indigenous Australians2. According to the National Aboriginal and Torres Strait Islander Social Survey 2008, ‘Indigenous peoples aged 18 years and over were almost four times more likely than non-Indigenous people to live in households that were unable to raise $2,000 within a week in an emergency (47% compared to 13%)2.