Lung cancer can begin in the respiratory system (primary lung cancer) or another part of the body and spread to the lungs (secondary or metastatic cancer in the lung) [44050]. It has a low survival rate [36045] and smoking is the largest risk factor for the disease [44050].

Lung cancer is the most commonly diagnosed cancer among Aboriginal and Torres Strait Islander people, and the leading cause of cancer-related mortality [42101]. However, evidence shows that rates of smoking among Aboriginal and Torres Strait Islander people have decreased substantially in recent years, particularly among young people [39231].

Targeted health initiatives, such as the Australian Government’s Tackling Indigenous Smoking program, aim to reduce smoking rates and lung cancer among Aboriginal and Torres Strait Islander people.

Prostate cancer develops when cells in the prostate gland grow in an uncontrolled way and form a malignant tumour [44124]. Anyone born with a prostate may develop prostate cancer, including transgender and gender diverse people [48998]. Risk factors for the disease include age, family history and genetics. It is also associated with high testosterone levels [44124].

Prostate cancer is the most commonly diagnosed cancer among Aboriginal and Torres Strait Islander males [42101], but it is less common among Aboriginal and Torres Strait Islander males than non-Indigenous males. It has a high survival rate [44124] and outcomes for Aboriginal and Torres Strait Islander people can be supported through equitable, multidisciplinary, culturally safe and patient-centred health care [39506][28182].

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].

Coronary heart disease (CHD; also known as ischaemic heart disease) happens when the coronary arteries get narrower and blood flow to the heart is reduced [34580]. It is the usual underlying cause of a heart attack.

Many Aboriginal and Torres Strait Islander people have CHD or experience heart attacks [33326], and CHD is a common reason for Aboriginal and Torres Strait Islander people to be hospitalised [42101]. CHD is also one of the most common causes of death from cardiovascular disease among Aboriginal and Torres Strait Islander people.

The risk factors for CHD include:

• smoking tobacco
• high cholesterol
• high blood pressure
• diabetes
• being inactive
• being overweight
• an unhealthy diet
• mental health conditions and social isolation [34579].

It is important that all people who experience a heart attack or have CHD receive equally good clinical care. Currently, there are some aspects of best-practice CHD care that Aboriginal and Torres Strait Islander people are less likely to receive than non-Indigenous people [31937][47217]. Fortunately, evidence indicates that this is improving [47217]. Projects like the Lighthouse Hospital Project, the ESSENCE project, and Better Cardiac Care for Aboriginal and Torres Strait Islander People have strived to achieve equity of care for Aboriginal and Torres Strait Islander CHD patients.

Most bowel cancers (sometimes called colorectal, colon or rectal cancers) start as benign, non-cancerous growths called ‘polyps’ that form on the inner lining or the wall of the bowel [43924]. These polyps may become cancerous if they are not removed.

Family history, genetics, inflammatory bowel disease and a previous diagnosis of bowel cancer can increase a person’s likelihood of developing the disease [43924]. Lifestyle factors can also increase the chance of developing bowel cancer, however this risk can be reduced by:

• eating a high-fibre diet – which includes lots of fruits and vegetables
• limiting the consumption of red meat and avoiding processed meat
• not smoking
• limiting alcohol consumption
• being physically active
• maintaining a healthy body weight [43924].

Bowel cancer is the third most common cancer among Aboriginal and Torres Strait Islander people. It has the highest survival rate of all cancers among this population, however it also has one of the highest mortality rates [42101], which may be due to low participation in bowel screening programs. This is a particular risk for those in remote areas, where access to health services can be limited [47262].

Initiatives such as the National Indigenous Bowel Screening Pilot Project have helped to address low rates of participation among Aboriginal and Torres Strait Islander people, which is important as when found early, bowel cancer is one of the most treatable cancers [43926]. Aboriginal and Torres Strait Islander people can currently receive free screening for bowel cancer via the Australian Government’s National Bowel Cancer Screening Program.

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].

Breast cancer occurs when there is abnormal and uncontrolled growth of the cells in breast tissue [43925]. These cells may to spread to other parts of the body. While both males and females can develop breast cancer, it is uncommon in males. Transgender and gender diverse people can also get breast cancer.

Some of the risk factors for breast cancer include age, family history and genetics [43925]. Lifestyle factors such as an inadequate diet, physical inactivity and alcohol consumption also increase the likelihood of developing the disease.

Breast cancer is the most commonly diagnosed cancer among Aboriginal and Torres Strait Islander females [42101] and is the second highest cause of cancer-related mortality among this population [44306].

Aboriginal and Torres Strait Islander people have low rates of participation in breast screening programs [47846], however initiatives such as The Beautiful Shawl Project aim to increase these rates of participation, by providing culturally safe and empowering health care experiences.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable health problems that affect many Aboriginal and Torres Strait Islander people and communities [45046][41853].

ARF is a sickness caused by a group A streptococcus, also known as strep A, infection [45046]. The strep A germ is a common cause of sore throats and skin sores. In some children and adults, ‘strep throat’ can cause sickness in other parts of the body, such as joints, skin, heart and the brain. This is known as acute rheumatic fever or ARF. Young people aged 5-14 years have the highest risk of getting ARF [46336][39666][45732].

Every time a person has ARF, it can cause more damage to the heart valves. Therefore, having ARF often can cause long-term damage [45046]. Heart valves are like doors; they allow blood to flow in the right direction. However, if they are damaged it can make the heart weak and blood cannot flow around the body properly. This damage is known as rheumatic heart disease (RHD) and people who get RHD can end up very sick [41853].

ARF and RHD are health conditions that many Aboriginal and Torres Strait Islander people get [39666][41853]. Nearly all people who are recorded as having ARF or RHD in Australia are Aboriginal and Torres Strait Islander. The rates of ARF and RHD in remote Aboriginal and Torres Strait Islander communities in Northern and Central Australia are among the highest reported in the world [39666][45046][45732].

ARF and RHD are also diseases often caused by social disadvantage [45046]. They can be controlled through improved living conditions, reduced overcrowding, access to health care, and antibiotics. Researchers, governments, peak bodies and advocacy groups are working together to try and eliminate RHD in Australia. The End Rheumatic Heart Disease Centre of Research Excellence, through the Telethon Kids Institute, developed The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031. Since 2022, RHD efforts are coordinated by the National Aboriginal Community Controlled Health Organisation (NACCHO).

Hospitalisation rates for cardiovascular disease (CVD) for Aboriginal and Torres Strait Islander people are high [30593]. Among the specific causes of CVD hospitalisation are coronary heart disease including heart attack, heart failure and cardiomyopathy, stroke, peripheral vascular disease, hypertensive heart disease, and acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

Hospitals play a critical role in improving access to evidence-based care and addressing disparities for Aboriginal and Torres Strait Islander peoples [33654]. For example, research shows that Aboriginal and Torres Strait Islander people hospitalised with heart attack currently:

• do not receive the same rates of important intervention as non-Indigenous patients
• are more likely to die from coronary heart disease while in hospital
• are more likely to leave hospital against medical advice.

In recognition of disparities such as these, many national and local projects are underway to improve hospital care for Aboriginal and Torres Strait Islander cardiac patients [33326][32583][33654][29243]. Improving hospital care focuses on aspects like workforce, care pathways, governance, and cultural competence [33654].

Cardiac rehabilitation – a coordinated program of exercise and education following a heart attack – often begins in hospital and continues when a patient goes home. Cardiac rehabilitation has been shown to be very beneficial following a heart attack, but participation rates of Aboriginal and Torres Strait Islander people are low [33326]. Barriers to participation may include the relatively young age of Aboriginal and Torres Strait Islander heart attack patients, competing family responsibilities, a lack of understanding of cardiac rehabilitation, the distance of a program from a patient’s home, and a program’s lack of cultural safety. Telehealth – including the use of text messaging to deliver lifestyle education following a heart attack – offers one possible solution to some of these barriers.