Cancer Screening in Australia: A Social and Cultural Analysis, PHE5SCP

This essay, authored by Naga Hussain Rao Juneboina for the PHE5SCP course in 2019, investigates cancer screening in Australia, with a specific focus on the potential hindrance to access for Indigenous Australians. The essay begins by establishing the prevalence of cancer in Australia and the importance of early detection, referencing key statistics and relevant literature. It highlights the problem of late-stage cancer diagnosis within Indigenous communities, linking this to factors such as low health literacy and socioeconomic disparities. The methodology involves a literature review utilizing PubMed and Cochrane Review. The essay then reviews the key aims of screening programs, cultural and social barriers, and details specific programs like BreastScreen Australia, the National Bowel Cancer Screening Program, and the National Cervical Screening Program. The implications of the findings reveal low participation rates in screening programs, particularly among Indigenous Australians, and the influence of historical, social, and cultural determinants on negative cancer outcomes. The essay concludes with reflections on the need for culturally appropriate screening programs and recommendations for improving access and coverage by incorporating Indigenous perspectives and addressing social dimensions. The references section provides a comprehensive list of sources used in the analysis.

Assignment
CANCER SCREENING IN AUSTRALIA
Name: Naga Hussain Rao Juneboina
Student Number: 19571001
Subject: social and cultural perspectives on Public health
Subject Code: PHE5SCP
Year: 2019.

PICO Question
Could being an indigenous Australian hinder access to cancer screening?
Cancer screening in Australia
Cancer accounts for around one-fifth of the total disease commonly faced by
Australians. According to Lauby-Secretan et al. (2015), it is more related to the growth of
tumour cells that involves disturbances in energy production through respiration. It is a
metabolic disease, which can be managed by following a body transition. It is of no wonder
that quick detection and screening can prevent premature death. According to Farnsworth,
(2016) Australia needs to be more aware of the ways that increase the chances of cancer
among the population. The most important step in the process is to understand what matters
to people, including their perception of the risks involved and things that counts in making a
quality life. According to Hersch et al. (2015) assessing the effectiveness of the screening
programs is a continuous and difficult method which involves the Government and the
organizations involved in health care.
Australian Statistics
An estimated 138,000 new cases of cancer are expected to be diagnosed in Australia
this year. Cancer is a leading cause of death in Australia where more than 48000 deaths are
estimated for 2018 (Olver & Roder, 2017). While around 69% of people diagnosed with
cancer remain alive five years after the diagnosis is made, the seriousness of the issue cannot
be ignored by the number of deaths happening in Australia. Statistics indicate that around one
in five cancer death are due to smoking, and about 3% of cancers are related to the
consumption of alcohol. Exposure to high radiations, unhealthy habits of eating, high
consumption of fast foods, family history, and lack of proper physical activities are also
responsible for cancer.
Statement of the problem
Indigenous Australians, descended from the original inhabitants of Australia, exhibit
high rates of cancer (Andrew, Tiggemann& Clark, 2016). The absence of proper health care
facilities, awareness programmes, government measures, immunization facilities makes the

problem more severe among remote indigenous communities. The spread of disease at
diagnosis – that is, late diagnosis – reduces cancer survival in this group. Low health literacy
is a major factor contributing to late diagnosis.
The problem of cancer among the indigenous population is further complicated by
multiple cancer diagnoses (Christou et al., 2010). When people are detected with multiple
cancers at similar stages only the initial record persists and the additional diagnoses may be
neglected, making the overall condition more dangerous and deadly. Major differences in the
socio-economic conditions among Aboriginals and the Torres Islanders are another major
problem faced in cancer screening methods. There is a direct relationship in the socio-
economic conditions and the living conditions among any section of the society. Indigenous
Australians as a group are disadvantaged compared with the majority of the population, and
their health suffers accordingly.
Data Methodology
The literature review was obtained through the use of PubMed online site and
Cochrane Review website in assessing and finding the challenges faced by indigenous
Australians.
Literature Review
The key aim of screening programs is to enable improvement of the health outcomes
of the population through detection of conditions associated with increased risks of cancer
and early stage cancer development. The screening tests are economically feasible and
accepted by the general population. Its effectiveness is determined by the population survival
benefit which s assessed based on the clinical and population registration data (Christou &
Thompson, 2013).
Delayed diagnosis of cancer is a potential priority. Identification of patient, health
care and tumour related factors within the primary health care system is key in identifying
delay in diagnosis, this aid in developing programs and strategies which addresses such
delays. The occurrence of poor knowledge, failure and awareness among the aboriginal
women often has lead to increase rates of cancer and low intake of cancer screening (Castles,
Wainer & Jayasekara, 2016).

There is need for assessing the psychological factors affecting patient perceptions and
motivation to seek cancer screening service among the indigenous community. Studies have
established role of psychological factors on the perceptions of the patient in interpreting
patient symptoms (Shreuders et al., 2015). The existing levels of worry, denial, fear, shame
and lack of awareness have been observed to affect indigenous populations in seeking
screening services (Shahidet al., 2016 )
Barriers in the screening of cancer in the Australian population overall
Cultural and social barriers
Most of the cancer hit people are migrants from low socioeconomic status. The
general tendency of people coming from these areas is that people of these areas are reluctant
to go for screening tests because they believe that it will happen if it is bound to happen.
Cultural factors play an important role in shaping the beliefs and behaviors of cancer.
Cancer screening programmes in Australia
Breast Screen Australia
Breast cancer is the most common type of cancer that affects the population of
Australia. The risk of breast cancer increases with age (Ewald, 2006). This program is
especially devoted to understanding the stage of breast cancer among the women of Australia.
These programs are well suited to address the problems of breast cancer and working towards
the redcueing the complication associated with late diagnosis Health care professionals
provide clinical and nonclinical methods of early prevention (National Cancer Institute,
2015).
The national bowel screening program
The National Bowel Cancer Screening Program makes an attempt to reduce the high
rates of late diagnoses of bowel cancer. Statistics show that one in 23 Australians will
develop bowel cancer in their lifetime. This program is designed for early detection and
prevention of bowel cancer, and invites all eligible Australians aged around 50 to 74 years of
age to screen for early detection in every two years. This is expected to save around 500 lives
every year by reducing the late detection of bowel cancer among Australians (National
Cancer Institute, 2015).

The national cervical screening program
Cervical cancer is one of the most preventable cancers when detected early. The
National Cervical Screening Program detects the HPV (Human Papillomavirus) which is
responsible for cervical cancer. There are much-improved tests involved in this program
which makes it so effective in the detection of cervical cancer among women in Australia
(National Cancer Institute, 2015).
Implication of findings
The research findings have shown that there are growing trends in rates of cancer.
Key among them is breast cancer among women. It is the second highest cause of death
among Australian women. Early detection programs provide for effective diagnosis. Breast
cancer program in Australia aims at reducing morbidity and mortality of breast cancer
through early detection. There is low participation of cancer screening programs in Australia,
with average ranges of between 54% - 55% (Goodwin, 2017).
Breast cancer is the type of cancer most experienced among aboriginal women.
However, there are disparities between mortality and incidences among the aboriginals and
non-aboriginal population in Australia. The high incidences of cancer mortality among
aboriginal women suggest that breast cancer is often diagnosed later in the stages of
development, which is consistent with lower screening rates for the Aboriginal population
(Moon et al., 2017).
Efforts have been made in Western Australia to improve cancer screening. The Breast
screen agency has played a crucial role in partnering and developing proactive strategies in
enhancing participation among Aboriginal population especially women to access to
screening services.
Factors which have been shown to increase negative cancer outcomes among the
indigenous Australians often reflect broad historical, social and cultural determinants. The
most common cancer types among aboriginals are lung cancer, breast cancer, and bowel
cancer. Some of the existing social determinants include the Aboriginal way of life and
people exposure to different aspects. Cultural determinants entail the way of life among the
Aboriginals which hinders their access to health care screening services (Pilington et al.,
2017).

Increased risks of developing cancer among the Aboriginal is influenced by various
cultural and societal factors which include family, age, socioeconomic, cultural and
geographical perspectives. The historical origins of these factors have always been
perpetuated by the social and cultural factors which contribute to the existing health
inequalities among the Aboriginal Australians (Castles, Wainer & Jayasekara, 2016).
Reflection
Cancer screening rates among indigenous Australians still remains low. There is a
need for cultural approximate programs for screening which target the social dimension of
this indigenous community. Implementation of early detection programs which incorporate
the perspectives of the Aboriginals is key to attaining high coverage screening. For the
programs to be effective there is an urgent need to be flexible and responsive to the needs of
the Aboriginal Australians. Key social dimension will involve offering quality screening
programs and giving the Aboriginal natives equal opportunities so as that they feel that the
health system does not seclude them.

References
Andrew, R., Tiggemann, M., & Clark, L. (2016). Positive body image and young women’s
health: Implications for sun protection, cancer screening, weight loss, and alcohol
consumption behaviours. Journal of health psychology, 21(1), 28-39.
Castles, S., Wainer, Z., & Jayasekara, H. (2016). Risk factors for cancer in the Australian
aboriginal and Torres Strait Islander population: a systematic review. Australian
journal of primary health, 22(3), 190-197.
Christou, A., & Thompson, S. C. (2013). Missed opportunities in educating Aboriginal
Australians about bowel cancer screening: whose job is it anyway?. Contemporary
nurse, 46(1), 59-69.
Christou, Aliki, Katzenellenbogen, Judith M., & Thompson, Sandra C. (2010). Australia's
National Bowel Cancer Screening Program: Does it work for indigenous
Australians. BMC Public Health, 10, 373.
Ewald, D. (2006). Screening programs. Australian Family Physician, 35(9), 663.
Farnsworth, A. (2016). Cervical cancer screening in Australia: Past and present. Cancer
Cytopathology, 124(4), 231-234.
Goodwin, M. (2017). The burden of cancer in Australia: Australian Burden of Disease Study
2011.
Hersch, J., Barratt, A., Jansen, J., Irwig, L., McGeechan, K., Jacklyn, G., & McCaffery, k.
(2015). Use of a decision aid including information on overdetection to support
informed choice about breast cancer screening: a randomized controlled trial. The
Lancent, 385(9978), 1642-1652.
Lauby-Secretan, B., Scoccianti, C., Loomis, D., Benbrahim-Tallaa, L.Bouvard, V., Bianchini,
F., & Straif, K. (2015).Breast-cancer screening—viewpoint of the IARC working
group. New England journal of medicine, 372(24), 2353-2358.
Moon, L., Connell, E., Rompotis, C., Martin, F., Bartlett, N., & Harvey, J. (2017). Cancer in
Australia 2017.

National cancer institute (2015). What is cancer? Retrieved from
https://www.cancer.gov/about-cancer/understanding/what-is-cancer.
Olver, I. N., & Roder, D. (2017). History, development, and future of cancer screening in
Australia. Public Health Res Pract, 27(3), 2731725.
Pilkington, L., Haigh, M. M., Durey, A., Katzenellenbogen, J. M., & Thompson, S. C.
(2017). Perspectives of Aboriginal women on participation in mammographic
screening: a step towards improving services. BMC public health, 17(1), 697.
Schreuders, E. H., Ruco, A., Rabeneck, L., Schoen, R. E., Sung, J. J., Young, G. P., &
kuipers, E. J. (2015). Colorectal cancer screening: a global overview of existing
programmes. Gut, 64(10), 1637-1649.
Shahid, S., Teng, T. H. K., Bessarab, D., Aoun, S., Baxi, S., & Thompson, S. C. (2016).
Factors contributing to delayed diagnosis of cancer among Aboriginal people in
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