The greatest gains in cancer control in Australia are to be made in prevention strategies, primarily changes in lifestyle. Some of the most effective measures have been government policy changes that required no taxpayer funding but a cultural shift, such as tobacco advertising prohibition in the 1970s.
Successful funded campaigns have provided strong economic returns, yet governments continue to invest only around one-hundredth of the overall healthcare budget in primary prevention. Tobacco is responsible for 21.6% of all cancer deaths, yet governments delay the implementation of tobacco control strategies, such as smoking bans in enclosed public spaces. Some governments defend investing taxpayers' money in tobacco companies as responsible economic management, despite the same taxpayers' money funding the treatment of tobacco-related diseases at least until the smokers die of them. Other lifestyle messages, including the balance between sun protection and vitamin D production, dietary and alcohol consumption advice and the relationship between exercise and cancer prevention, require more subtle public education messages. Likewise, the benefit of screening for breast cancer and cervical cancer requires continual reinforcement, while it can be difficult to explain why other cancers lack accurate screening methods, without provoking emotive debate. The most recent Australian screening program to be introduced targets colorectal cancer, demonstrating the requirement for patient registries and for supportive programs of public and general practitioner education, while exemplifying the major barrier to efficient health policy implementation in Australia - the federal/state administrative divide. Basic research has yielded new diagnostic tests at the genetic level and new understanding of the mechanisms of cancer. The future of multimodality cancer treatment is promising, where research has yielded advances in surgery such as sentinel node biopsy, techniques resulting in more accurate delivery of radiotherapy and the new targeted systemic therapies. A major challenge is how to pay for high-cost drugs and what constitutes a reasonable balance between responsible stewardship of society's resources and pharmaceutical industry profit. The cervical cancer vaccine exemplifies research translating into advances in prevention, but highlights the need to ensure that its initial use is in groups at highest risk of cervical cancer, such as Aboriginal girls. Under-funded in Australia is health services research, despite its potential to address such problems as inequities in cancer treatment access and outcomes in rural and remote areas, and psychosocial research into supporting patients through their cancer experience. Research in Australia must be targeted to the most pressing problems which we have the expertise to be competitive in resolving. Governments and the non-government sector must jointly lead these efforts.(Source: Clinical Oncological Society of Australia : The Cancer Council Australia: I.N. Olver : November 2006.)