Cancer is a major cause of illness in Australia—there are over 1 million people alive in Australia who are either living with or have lived with cancer (AIHW 2019b). Around 30 years ago, about 5 in 10 people survived for at least 5 years after their cancer diagnosis. More recent figures are closer to 7 in 10 people surviving at least 5 years (AIHW 2019b). Understanding and avoiding the risk factors associated with cancer can help to reduce the chance of getting the disease. Cancer screening programs increase the likelihood of detecting cancer early, enabling better outcomes from treatments. Improvements in treatments and care are also important contributors to improvements in survival. This page focuses on cancer screening programs and cancer treatments in Australia. See Cancer for information on cancer incidence, mortality, prevalence and survival.

Cancer screening

Population-based cancer screening is an organised, systematic and integrated process of testing for signs of cancer or pre-cancerous conditions in populations without obvious symptoms. In Australia, there are national population-based screening programs for breast, cervical and bowel cancers. They are run through partnerships between the Australian Government and state and territory governments. The programs target populations and age groups where evidence shows that screening helps to reduce ill health and deaths from cancer.

BreastScreen Australia

BreastScreen Australia provides free 2-yearly screening mammograms (see Glossary) to women aged 40 and over, and actively targets women aged 50–74. Between 1 January 2016 and 31 December 2017:

  • more than 1.8 million women aged 50–74 participated in BreastScreen Australia—around 55% of the target population (AIHW 2019a, 2019e)
  • participation in BreastScreen Australia for women aged 50–74 varied between population groups (AIHW 2019a):
    • around 41% of Aboriginal and Torres Strait Islander women participated in BreastScreen Australia compared with 54% of non-Indigenous women
    • around 43% of women living in Very remote areas participated in BreastScreen Australia compared with 57% for those living in Outer regional areas
    • around 46% of women from culturally or linguistically diverse backgrounds participated in BreastScreen Australia compared with 56% for English-speaking women
  • Between 1 January 2017 and 31 December 2017, more than half (59%) of all breast cancers detected through BreastScreen Australia were small (≤15 mm); small breast cancers are associated with more treatment options and improved survival (AIHW 2019a).

National Cervical Screening Program

From 1991 to 30 November 2017, the National Cervical Screening Program (NCSP) targeted women aged 20–69 for a 2-yearly Papanicolaou smear, or ‘Pap test’ (see Glossary).

  • Between 1 January 2016 and 30 June 2017 (the last monitoring period for the Pap test-based NCSP) nearly 3 million women aged 20–69 participated in cervical screening—estimated to be around 54–56% of the target population (AIHW 2019c, 2019e).
  • Participation varied across remoteness areas—it was highest in Inner regional areas (57%) and lowest in Very remote areas (46%), and ranged from 50% for those living in the lowest socioeconomic areas to 62% for those living in the highest socioeconomic areas (AIHW 2019c).
  • Between 1 January 2017 and 30 June 2017, for every 1,000 women screened, around 7 had a high-grade abnormality detected, providing an opportunity for treatment before possible progression to cervical cancer (AIHW 2019c).

Changes to cervical screening

Over time there have been improvements in technology as well as a greater understanding of the role of the human papillomavirus (HPV) in the development of cervical cancer. A HPV vaccine has been introduced that is administered to girls and boys under the National Immunisation Program (see also Immunisation and vaccination). All these developments led to a process by which the NCSP was reviewed and ‘renewed’, to ensure that the program continued to provide Australian women with safe and effective cervical screening. On 1 December 2017, a ‘renewed’ NCSP was introduced.

The renewed NCSP changed the way that women are screened. Instead of women aged 20–69 having a Pap test every 2 years, women aged 25–74 now have a Cervical Screening Test (CST) every 5 years (the CST is a HPV test, followed by a cytology test (see Glossary) if HPV is found). Another change is the collection of cervical screening data by the National Cancer Screening Register, which is now the primary source of cervical screening data.

National Bowel Cancer Screening Program

The National Bowel Cancer Screening Program (NBCSP) was established in 2006, offering screening to 2 target ages (55 and 65). In 2014, the Australian Government announced that the target ages would be expanded to offer 2-yearly screening to all Australians aged 50–74. This expansion was completed in 2020.

In 2017–2018 (the latest reportable period), the program invited men and women turning 50, 54, 55, 58, 60, 62, 64, 66, 68, 70, 72 and 74 to screen for bowel cancer using a free immunochemical faecal occult blood test (iFOBT) (see Glossary).

  • Since the expansion of the program from 2014, the NBCSP participation rate has increased from 39% in 2014–2015 to 42% in 2017–2018 (AIHW 2019e).
  • Of the diagnostic assessment data available, for participants in 2017 who underwent a diagnostic assessment after a positive screen, 3.4% were diagnosed with a confirmed or suspected bowel cancer, and 5.4% were diagnosed with an advanced adenoma (pre-cancerous tumour) (AIHW 2019d). The return of NBCSP forms is not mandatory, and as a result these diagnostic assessment data (adenoma and cancer detection rates) are incomplete and should be interpreted with caution.

How effective are the cancer screening programs?

National cancer diagnosis data do not reveal if a new case of cancer was identified through a screening program. This information can currently only be determined using data linkage. Recent linkage work conducted by the AIHW examined the effectiveness of the 3 national cancer screening programs on cancer mortality (AIHW 2018).

  • Women aged 50–69 who were diagnosed with a breast cancer through BreastScreen Australia between 2002 and 2012 had a 42% lower risk of dying from breast cancer by 2015 than women with breast cancers who had never been screened (AIHW 2018).
  • Women aged 20–69 who were diagnosed with a cervical cancer through the National Cervical Screening Program between 2002 and 2012 had an 87% lower risk of dying from cervical cancer by 2015 than women with cervical cancers who had never had a Pap test (AIHW 2018).
  • People aged 50–69 who were diagnosed with a bowel cancer detected through the National Bowel Cancer Screening Program had a 40% lower risk of dying from bowel cancer by 2015 than those with a bowel cancer who had not been invited to screen during the study period (AIHW 2018).

Cancer treatment

While population-based cancer screening in Australia focuses on asymptomatic populations for breast, cervical and bowel cancers, treatments for cancer aim to improve outcomes for individuals once they have received a cancer diagnosis, irrespective of the cancer type. Detailed reporting on cancer-related treatments can be found in Cancer in Australia 2019 (AIHW 2019b). Summaries of 4 key areas of cancer treatment (hospitalisations, chemotherapy, radiotherapy and palliative care) are presented below.

Cancer-related hospitalisations

In 2016–17, there were around 1,229,000 cancer-related hospitalisations, accounting for about 11% of all hospitalisations in Australia (AIHW 2019b). Of these:

  • 72% (around 888,000) were same-day hospitalisations (see Glossary). The large number of same-day hospitalisations is in part accounted for by the number of chemotherapy treatments
  • 28% (around 341,000) were overnight hospitalisations (see Glossary), with an average length of stay of 7.8 days. Cancer of other central nervous system had the longest average length of stay (14.4 days), followed by cancer of other plasma cell (12.7) and leukaemia (12.5)
  • non-melanoma skin cancer was the most common cancer recorded as a principal diagnosis (25%), followed by cancer of secondary site (see Glossary) (9.5%) and prostate cancer (8.4%).

Chemotherapy

Chemotherapy involves the use of drugs (chemicals) to prevent or treat disease (in this case, cancer). Chemotherapy can be used on its own or in combination with other methods of treatment. 

In 2016–17, around 684,000 chemotherapy procedures were performed for cancer-related hospitalisations (AIHW 2019b). Of these:

  • lymphoma was the most common principal diagnosis for both males (21%) and females (17%). This was followed by leukaemia (16% for males and 14% for females) and colorectal (bowel) cancer (11% for males and 12% for females)
  • females accounted for just over half of chemotherapy procedures for cancer-related hospitalisations (around 361,000 hospitalisations; 53%).

Radiotherapy

Radiotherapy is the use of X-rays to destroy or injure cancer cells so they cannot multiply and is an important part of cancer treatment. Australian research indicates that 48% of cancer patients should receive external beam therapy (the most common form of radiotherapy) at least once during their treatment (Barton et al. 2014). Similarly to chemotherapy, radiotherapy can be used on its own or in combination with other treatment methods.

In 2016–17, more than 63,500 courses of radiotherapy were administered in Australia (AIHW 2019b). Of these, around one-quarter of the radiotherapy courses for males were for prostate cancer (26%) and 44% of radiotherapy courses for females were for breast cancer.

In 2017, around 67,900 people received more than 2.2 million Medicare-subsidised radiotherapy services (AIHW 2019b). Of these:

  • patients had, on average, 32 radiotherapy services (34 for males and 30 for females)
  • the Australian Government contributed, on average, $6,684 per patient ($7,011 for males and $6,350 for females)
  • around 90% of patients were over the age of 50.

Palliative care

Palliative care—sometimes referred to as ‘hospice care’, ‘end-of-life care’ and ‘specialist palliative care’—is an approach that aims to improve the quality of life of patients and their families facing the problems associated with life-threatening illness. This is done through the prevention and relief of suffering by means of early identification and assessment and treatment of pain and other problems, physical, psychosocial and spiritual (WHO 2002).

In 2016–17, around 77,400 hospitalisations in Australia involved palliative care (0.6% of all hospitalisations). Of these, 54% were cancer-related (AIHW 2019b).

The most common type of cancer recorded for palliative care hospitalisation was secondary site cancer (21%), followed by lung cancer (13%) and colorectal (bowel) cancer (6.8%) (AIHW 2019b).

Where do I go for more information?

For more information on cancer screening and treatment, see:

Visit Cancer screening and Cancer for more on this topic.

References

AIHW (Australian Institute of Health and Welfare) 2018. Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia. Cat. no. CAN 115. Canberra: AIHW.

AIHW 2019a. BreastScreen Australia monitoring report 2019. Cat. no. CAN 128. Canberra: AIHW.

AIHW 2019b. Cancer in Australia 2019. Cat. no. CAN 123. Canberra: AIHW.

AIHW 2019c. Cervical screening in Australia 2019. Cat. no. CAN 124. Canberra: AIHW.

AIHW 2019d. National Bowel Cancer Screening Program: monitoring report 2019. Cat. no. CAN 125. Canberra: AIHW.

AIHW 2019e. National cancer screening programs participation data. Cat. no. CAN 114. Canberra: AIHW. Viewed 2 December 2019.

Barton M, Jacob S, Shafiq J, Wong K, Thompson S, Hanna T et al. 2014. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiotherapy and Oncology 112:140–4.

WHO (World Health Organization) 2002. National cancer control programmes: policies and managerial guidelines. 2nd edn. Geneva: WHO.