Informed, engaged communities for health

Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
#iDEA24
#ASMIRT2024
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
#iDEA24
#ASMIRT2024
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

Cancer screening programs: challenges and future directions

Australia’s cancer screening programs have successfully reduced the burden of cancer on our community but it is important that we continue to question their role and evaluate their performance.

Are the existing programs achieving their maximum potential? How can we build on their success to improve future outcomes? Which groups in Australia are missing out on the benefits of these important programs?  What other cancers might benefit from a more systematic approach to screening and testing?

The latest edition of Public Health Research & Practice explores these and other important questions about the future of cancer screening in Australia through a series of articles by leading cancer researchers and screening experts.

The key findings from this edition are summarised below.


Jennifer Doggett writes:

For a cancer to be suitable for a screening program it needs to satisfy three key criteria: 1) be a disease with a latent or early stage; 2)  have an acceptable means of finding the cancer or precancerous condition early; and 3) have an available and acceptable treatment that can demonstrably change the expected outcome.

Australia has established three population screening programs for cancers that meet these criteria: the National Bowel Cancer Screening Program (NBCSP); BreastScreen Australia; and the National Cervical Screening Program (NCSP).  All three programs have successfully prevented the impact of cancer on their target populations but also face challenges in their design and/or implementation.

Participation rate challenges

One specific challenge facing all of these programs is their lower-than-desired participation rates, especially in communities that are hard to reach.

In fact, all three programs are falling significantly short of the target 70% participation rate:

  • NBCSP: Of the 4.1 million people aged 50­–74 invited to screen, only 41% participated (2016-17)
  • BreastScreen Australia: Out of all eligible women aged 50–74 only 55% participated (2016-17)
  • NCSP: Out of eligible women aged 20–69 only 56% participated (2015-16)

This low participation rate is concerning as it reduces both the overall outcomes and the equity of our investment in cancer screening.

Image source: www.aihw.gov.au

Geographic differences

Data from the Australian Institute of Health and Welfare shows that there are major differences in participation rates between different geographic areas. For example, the Primary Healthcare Network (PHN) with the highest participation rate for BreastScreen Australia was Northern Sydney (64%), almost 20 percentage points higher than the PHN with the lowest rate, the Northern Territory (46%).

At the Statistical Area 3(SA3) level, there are even larger regional differences, even between communities of similar sizes, such as Armidale, NSW which had a participation rate of 68% and Alice Springs, with a rate of only 35%.

There were also large geographic differences in participation in the NBCSP with Central and Eastern Sydney PHN having the highest participation rate of 49%, compared with the ACT and Northern Territory PHNs which had the lowest rate of 35%.  Data by PHN or SA3 is not available for the NCSP.

Overall, screening participation rates are lower among Aboriginal and Torres Strait Islanders than among non-Indigenous Australians. For example, in 2015–2016, the age-standardised breast screening participation rate for Indigenous females aged 50–74 years (39.1) was lower than for non-Indigenous females (54.3%). This difference in screening rate adds to the health gap that already exists between these two population groups.

Image source: www.indigenousbowelscreen.com.au

High priority for action

The need to identify and address the reasons for low participation rates is addressed in a number of different articles.  For example, Ee and St John strongly argue that this should be a high priority for the NBCSP, given that the efficacy of the program has been established in the Australian setting.

They state: “On current evidence, increasing participation among the established 50–74-year-old cohort will yield the strongest investment in improved outcomes.” Some suggestions for improving participation rates are provided in the article by Lotfi-Jam et al, including widespread mass media strategies, targeted education sessions with under-screened communities and GP endorsement initiatives.

In their introduction to the series of articles, Sanchia Aranda and David C Currow also emphasise the importance of understanding the causes of low participation rates in some communities in order to address the rising gap in outcomes.

A balancing act

Balancing the benefits of screening programs with any potential harms and determining their cost-effectiveness is an important component of developing future screening policies. An article by Lew et al explores the role of modelling through microsimulation in informing any potential changes to screening programs.  Getaneh et al.also explores microsimulation in relation to future screening in prostate cancer, where there is a need to balance concerns about the negative impact of overtreatment.

The potential benefits of adopting a more risk-based approach to screening is discussed in a paper by Nickson et al.  They explain that screening is, by definition, a population-level intervention, but the one-size-fits-all approach limits tailoring screening to best suit individuals with varying levels of risk.

Emerging knowledge of risk factors, such as the relationship between breast density and breast cancer risk, opens the door for risk-stratified approaches.  This could improve outcomes, particularly for those most at risk for whom current screening protocols are not optimal.

However, Nickson et al also explain that developing these approaches is not straightforward, and risk-based screening could make both the system and the messaging to the public more complicated. This presents challenges which must be overcome if the benefits of risk stratification within screening programs are to be realised.

Image source: www.bedenseaware.com

Cervical screening program

The change in the NCSP from 2-yearly cytology-based screening to 5-yearly primary HPV screening is discussed by Smith et al who found that the change process was more complex and demanding than initially anticipated.

One specific issue identified as delaying the roll-out of this program was the time taken to build and implement the National Cancer Screening Register. The need to develop regulatory requirements for self-collection was also mentioned as a complication because self-collection was not formally included as an intended use by HPV test manufacturers.

Smith et al also noted that problems with unexpected colposcopy demand caused issues for providers and consumers and may have been due, in part, to some testing outside guideline recommendations, highlighting the importance of training providers in the rationale for guidelines as well as the content.

Overall the authors stressed the need for earlier and more extensively delivered information to healthcare providers and improved coordination of stakeholder support between government and nongovernment organisations in order to extend both the reach and credibility of communication about the program changes.

Looking to the future

With a track record of successful and well-established national screening programs for breast, bowel and cervical cancers, researchers are now exploring the feasibility of developing systematic and targeted screening programs for a number of other cancers, including lung cancer, melanoma, Lynch syndrome, and hepatocellular carcinoma.

While population-wide screening programs for these conditions are not currently supported by evidence, there may be opportunities to save thousands of lives through a more systematic approach to screening, testing and/or surveillance for these conditions.

For example, there is evidence from the US that a targeted screening program of current and former high -risk smokers could prevent deaths from lung cancer. Weber et al suggest that this approach could help reduce Australia’s largest cause of cancer mortality among the population group most at risk.

Melanoma is another well-known cancer where there is insufficient evidence to support population-wide screening. However, Dunlop et al argue that shifting from the current opportunistic approach to melanoma screening to a national, risk- stratified program may be a promising way forward to reduce the heavy burden of the disease

Lynch syndrome is a common but hidden genetic condition that increases the risk of several different types of cancer. Systematic testing for the syndrome in patients with colorectal cancer, as well as genomic developments, could help address under-diagnosis of this condition, according to research conducted by Taylor et al.

Lockart and Danta argue for a better system of routine surveillance for hepatocellular carcinoma in order to reduce the growing incidence and mortality from the disease in Australia, in particular among high-risk populations.

In relation to testing for prostate cancer, Armstrong provides evidence that the new Australian guidelines on prostate specific antigen testing have only had a limited impact on practice and argues that a more thorough evaluation is needed of their impact.

Take-away messages

The overall theme of this issue is that for the benefits of screening to be maximised, Australian policy makers and governments must be prepared to engage in ongoing analysis of program effectiveness, and be open to considering program changes to balance benefits, harms and costs.

As in many other areas of population health, high quality data is crucial. In particular, researchers in this area stress the need for investing in linked datasets that enable more complex understandings of the varying impacts of early diagnosis and improvements in treatment on mortality and survival across our community.