Cancer is a major cause of illness in Australia, where it is responsible for 18% of the burden of ill health suffered by Australians, and almost 9% of health system expenditure attributable to specific diseases.

There are over 1 million people alive in Australia who are either currently living with or have lived with cancer. This number is expected to grow over time as both cancer incidence and cancer survival continue to increase. In 2021, it is estimated that 151,000 people will be diagnosed with cancer (excluding basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) of the skin), and 49,000 people will die as a result of cancer. Influenced by population growth and older people becoming a larger proportion of the population (Australia’s ageing population), the number of new cases of cancer diagnosed is estimated to increase to 185,000 in 2031.

Cancer survival varies from cancer to cancer but overall cancer survival has improved, with 70% of all people diagnosed with cancer (excluding BCC and SCC) surviving at least five years after diagnosis; up from 51% about 30 years ago.

Almost half (42%) of the cancer burden is attributable to personal and behavioural risk factors (for example, smoking and overweight). Understanding and avoiding the risk factors associated with cancer can help to reduce the chance of getting cancer, while participation in cancer screening programs can increase the likelihood of detecting cancer early, enabling better outcomes from treatments. Improvements in cancer treatments and care are also important contributors to improvements in survival.

The age-standardised incidence rate of cancer has decreased from a peak of 508 cases per 100,000 people in 2008, to an estimated 486 cases per 100,000 people in 2021, influenced by strong decreases in prostate cancer incidence, likely linked to previous changes in diagnostic guidelines. If prostate cancer is excluded, the all-cancer incidence rate for males has been relatively stable over the past 20 years. On the other hand, the all-cancer incidence rate for females has increased from 404 to an estimated 441 cases per 100,000 females. Increasing incidence rates for females reflects, amongst other things, an increase in the incidence rate of lung cancer due to the historical increase in the smoking rate amongst females.

Over the past 20 years, incidence rates for most of the common cancers have increased. However, some have remained steady and others have decreased.

Cancer mortality rates continue to fall, with a sharper decline for males than for females. Between 1989 and 2021, age-standardised cancer mortality rates have declined substantially for both males and females from 287 to an estimated 182 deaths per 100,000 males, and from 165 to an estimated 122 deaths per 100,000 females.

Cancer incidence and survival outcomes are not evenly spread across the population. For example:

  • On average, Indigenous Australians were 14% more likely to be diagnosed with cancer and 20% less likely to survive at least five years after diagnosis compared with non-Indigenous Australians. Survival for Indigenous Australians was lower in regional and remote areas than in other areas.

  • Cancer incidence rates were slightly higher in regional areas, while survival declined with increasing remoteness, at least partially reflecting poorer survival for Indigenous Australians in more remote areas.

  • Compared with people living in the least socioeconomically disadvantaged areas, cancer incidence rates for people living in the most disadvantaged areas were 5% higher, but survival rates were almost 20% lower, and cancer mortality rates were over 40% higher.

In this report, rare and less common cancers are defined as those with incidence rates lower than 12 cases per 100,000 people. While 30% of all cancers diagnosed are classified as rare or less common cancers, these are responsible for 42% of all cancer deaths.

The effect of the COVID-19 pandemic on cancer diagnosis and treatment

The COVID-19 pandemic appears to have had at least some effect on the uptake of cancer-related services. In this report, the incidence data presented for 2021 are estimates based on the latest available information and time-series trends to 2017. These estimates do not take into account the potential impact of COVID-19 on cancer diagnoses. Fewer people may have been diagnosed with cancer during COVID-19 restrictions than would otherwise have been the case.

After having increased by an average of 1% per year over the previous 20 years, the rate of cancer-related hospitalisations decreased by 1% between 2018–19 and 2019–20, noting that COVID-19 restrictions were in place only during the last quarter of 2019–20. COVID-19 restrictions also appear to have affected uptake of breast ultrasound, mammography, breast MRI and colonoscopy. For example, the number of people having MBS-subsidised colonoscopies was 11% lower in 2020 compared with 2019, following average growth of around 3% per annum since 2011.

The full impact of the COVID-19 pandemic on cancer diagnosis and treatment will not be known for several years.