Royal Hobart Hospital

To the already well-known health disadvantages of Australia’s Indigenous citizens must now be added the problem of cancer. David Roder’s paper (page 7) in this special issue ofCancer Forum brings to light previously unobtainable statistics which show that our Indigenous population suffers disproportionately from cancer in several ways. Firstly, compared with the general Australian population, Indigenous Australians have a higher incidence of cancers with poor outcomes, such as those of the lung and liver. In contrast, the rate is lower for cancers which generally respond well to treatment, such as lymphomas and breast cancer. However, even when afflicted with the same cancers, the outlook for Indigenous people is worse. Partly this is due to later diagnoses, but even stage-matched the prognosis is inferior. These disturbing statistics should ring alarm bells for those of us concerned to ensure that all Australians benefit from recent improvements in cancer management, no matter their race, background or place of residence.

The practicalities of dealing with Indigenous cancer are brought into focus in the paper from Ian Olver and his colleagues (page 10). Using a technique that is novel for a scientific publication but that will be familiar to health professionals who work in the field, namely story-telling, they describe day-to-day difficulties that need to be overcome if we are to improve the outlook for Aborigines and Torres Strait Islanders. They highlight the need for the non-Indigenous population to develop an understanding and appreciation of Indigenous culture.

In a contribution that should open the eyes of the rest of the community, Sandy Angus, an Aboriginal health worker from Queensland, gives an Indigenous perspective (page 13). She tellingly illustrates how questions of Indigenous health cannot be divorced from the broader issues of racism, neo-colonialism, community disadvantage and loss of social capital. However, on a positive note, she describes how a culturally-respectful program with community involvement has dramatically improved the outlook for cancer of the cervix for Queensland’s Indigenous women. The method by which this gratifying result has been achieved provides a model which should be noted by everyone working in this challenging field.

These three papers came out of Australia’s first ever conference focusing on Indigenous cancer, held in Darwin in August, 2004 under the auspices of The Cancer Council Australia. With the permission of the publishers of the Medical Journal of Australia, an overview of the conference (entitled “Reducing the impact of cancer in Aboriginal and Torres Strait Islander communities: ways forward”) is reprinted on page 17. Those who attended heard a series of unique presentations from workers at the ‘coal face’ – it was a privilege to be present. Some of the highlights that are not otherwise acknowledged in the papers in this issue of Cancer Forum, are given in the Summary of Presentations.

The Australian cancer establishment and the country’s federal, state and territory governments need to confront the issue of Indigenous cancer. That its importance has hitherto been overlooked and neglected shames us all; the matter is urgent. Cancers are occurring that could be prevented and lives are being lost that could be saved, now. The good news is that ‘ways forward’ were indeed identified at the conference. As described by Sandy Angus, the ‘talk-fest’ is over; now is the time for action.

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