Examining the historical evolution of cancer policy in Australia: impact of key initiatives on equity and outcomes

Summary

Australia's cancer policy has progressed from fragmented, disease-specific initiatives in the 1960s–70s to coordinated national frameworks that aim to prioritise equity and patient-centred care. Early policies focused on treatment and prevention, with limited attention to disparities affecting different communities and population groups. This review aimed to examine the historical development of cancer policy in Australia and assess the impact of key initiatives on equity outcomes. A narrative review methodology was employed, drawing on policy documents, government reports, and peer-reviewed literature. Key milestones, systemic gaps, and strategies addressing disparities were identified and discussed. The review found a growing policy focus on addressing socioeconomic, geographic, and cultural barriers to care, reflected in initiatives such as the Australian Cancer Plan and Optimal Care Pathways. However, persistent challenges in implementation, resource allocation, and adherence monitoring limit progress. Strengthening monitoring systems and investing in prevention, early detection, high-quality care, and inclusive research remain critical to reducing the cancer burden and achieving equitable outcomes.

Background

Cancer remains a significant public health challenge in Australia.¹ In 2023, an estimated 165,000 new cancer cases were diagnosed,¹ and projections suggest this could increase to around 209,000 cases annually by 2034.¹ Between 2020 and 2044, new diagnoses are expected to grow by 51%, with cancer related deaths rising by 36%.² Importantly, while the absolute number of cases is rising, incidence rates for several common cancers have stabilised or declined, reflecting the impact of prevention and screening efforts.³ However, incidence rates are increasing among some younger populations,⁴ underscoring cancer's ongoing and evolving impact on individuals, families, and the health system.^1,5, 6, 7, 8, 9

Cancer is a leading contributor to illness in Australia, accounting for 18% of the nation's overall disease burden and nearly 9% of health system spending related to specific conditions.¹⁰ More than one million Australians are currently living with or beyond a cancer diagnosis,¹⁰ often with additional comorbidities that complicate care.¹¹ The cancer burden is especially significant among Aboriginal and Torres Strait Islander Australians, for whom cancer has been the leading cause of death since 2015.¹² While mortality rates have declined, cancer is expected to remain the leading cause of premature death in Australia over the next 20 years.¹³ This places increasing pressure on the healthcare system and highlights the need for urgent, robust action from policymakers and healthcare providers alike.

Australia has long invested in cancer prevention, screening, and treatment. However, unlike many comparable countries, it did not introduce a comprehensive National Cancer Control Plan (NCCP) until 2023. Evidence suggests that such coordinated national strategies are associated with improved outcomes, especially when equity goals are embedded.^14,15 The Australian Cancer Plan (ACP),¹⁶ embeds equity as a central principle, identifying ten ‘priority populations’ (Box 1) that continue to experience marked disparities in cancer risk, access to care, treatment outcomes, and overall experience.^10,17, 18, 19 At the heart of the ACP is a commitment to improving outcomes for Aboriginal and Torres Strait Islander people, recognising the need for culturally safe and community-led care.^16,20 It also outlines six strategic objectives: prevention and early detection, coordinated care, person-centred care, health system integration, data and research, and workforce development,^16,20 and is underpinned by the Optimal Care Pathways (OCPs) which provide a nationally endorsed framework to support consistent, safe, high-quality and evidence-based care across the cancer continuum.²¹ By aligning national efforts through the ACP and OCPs, Australia aims to deliver more equitable, high-quality cancer care that is responsive to the diverse needs of its population.

Box 1. Ten priority populations listed in the Australian Cancer Plan.

Aboriginal and Torres Strait Ialander people	People living in rural and remote areas	Lesbian, Gay, bisexual, transgender, intersex, queer and asexual (LGBTIQA+) people	People from culturally and linguistically diverse (CALD) backgrounds	People living with a disability
People in lower socio-economic groups	People living with a mental illness	Older Australians	Adolescents and young adults	Children

As Australia progresses into its early implementation of the ACP, it is critical to understand the historical and policy context of cancer control. This will provide valuable insights for shaping future policies, research, and implementation strategies both nationally and globally. Examining the evolution of cancer policy provides insight into how equity has been considered (or overlooked), highlights enablers and barriers to reform, and informs future strategies to ensure that equity commitments translate into measurable improvements. Given the increasing global focus on equity in cancer care, this paper contributes to the broader discussion on how NCCPs can be designed and implemented to drive meaningful improvements in outcomes and reduce disparities within both Australian and international contexts.

This review also responds to a pressing policy challenge: the alignment of research and funding priorities with national cancer control goals. While the ACP emphasises equity and system-wide reform, we will explore whether trends in research funding mirror these ambitions, particularly in relation to equity and health services research. Assessing the policy trajectory provides context for understanding potential gaps and identifying opportunities to better integrate funding strategies with national priorities.

Taken together, a historical perspective on cancer policy may not only illuminate the evolution of Australia's response but also inform how the ACP can be operationalised to deliver equitable outcomes, supported by targeted and aligned funding. This review therefore examines the historical evolution of cancer policy in Australia and assesses the impact of key initiatives on equity and outcomes.

Method

A comprehensive search strategy was employed to identify relevant literature and policy documents related to cancer policy in Australia. The electronic database PubMed was searched using broad search terms including “cancer policy” AND “Australia.” No date restrictions were applied in order to capture the full historical scope of cancer-related policy development. The database search was conducted between October and December 2024.

In addition to peer-reviewed literature, grey literature was methodically explored. This included targeted Google searches and manual browsing of key Australian government websites, such as the Department of Health and Aged Care, Cancer Australia, and the Australian Institute of Health and Welfare. Relevant parliamentary reports and other publicly available government publications were also identified and reviewed. A qualified librarian was engaged to assist in locating and sourcing physical copies of historical or hard-to-access policy documents housed in public and institutional archives.

Hand-searching of reference lists from included documents was conducted to ensure comprehensive coverage and to identify any additional sources that may not have been captured through electronic searches. Sector consultation was undertaken with key stakeholders involved in cancer control and policy development, including government officials, researchers, and consumer representatives, to identify additional relevant documents and contextual insights.

Eligibility criteria included any document, published or unpublished, that originated in Australia and contained substantive content related to cancer policy. Documents from any time period were eligible for inclusion. All documents were reviewed for relevance and inclusion by a single author.

A narrative synthesis approach was used to analyse the included documents. Documents were first grouped chronologically, allowing for examination of the historical trajectory of cancer policy in Australia. Within these chronological categories, documents were thematically analysed to identify recurring policy themes, major shifts in strategic direction, and the evolving emphasis on equity and national coordination.

The synthesis aimed to uncover the underlying logics and drivers of cancer policy across time, with a particular focus on how national priorities and equity considerations have been addressed and reshaped. Thematic patterns were iteratively refined to reflect both content frequency and contextual significance, drawing on both textual data and sector consultation insights.

Results were presented narratively, structured into sections organised by time period and overarching thematic focus. This structure enabled a clear examination of the development of cancer policy over time and provided a framework for assessing the impact of key initiatives on equity outcomes and national cancer control priorities. By contextualising policy developments within their historical and thematic settings, this approach facilitated a comprehensive understanding of how Australia's cancer policy landscape has evolved and where opportunities for future policy strengthening may lie. Furthermore, this narrative approach allowed for the identification of patterns, gaps, and emerging priorities, supporting targeted recommendations for improving equity and effectiveness in national cancer control strategies.

Findings

Cancer as a medical and scientific challenge: foundational development and biomedical framing (Pre-1990s)

During the mid-20th century, cancer was predominantly understood and addressed as a biomedical problem, with responses centred on curative treatment, specialist care, and hospital-based services.²² Policy approaches were largely reactive and institutionally driven, reflecting the dominance of the medical profession, particularly clinicians and researchers in shaping cancer control initiatives.²² National coordination remained weak, with fragmented policy activity across Australia's states and territories, and cancer was not yet conceptualised as a public health priority requiring comprehensive national action (Fig. 1).²³

Fig. 1.

Timeline of Australian cancer policy infrastructure and key milestones. Boxes coloured in grey note general public health policies and infrastructure indirectly impacting cancer. Boxed coloured orange note cancer-specific policies and infrastructure.

Early cancer-related efforts focused on treatment and research, rather than prevention or population health. The stigma and fear surrounding cancer meant public discourse was minimal, and a diagnosis was often equated with a terminal outcome.²² These attitudes constrained both public awareness and political will.²² Initial cancer control efforts were spearheaded by non-government organisations and the medical profession.^24,25 State and territory Non-Governmental Organisations (NGOs) (in Australia, these include Cancer Councils) also played a critical role in advocacy and patient support. While not nationally coordinated, their efforts raised awareness and informed policy within jurisdictions, laying groundwork for later national coordination. The formation of the Australian Cancer Society in 1961, driven by a coalition of state-based cancer charities and surgeons, marked an early attempt to consolidate influence and offer independent policy advice.²⁶ This society later evolved into Cancer Council Australia, reflecting an increasing ambition to shape national cancer control strategies.^25,26

The 1970s marked the emergence of oncology as a recognised medical subspeciality, and the establishment of the Clinical Oncological Society of Australia (COSA) further professionalised the field.²⁷ COSA facilitated interdisciplinary collaboration, education, and research, key elements in consolidating cancer as a scientific challenge necessitating ongoing medical innovation.²³

Access to cancer care during this period remained inequitable, often reliant on private insurance or charitable provision.²⁸ For example, in the early 1970s, fewer than half of Australians held private health insurance, leaving substantial gaps in coverage and affordability.²⁸ The introduction of Medibank in 1975, followed by its replacement with Medicare in 1984, was transformative, extending universal health coverage and markedly broadening access to cancer services.²⁹ Despite these advances, comprehensive national cancer control policy remained underdeveloped, and cancer prevention efforts, such as those targeting tobacco use, were sporadic and lacked coordination.

By the 1980s, despite Australia's relatively strong health indicators, cancer had become the second leading cause of death, and the limitations of a purely biomedical approach were increasingly evident.²⁶ During this period, the structure of the healthcare system, along with its legislative and policy frameworks, was primarily centred on the diagnosis and treatment of diseases.³⁰ Health outcomes were rarely measured systematically, as national data collections and evaluation mechanisms were limited.³⁰ Policy attention during this period remained largely anchored in a biomedical response, with prevention efforts and broader determinants of health receiving comparatively limited focus, and priorities were often set without strong consideration of epidemiological evidence or meaningful community engagement.³⁰ It became evident that, despite investments in the healthcare system, the overall health of the population was not improving, and health inequalities appeared to be widening.³⁰ In response to international calls for health reform,³⁰ the Australian government commissioned the Looking Forward to Better Health report (1985), which identified major gaps in national strategy, prevention funding, and leadership.^30,31

This led to the development of Health for All Australians (1988) see Table 1, the country's first national set of health goals and targets, including those for cancer.³² The report acknowledged the need to address upstream determinants of health and called for multisectoral collaboration in cancer prevention, particularly around lung, breast, colon, prostate, and skin cancers.³² These targets, while reflecting prevailing epidemiological data and the influence of organisations like the Australian Cancer Society,^30,33 were shaped without substantial community consultation, leading to concerns about their inclusivity and applicability to current ACP priority populations. Furthermore, despite its aim to reduce healthcare inequalities, the focus on these five cancers may have unintentionally contributed to disparities by potentially overlooking other cancer types and the broader complexities of health inequities. By prioritising cancers common in the general population, policy attention bypassed cancers disproportionately affecting underserved groups, such as head and neck cancer in those from lower socio-economic groups.³⁴ A prevention-oriented strategy aligned with population burden and social determinants of health may have supported earlier recognition of these disparities. The launch of the National Better Health Program (NBHP) in 1988 provided an initial policy platform for cancer prevention,³⁰ with funding directed primarily towards lung and skin cancer prevention, and breast and cervical cancer screening.^30,31 While the NBHP demonstrated early success, its selective focus risked neglecting less common or more complex cancers, such as liver and pancreatic cancer, which disproportionately affect certain populations, including Aboriginal and Torres Strait Islander peoples.³⁵

Table 1.

Key cancer policy documents and reports in Australia.

Policy/Report title	Year	Summary
Looking Forward to Better Healtha	1985	Early national report recommending a shift towards health promotion and disease prevention, forming the foundation for later national health strategies.
Health for All Australiansa	1988	National health policy influenced by the WHO “Health for All by 2000” strategy; emphasised equity, community involvement, and preventive health.
National Better Health Program (NBHP)a	1989–1992	Commonwealth-funded initiative to implement health promotion strategies in line with “Health for All” goals; laid groundwork for chronic disease prevention.
Goals and Targets for Australia's Health in the Year 2000 and Beyonda	1993	Follow-up to “Health for All”; established measurable health goals and targets; cancer was identified as a key health concern.
Better Health Outcomes for Australiansa	1994	Identified priority health outcomes and outlined national strategies to address major causes of disease, including cancer.
National Health Priority Areas (NHPA)a	1996	Cancer identified as one of the first priority areas; initiative aimed to focus policy and funding on conditions with significant health burden.
National Cancer Control Initiative (NCCI)	1997	Established to coordinate cancer control efforts across Australia and provide expert guidance to government and stakeholders.
Cancer Control Towards 2002	1997	Outlined goals for a more integrated national cancer control approach over five years; formed the basis for future cancer policy initiatives.
National Cancer Control Plan (NCCI/CCA)	2003	Developed by NCCI and Cancer Council Australia; comprehensive framework for prevention, early detection, treatment, and research.
Optimising Cancer Care in Australia (OCCA)	2003	Landmark report highlighting disparities in care and calling for multidisciplinary, coordinated, patient-centred cancer services.
Strengthening Cancer Care: A Policy Framework	2005	Set policy directions for enhancing the quality, access, and integration of cancer care nationally.
National Service Improvement Framework for Cancer	2006	Framework under the AHMAC outlining core components of optimal cancer care and system-wide improvement strategies.
Establishment of Cancer Australia	2006	Formation of the national agency to lead and coordinate cancer control efforts, research, and policy implementation.
National Cancer Work Plan (AHMAC/CSA)	2006	Coordinated plan for cancer system improvements, monitoring, and stakeholder collaboration under the leadership of Cancer Australia.
National Aboriginal and Torres Strait Islander Cancer Framework	2015	Framework addressing cancer disparities for Indigenous Australians through culturally safe, equitable, and accessible care strategies.
Aboriginal and Torres Strait Islander Cancer Plan	2023	Cancer plan emphasising culturally safe, community-led solutions, sustainable funding, and structural reforms to improve accessibility and responsiveness of mainstream cancer services for Aboriginal and Torres Strait Islander peoples.
Cancer Australia Strategic Plan 2022–2026	2022	Provides a roadmap for Cancer Australia's leadership in research, system reform, and equitable cancer outcomes.
Australian Cancer Plan (ACP)	2023	National plan setting out a 10-year vision to achieve world-class, equitable cancer outcomes through prevention, early detection, treatment, and survivorship.

^aNotes general public health policies indirectly impacting cancer; cancer-specific policies are unmarked.

Overall, during this period, prior to 1990s, cancer was framed largely through the lens of medical science, with clinical care and research dominating policy attention. While early steps toward prevention and national coordination were taken, cancer control efforts remained shaped by biomedical priorities, with public health strategies only beginning to gain traction at the close of the 1990s. This emphasis on biomedical solutions often overshadowed the social determinants of health and the structural drivers of inequity. Consequently, the needs of priority populations, such as Aboriginal and Torres Strait Islander peoples, rural and remote communities, and socioeconomically disadvantaged groups, were insufficiently addressed in both policy design and implementation (Table 2). The limited inclusion of community voices in national priority-setting further exacerbated disparities, as cancer types that disproportionately impacted priority populations, including liver and pancreatic cancers, received comparatively less attention and funding.³⁶ As a result, while there was progress in establishing national goals and prevention programs, these advances were unevenly distributed, with enduring gaps in access, cultural relevance, and health equity that would shape the trajectory of Australian cancer control in the decades to follow.

Table 2.

Key milestones in Australian cancer policy and equity implications.

Year	Policy initiative	Focus area	Equity implications
1961	Australian Cancer Society established	Cancer control advocacy	No formal equity focus.
1984	Medicare introduceda	Universal healthcare access	Improved general access but inequities for priority groups persisted.
1988	Health for All Australians developeda	National health goals	Priority groups (women, Aboriginal and Torres Strait Islanders) were initially excluded and there was a lack of community consultation.
1993	Goals & Targets for Australia's Health in the Year 2000 and Beyond releaseda	Framework for goals and strategies	Exclusive focus on particular cancer types and no equity focus.
1994	Better Health Outcomes for Australians launcheda	Goals, targets, and strategies	Expanded cancer types but no equity focus.
1996	National Health Priority Areas (NHPA) establisheda	Reporting and coordination	Equity not central; limited data on priority populations.
1997	National Cancer Control Initiative (NCCI) developed	National cancer priorities	Identified gaps but limited priority population focus.
2002	Optimising Cancer Care in Australia released	Multidisciplinary care models	First time those with lived experience were engaged in policy but lacked representation from priority populations. Explicit mention of rural/remote and Indigenous disparities.
2006	Cancer Australia established	National leadership in cancer control	Shift towards system-wide, evidence-based policy; growing equity focus.
2010	Optimal Care Pathways (OCPs) developed	Standardised patient care pathways	Some consideration of equity; tailored pathways emerged including Aboriginal and Torres Strait Islander (2018) and Adolescent and Young Adult (2022) OCPs.
2023	Aboriginal and Torres Strait Islander Cancer Plan	Aboriginal and Torres Strait Islander people	The first national cancer plan for Aboriginal and Torres Strait Islander people with a strong commitment to improving access and care.
2023	Australian Cancer Plan (ACP) launched	National cancer control plan with embedded equity	Strong commitment to reducing inequities across ten identified priority populations.

^aNotes general public health policies indirectly impacting cancer; cancer-specific policies are unmarked.

Systematisation, prevention, and equity: national coordination and population health approach (1990s–2010s)

From the early 1990s onward, cancer control in Australia entered a new era marked by increasing national coordination, systematisation of care, and a growing, albeit uneven, recognition of equity concerns. Catalysed by the Health for All Australians review²⁶ and subsequent Goals and Targets for Australia's Health in the Year 2000 and Beyond,³¹ the federal government began to articulate an integrated framework for improving health outcomes, including cancer-specific goals.³¹ This new policy direction prioritised prevention and early detection, incorporated broader social determinants of health, and introduced targets for reducing preventable mortality and morbidity.³¹ The framework promoted a more holistic approach to health system reform, including prevention, treatment, and palliative services.³⁷ However, these strategies remained centred on a limited set of cancer types: breast, cervical, lung, and skin,³¹ which may have inadvertently widened existing inequalities.

This narrowing of focus could have been partly driven by the lack of comprehensive data and limited early detection capabilities for other cancer types, leading to a prioritisation of more well-documented cancers. As a result, policy decisions continued to reflect this focus, potentially contributing to less attention for cancers that disproportionately affect priority populations. One of the starkest examples is the seven-fold increase in liver cancer mortality rates between 1968 and 2008, with most disease burden associated with hepatitis B and C infection, borne predominantly by priority population groups.^1,38 Another example is stomach cancer, which occurs at higher rates in migrant communities, who have poorer access to services which led to reduced rates of liver cancer in the 1990s.^39,40 This oversight may have further exacerbated disparities in cancer outcomes and deepened health inequities, as those cancers affecting underserved groups remain underrepresented in national initiatives.

The Better Health Outcomes for Australians (1994) initiative reinforced cancer as a national priority, expanding the list of targeted cancers and promoting population-level interventions.³⁷ However, persistent emphasis on a limited group of cancers perpetuated existing inequities. Factors such as age, socioeconomic status, geography, and race influenced both cancer incidence and access to care.41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53 For instance, Aboriginal and Torres Strait Islander peoples and those living in rural areas continued to face barriers to early detection and treatment, even as screening programs such as BreastScreen Australia,^44,54, 55, 56 cervical screening,^42,57,58 and later, the national bowel cancer screening program were rolled out.

Efforts to improve the quality and consistency of cancer care took a systematic turn with the launch of the National Health Priority Areas in 1996.⁵⁹ This initiative sought to establish consistent indicators across prevention, treatment, and survivorship.⁵⁹ Yet, despite a broader conceptual framework,⁶⁰ equity considerations remained largely absent in implementation. Reporting mechanisms highlighted disparities in outcomes but lacked the actionable levers to address them,³⁰ resulting in fragmented responses across jurisdictions.

The establishment of the National Cancer Control Initiative in 1997 marked a turning point in systematising cancer control policy.²⁶ Through the Cancer Control Towards 2002⁶¹ and Priorities for Action in Cancer Control 2001–2003,⁶² national strategies increasingly emphasised primary prevention, population screening, and coordinated treatment. However, representation from priority populations, especially Aboriginal and Torres Strait Islander peoples and those from low socioeconomic or rural communities was notably limited in these strategic consultations.⁶³ As such, initiatives often lacked the cultural and structural responsiveness needed to address the needs of diverse communities.

The publication of Optimising Cancer Care in Australia (2003),⁶⁴ was the first national policy document to explicitly highlight the role of equity in cancer care, notably led by two nongovernment organisations, COSA and Cancer Council Australia, and the federal government funded National Cancer Control Initiative. It identified systemic barriers, including jurisdictional fragmentation and inadequate service integration, and recommended reforms such as multidisciplinary models of care, improved data infrastructure, and consumer involvement.⁶⁴ Importantly, this report acknowledged the specific disadvantages faced by Indigenous Australians and rural populations,⁶⁴ though many recommendations lacked detail and actionable strategies to bridge access gaps effectively. For example, while travel support and culturally sensitive care were highlighted, concrete funding mechanisms or accountability structures were absent.⁶⁵ Similarly, workforce initiatives, such as training cancer specialists in regional areas, focused on supply-side improvements but did not address other barriers, like resource limitations or incentives for practitioners.⁶⁵

Following this, the National Service Improvement Framework was developed in 2002 and finalised in 2005 to guide consistent and equitable care across jurisdictions.⁶⁶ It sought to reduce unwarranted variation in outcomes and embed principles of timely, effective, and person-centred care.⁶⁶ However, evaluations of its effectiveness in addressing entrenched disparities remain limited.

Cancer Australia was established in 2006 in order to reduce fragmentation of cancer services, strengthen national coordination, and address gaps in equity identified across jurisdictions.⁶⁷ Its creation was strongly influenced by recommendations from the Optimising Cancer Care in Australia (2003) report, which called for greater integration, multidisciplinary care models, and national leadership to improve outcomes.⁶⁴ Cancer Australia consolidated efforts in research, policy development, and service coordination to provide strategic leadership across the cancer continuum.⁶⁷ The merger of Cancer Australia with the National Breast and Ovarian Cancer Centre in 2010⁶⁸ further centralised policy leadership, creating a single national agency with a clear leadership mandate across all cancer types.⁶⁸ It also enhanced Cancer Australia's capacity to better focus on its responsibilities under the Cancer Australia Act 2006.⁶⁹

Despite these advances, equity remained a persistent gap across national cancer policy efforts. Structural reforms consistently prioritised efficiency and systematisation, while the needs of priority populations were addressed only intermittently and without sufficient accountability mechanisms. The absence of comprehensive equity frameworks and underrepresentation of priority groups in policy formulation risked perpetuating existing disparities, underscoring the need for sustained investment in culturally responsive, accessible, and inclusive cancer control strategies.

Cancer as a complex whole-of-system issue: integration, personalisation, and system reform (2010s–Present)

In the contemporary era, cancer is increasingly recognised not only as a biomedical challenge but as a complex, chronic, and socially embedded issue requiring coordinated, whole-of-system responses.⁷⁰ Australian cancer policy has progressively evolved to reflect this understanding, marked by a shift towards personalised medicine, integrated care models, and consumer-driven policy design.^21,71

The foundations for a system-wide approach were laid in 2010 when the Council of Australian Governments (COAG) established a national direction for standardising cancer care.⁷⁰ In response, the National Cancer Expert Reference Group (NCERG) was formed comprising clinical, government, and consumer representatives.⁷⁰ The NCERG highlighted disparities in outcomes based on geography, Indigenous status, and socioeconomic factors, three current ACP priority populations.⁷⁰ The NCERG underscored the fragmented nature of the healthcare system, lack of comprehensive outcome data, and inadequate pre-treatment information as barriers to equitable cancer care.⁷⁰ In addressing these structural weaknesses, national standards were proposed that would ensure a continuum of high-quality, patient-centred care from prevention through to end-of-life.⁷⁰

This system-level ambition materialised in the creation of cancer-specific OCPs between 2014 and 2015.⁷² The OCPs provide nationally endorsed guidance describing the ideal cancer journey across seven key steps, from prevention and early detection through to survivorship and end-of-life care.⁷² They are designed to reduce unwarranted variation, ensure evidence-based practice, and embed principles of patient-centred and culturally responsive care.⁷² Developed through wide consultation with clinicians, policymakers, and consumers, the OCPs represent a distinctive Australian innovation in cancer policy.⁷² Importantly, they extend beyond clinical guidance to include sociocultural and equity considerations.⁷² However, their development and implementation were historically jurisdictional, shaped by varying state-based priorities, funding structures, and healthcare capacities. This fragmentation limited the national coherence and equity impact of the OCPs in their early years. Initially, only three priority populations were formally recognised, and this scope has since expanded²¹ to include specific pathways for Aboriginal and Torres Strait Islander peoples (2018, revised in 2024)⁷³ and Adolescents and Young Adults (2022),⁷⁴ with more underway for Older Adults, People Living in Rural and Remote Australia,⁷⁵ and LGBTQIA+ individuals. Despite this progress, significant equity gaps remain unaddressed, particularly for other priority populations, such as culturally and linguistically diverse communities and people with disability. Furthermore, the uneven implementation of OCPs, contingent on local resource availability, and the absence of rigorous monitoring frameworks continue to hinder their potential to drive system-wide equity improvements.

In 2023, the Aboriginal and Torres Strait Islander Cancer Plan was launched following extensive consultation with the Aboriginal Community Controlled Health Organisation sector.⁷⁶ This plan emphasises culturally safe, community-led solutions, sustainable funding, and structural reforms to improve accessibility and responsiveness of mainstream cancer services for First Nations peoples.⁷⁶

Building on these initiatives, formalisation of a truly national approach emerged with the launch of the ACP¹⁶ in 2023, the first unified cancer control plan for all Australians. Framed around whole-of-system reform, the ACP adopts co-design principles and prioritises equity, innovation, and Aboriginal and Torres Strait Islander leadership.¹⁶ It aims to reduce structural disparities by promoting culturally safe models of care, leveraging digital and genomic technologies, expanding telehealth access, and addressing financial toxicity among disadvantaged populations.¹⁶ Importantly, the ACP signals a shift towards outcome-based funding models and system integration across jurisdictional and sectoral boundaries.¹⁶ However, while the plan outlines these critical equity-focused goals, its effectiveness will depend on a well-defined implementation plan, a national data framework, a comprehensive framework for monitoring and improving outcomes, sufficient funding, workforce capacity and an ongoing commitment to research. These elements are essential to ensuring effective implementation and meaningful impact on reducing disparities in cancer care.

Aligning research investment with cancer policy and equity goals

Cancer research funding in Australia is central to advancing evidence-based policy and equitable cancer control. The National Health and Medical Research Council (NHMRC) has traditionally supported research across basic science, clinical care, public health, and health services to inform system-wide reform.⁷⁷ Ideally, this aligns with national strategies like the ACP,¹⁶ which emphasise equity, innovation, and population impact.

However, recent funding trends suggest a potential misalignment between the nation's evolving cancer policy ambitions and its research investment priorities (Table 3).⁷⁷ From 2014 to 2023, while total NHMRC cancer research funding fluctuated, ranging from a peak of $191.4 million in 2015 to a low of $153.7 million in 2021, the proportion of NHMRC funding directed to cancer has steadily declined.⁷⁷ NHMRC funding for cancer declined proportionally from 23.2% to 18.4% of total health research investment, despite growing policy commitments.⁷⁷ Similarly, while the Medical Research Future Fund (MRFF) continues to support cancer research, equity gaps remain.⁷⁹ Only 30% of MRFF-funded clinical trials in 2024 are based in regional, rural or remote areas,⁷⁹ with the proportion involving cancer trials unknown, reflecting broader disparities in access to care and research infrastructure.

Table 3.

Disease, research, and health areas funding provided by the NHMRC from 2014 to 2023.⁷⁸

	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
Funding cancer research ($ million)	188.3	191.4	170.6	175.8	178.9	181.6	170.2	153.7	158.9	165.6
Total funding ($ million)	812	780.6	896.1	828.8	877.7	783.3	923.2	760.2	986.1	900
% of funding spend on cancer research	23.2	24.5	19.0	21.2	20.4	23.2	18.4	20.2	16.1	18.4

These inequities in research investment mirror broader systemic funding shortfalls. Recent analysis found that rural Australians received approximately $8.35 billion less in healthcare funding compared to urban Australians, equivalent to $1090.47 less per person annually.⁸⁰ Such underinvestment has profound implications for cancer control, given the higher burden of disease and mortality risk in rural and remote populations.¹ Without deliberate rebalancing of both research and service funding, national equity goals outlined in the ACP will remain difficult to achieve.

These trends raise important considerations regarding the sufficiency of investment in cancer research, particularly OCP implementation efforts, relative to the burden of the disease and its role in achieving national cancer control objectives. The proportion of funding allocated to priority populations is unknown, as is the breakdown of funding for cancer research in basic science versus health service research. Addressing this data gap and funding disparity may be essential to sustain progress in implementing the ACP and addressing inequities in care.

Interpretation

This review provides a summary of the evolution of cancer policy in Australia with an emphasis on equitable care. Historically, Australia's commitment to universal healthcare and a national cancer agency has established it as a leader in cancer control. However, findings from a study coordinated by Union for International Cancer Control (UICC) and the International Cancer Control Partnership (ICCP), which analysed 156 NCCPs and non-communicable disease plans from countries across income levels, highlight key challenges that persist globally, including in Australia.⁸¹ These include resource constraints, the need for health system strengthening, equity issues, and gaps in data and surveillance.⁸¹ In addition, in a recent review the ICCP found that only 14% of NCCPs globally included a dedicated health equity goal.¹⁵

Despite Australia's progress, disparities persist, particularly among the ten priority populations identified in the ACP.¹⁶ Furthermore, existing data limitations may hinder the recognition of other vulnerable groups, reinforcing the ICCP study's emphasis on strengthening cancer registries and surveillance systems.⁸¹ This review highlights the need for robust monitoring mechanisms and culturally adapted care models to achieve the ACP's ambitious equity goals. The adaptability of cancer control plans, another key finding from the ICCP study, is especially relevant in Australia's context as it refines strategies to address emerging health threats.⁸¹ Globally, the ICCP study emphasised that only 32% of reviewed NCCPs mentioned vulnerable populations, and a mere 18% included strategies tied to universal health coverage, highlighting a gap between equity rhetoric and actionable planning.¹⁵ While federal initiatives such as the ACP embed equity as a guiding principle, it remains unclear whether associated funding mechanisms, both federal and state, are proportionately allocated to priority populations. For example, although Cancer Australia's establishment sought to reduce fragmentation, evaluations of funding distribution rarely report equity benchmarks, leaving questions about whether fiscal commitments have matched policy intent.

Australia's experience, particularly its integration of equity into national cancer strategies, offers valuable lessons for similarly economically placed countries such as those in Europe and the United Kingdom (UK), where healthcare systems also face disparities in cancer outcomes. Notably, the UK is the process of developing its own NCCP, presenting a timely opportunity to incorporate approaches that prioritise equity form the outset.⁸² Countries could adapt Australia's ACP framework for culturally safe practices, workforce redistribution, and equity monitoring to their contexts. The ICCP review underscores that multisectoral involvement is critical, yet only 18% of NCCPs involved people living with cancer, further affirming Australia's more inclusive stakeholder engagement as a strength.¹⁵ Moreover, Australia's history of addressing cancer as a public health priority demonstrates the importance of coordinated national efforts, aligning with the ICCP study's call for improved health system capacity to deliver comprehensive cancer care.¹⁵

For Australian policymakers, the review underscores the importance of funding equity-driven implementation initiatives and developing robust adherence measures for the ACP. For European and UK counterparts, it advocates learning from Australia's nationally coordinated approach that integrates federal and state responsibilities under a unified strategic framework. This centralised strategy offers important lessons for harmonising regional disparities and ensuring consistent care across jurisdictions. Overall, Australia's approach exemplifies how high-income countries can leverage policy history to refine cancer care frameworks, embedding equity as a central pillar of national cancer policy to ensure that initiatives addressing disparities remain a priority.

Future directions

Future directions for cancer control in Australia should focus on advancing the implementation of the ACP by prioritising three critical areas: enhancing support for implementation efforts, measure adherence and outcomes against the OCPs, and addressing inequities among priority populations (Table 4). While the ACP provides a comprehensive framework of priorities and recommendations, in 2025, it leaves notable gaps in these areas, creating challenges for health services seeking to operationalise its goals. Aligning research and policy is essential to address these gaps effectively, leveraging their combined influence to advance the national cancer control agenda.

Table 4.

Future directions for cancer control in Australia- A research-policy integration framework to support the Australian Cancer Plan.

Key area	Action priorities	Research needs	Policy needs
Monitoring adherence to Optimal Care Pathways	-Track alignment with ACP objectives (quality, safety, satisfaction, efficiency) -Identify barriers and variation in practice -Ensure responsiveness to emerging priority populations	-Develop adherence metrics and digital monitoring tools -Investigate reasons for inconsistent application -Enable population-sensitive data systems	-Standardise data definitions nationally -Establish systems for patient-level outcomes monitoring -Support translation into real-world care
Reducing inequities among priority populations	-Focus on culturally safe, accessible models -Ensure equity in resource allocation and service delivery -Engage communities and people with lived experience	-Map disparities in access and outcomes -Evaluate equity-focused interventions -Prioritise creation of OCPs for all recognised priority populations	-Expand community consultation -Tailor care models to diverse populations -Embed equity goals in performance and funding mechanisms
Supporting implementation efforts	-Enhance integration of OCPs into local settings -Build capability across health services -Address regional gaps in screening, prevention, and early detection	Fund health services and implementation research -Develop regionally adaptable interventions -Assess real-world application in underserved areas	-Provide operational guidance to services -Increase non-research funding to support OCP uptake -Align policy incentives with best-practice care

Measuring adherence to Optimal Care Pathways

Measuring adherence to OCPs is fundamental to ensuring that cancer care aligns with the ACP's objectives of improving quality, safety, patient satisfaction, and resource optimisation. Work is required to develop nationally-consistent robust metrics to evaluate adherence, identify barriers to consistent application, monitor outcomes and explore innovative solutions such as digital health tools. Data that is flexible to detect emerging priority populations is also essential so that the strong focus on currently identified priority populations don't leave behind other vulnerable groups, thereby ensuring history isn't repeated. Australia's healthcare and cancer data landscape provides important foundations for this work, with national collections managed by the Australian Institute of Health and Welfare (AIHW)¹ and population-based cancer registries in each state and territory. Cancer Australia's National Cancer Control Indicators³⁴ and initatives such as the Australian Cancer Atlas⁸³ also provide valuable platforms for monitoring outcomes and inequities. However, these datasets vary in scope, timeliness, and linkage capacity, limiting their current utility for assessing OCP adherence. Strengthening integration across jurisdictions and improving equity-focused data fields will be critical for tracking progress.

At the policy level, establishing systems to track adherence and collect patient-level data on outcomes is critical, with a strong need to ensure consistency in data definitions and collections across regions, states, and territories. These efforts must be aligned to provide health services with the tools and guidance needed to translate OCP recommendations into consistent, real-world practices specifically designed to improve cancer outcomes. Strengthening adherence will require not only robust monitoring and data infrastructure but also funding models that incentivise equity-focused implementation. Dedicated investment in workforce support, culturally responsive care, and regional service delivery could ensure that OCP uptake actively reduces disparities rather than reinforcing them.

Reducing inequities among priority populations

Reducing inequities among priority populations requires an integrated approach across research, policy and pratice. Research should identify specific inequities in access to and outcomes of cancer prevention, early detection, screening, and care, and evaluate targeted programs and interventions to mitigate these disparities. Concurrently, policy should continue to prioritise culturally tailored, accessible models, equitable resource distribution, and the integration of telehealth and other tailored innovations to reach underserved populations. To achieve this, consultation with people with lived experience of cancer, communities and experts should ensure that diverse and broad representation is achieved. Additionally, prioritising the creation of OCPs for all ACP recognised priority populations is required. Together, these efforts can address the structural barriers that perpetuate inequities and ensure that the ACP's equity goals are met.

Supporting implementation efforts

Supporting implementation efforts is another critical gap requiring close collaboration between research and policy. Research funding programs need to prioritise research that explores practical strategies for integrating OCPs and associated healthcare performance improvement practices into diverse healthcare settings, considering resource constraints and local contexts. This includes the development and evaluation of prevention, early detection, and screening programs that can be effectively implemented across various regions, particularly in underserved areas. These initiatives will play a key role in reducing the cancer burden and improving outcomes through early intervention. This may require increased funding allocation to cancer control, specifically in population health and health service research. Policymakers, in turn, should provide non-research funding and clear guidance to health services to operationalise these strategies. Alignment between research findings and policy initiatives can equip health services with the resources and frameworks needed to embed OCPs effectively, ensuring consistent and equitable delivery of cancer care.

Research funding priorities also need stronger alignment with equity objectives. Current NHMRC and MRFF allocations remain weighted towards biomedical research, with limited investment in health services and equity-focused studies. Clearer reporting on funding for ACP priority populations would strengthen accountability and help ensure equity goals are resourced effectively.

Reframing the future of cancer control in Australia around these priorities highlights the opportunity to align research and policy to achieve the ACP's goals and develop a consistent approach to addressing equity in cancer at a national level. By addressing current gaps, Australia can strengthen its cancer care framework, empowering health services to deliver high-quality, equitable care across the continuum, and helping ensure the ACP's vision is translated into measurable outcomes for all Australians.

Future directions for cancer control in Australia must focus on addressing key gaps in the implementation of the ACP. These gaps: monitoring adherence to OCPs, reducing inequities among priority populations, and enhancing support for implementation efforts present significant challenges for health services attempting to operationalise the ACP's goals. Aligning research and policy is crucial to tackling these challenges and advancing a consistent, equity-focused approach to cancer care. Cancer Australia's current implementation priorities, underpinned by its Equity Framework provide a foundational platform for this reform agenda.^20,78

By focussing on these priority areas, Australia can build on the ACP's foundation to create a cancer care system that is equitable, efficient, and responsive to the needs of all Australians. This approach will not only address current gaps but will also ensure that the ACP's ambitious goals are translated into measurable improvements in cancer care and outcomes across the nation.

Importantly, Australia is now entering a pivotal implementation phase. The launch of the national lung cancer screening program, one of the largest population-level cancer control initiatives focused on high-risk and underserved groups, offers a landmark opportunity to deliver on the ACP's equity commitments in practice. As a system-wide intervention, it will serve as a critical test case for the operational readiness of services to respond equitably and effectively to population need.

Conclusion

The historical evolution of cancer policy in Australia reflects a steady progression toward addressing disparities and improving outcomes through coordinated national efforts. Key milestones, such as the establishment of Medicare, the development of the OCPs, and the recent launch of the ACP, have underscored the importance of equity-driven strategies in cancer control. However, significant challenges remain, particularly in bridging gaps for priority populations, ensuring consistent implementation of OCPs, and addressing systemic inequities in funding and resource allocation.

Contributors

HR, SM, AU, and AC conceptualised the study. HR conducted the literature review, with SM, AU, and AC contributing to the thematic organisation of the literature. HR drafted the initial manuscript, with critical input and editorial support from AU, AC, SM, RB, PG, MV, and AB. All authors contributed to the interpretation of findings. HR led the revision of the manuscript, with support from SM, AU, and AC. All authors reviewed and approved the final version of the manuscript.

Data sharing statement

Not applicable.

Declaration of interests

All authors declare no conflicts of interest.