While different types of cancer have unique risk factors, there are several risk and protective factors that are common to most cancers [44125]. These factors can be genetic, lifestyle and environmental. Factors relating to behaviour and lifestyle can be adjusted to reduce the risk of getting cancer.

To help protect against getting cancer, people should be supported to:

• not smoke tobacco
• drink alcohol in moderation
• have a healthy diet that is high in fibre (including fruits, vegetables, legumes and cereals) and low in red and processed meats
• limit sun exposure
• be physically active
• maintain a healthy body weight [44125][44126][44127].

Cancer can be associated with chronic infections such as human papillomavirus (HPV), hepatitis B and C viruses and human immunodeficiency virus (HIV) [49032] . Human T-cell lymphotropic virus type 1 (HTLV-1) is another viral risk factor for cancer [49031], with some of the highest rates reported among Aboriginal and Torres Strait Islander people in Central Australia [44396]. There are also environmental risk factors for cancer, including exposure to carcinogens (cancer-causing agents) such as radiation, chemicals and pollution [36771][44128].

For Aboriginal and Torres Strait Islander people, the prevalence of risk factors can be driven by social determinants, including racism and discrimination [47115][49154], while cultural factors such as connection to Country, knowledge and beliefs, language, self-determination, family and kinship and cultural expression can be protective factors for health [45520].

Importantly, being exposed to a risk factor does not mean that a person will definitely develop cancer; some people exposed to one or more risk factors may never develop a cancer, and other people who do develop cancer have no apparent risk factors [44125].

Some behaviour and health factors can protect against developing diabetes (protective factors), while others can increase a person’s risk of developing the condition (risk factors) [44997].

Currently, there are no known protective factors for type 1 diabetes. However, changes in lifestyle such as losing weight, increasing physical activity and eating healthy foods are protective factors for type 2 diabetes [44997]. There is also evidence that breastfeeding can reduce the risk of maternal type 2 diabetes later in life [44621].

For Aboriginal and Torres Strait Islander people, cultural factors can also be protective. These can include cultural identity, family and kinship, access to Country and participation in cultural activities [47098][44397].

The risk factors for diabetes can be divided into two categories: modifiable (can be changed) and non-modifiable (cannot be changed) [44997]. Non-modifiable factors include a person’s family history and age. Modifiable factors include:

• high blood pressure
• high blood cholesterol
• tobacco smoking
• low levels of physical activity
• inadequate diet
• overweight or obesity [44185].

Another modifiable risk factor is pre-diabetes. Pre-diabetes is a condition when sugar (glucose) levels in the blood are high, but not high enough to be diabetes [34460].

Having more than one risk factor increases the risk of developing diabetes [44997].

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030. The strategy advocates for communities to have food security, and be supported to make healthy choices and lifestyle changes [44185].

Type 1 diabetes is an autoimmune disease that cannot be prevented. However, type 2 and gestational diabetes can be prevented or delayed by understanding risk factors and making lifestyle changes [45543][27354]. Access to health services, diabetes-related education programs, healthy and affordable food, and places to exercise are important factors in preventing diabetes [44997].

The management of diabetes once diagnosed includes, but is not limited to, healthy eating, being active, taking medications and monitoring blood glucose levels [47945][45667]. Targeted programs, such as Diabetes Yarning – All About Diabetes, provide information about diabetes and how to manage it, presented from a cultural perspective and reflecting the experiences that are specific to Aboriginal and Torres Strait Islander people.

Culturally competent diabetes support, education and services play a significant role in the prevention and management of diabetes among Aboriginal and Torres Strait Islander people [44997][44185].

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030 [44185]. Partnerships with communities and Aboriginal and Torres Strait Islander community controlled health services are an important part of designing and delivering diabetes prevention and management programs.

Diabetes can cause many serious health complications [44997][45543]. Some may develop soon after diagnosis while others may develop over several years.

Complications associated with all types of diabetes can include:

• heart disease
• stroke
• kidney disease
• eye disease
• nerve damage resulting in lower limb and foot disease
• bladder and kidney health
• depression and mental health
• skin, teeth and gum health
• sexual health [44997][45667][47945].

Gestational diabetes can cause complications during pregnancy, labour and delivery including hypertension, pre-eclampsia, pre-term birth, still birth, low and high birthweight, admission to neonatal intensive care and longer stays in hospital [44997].

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030 [44185]. Areas identified for action include:

• communicating the seriousness of diabetes and its complications via community-wide and culturally relevant services and programs
• providing specialist support and care in regions and enhance telehealth services and facilities to treat serious complications of diabetes.

On average, over 1800 Aboriginal and Torres Strait Islander people are diagnosed with cancer each year [42101], however up to one third of cancer diagnoses in Australia are preventable through lifestyle changes [44125].

The early detection of cancer is often key to good health outcomes [44129]. There are different types of screening for different types of cancer, and there are national screening programs for breast cancer, cervical cancer, and bowel cancer.

The treatment and management of cancers depends on the type of cancer, but can include a combination of chemotherapy, radiotherapy, surgery, immunotherapy and hormone therapy [44296]. For Aboriginal and Torres Strait Islander people, culture and family connections play an important role in the cancer treatment process [39509].

The prevention and management of cancer among Aboriginal and Torres Strait Islander people requires initiatives that prioritise community engagement, culturally appropriate resources and communication, as well as culturally safe, accessible health services [39506][44419][48600].

The challenges experienced by Aboriginal and Torres Strait Islander people with cancer are well documented [34298]. For many Aboriginal and Torres Strait Islander people, cancer is associated with death, and holds negative connotations due to stigma and fear surrounding the disease [34298][37413][44300]. As such, it is important to offer culturally safe and responsive health care, to ensure a more positive experience and better health outcomes [35381].

Cancer care for Aboriginal and Torres Strait Islander people should be multidisciplinary, flexible and strength based [43888]. Central to this approach is the need to understand and respect Aboriginal and Torres Strait Islander people’s philosophies of health and wellbeing as holistic concepts, and ensure knowledge, values and beliefs are at the core of the delivery of care [35381].

Care coordination that is informed by cultural factors such as traditional healing, connection to Country, gender, kinship and family ties can support positive health outcomes [35381][43888]. In addition, consideration should be placed on appropriate mental health support and the inclusion of family, Elders and the wider community in the cancer treatment process where requested [35381][43888][39509].

Importantly, a skilled, well-resourced Aboriginal and Torres Strait Islander health workforce is necessary to ensure improved cancer outcomes [47950]. This includes staff who demonstrate cultural safety through sensitive, trauma-informed care and culturally appropriate communication [35381].