Background: Liver cancer, primarily Hepatocellular Carcinoma (HCC), is the fastest-growing cause of cancer-related deaths in Australia, with a survival rate of only 22%, largely due to late diagnosis. Screening high-risk populations for HCC aligns with the Australian Population-Based Screening Framework and WHO’s early disease detection principles. Targeted screening programs in Japan and Korea have improved survival rates, and Australian modelling shows this approach could be cost-effective. Despite this, there is no national liver cancer screening program or supporting infrastructure, such as a registry, to maximize impact.
The recent introduction of the National Lung Cancer Screening Program has sparked interest in what it might take for liver cancer screening to become a national initiative.

Objective: Drawing from lessons learned from what helped lung cancer screening receive support to be a targeted national screening program, this session will outline various opportunities that could advance the implementation of a targeted liver cancer screening program.

Opportunities:
1. Starting Small: Unlike lung cancer, where large international trials provided robust data, liver cancer's varied causes and affected communities could be addressed with smaller trials targeting specific groups. This could help garner the necessary evidence for implementation feasibility in various settings.
2. Step-Wise Expansion: starting with a centralised national register for patients with cirrhosis or hepatitis B could be the first building block towards a national screening program. Whilst regional liver cancer registers exist and have been shown to promote better adherence to surveillance guidelines, leading to higher rates of early cancer detection and timely treatment interventions – a centralised national register ensures equitable access across the country.
3. Leveraging existing infrastructure: Australia has established screening infrastructure such as the National Cancer Screening Registry and quality assurance frameworks. This robust infrastructure could potentially be adapted to support new screening programs, such as liver cancer, to increase cost effectiveness and speed of implementation.

Conclusion: There are various opportunities to move liver cancer screening from a public health priority to a reality, and demonstrate implementation feasibility and economic viability in the Australian context.

Problem  

Bowel cancer is the second most common cancer diagnosed in Australia and takes more lives than breast, prostate or skin cancer. 

The National Bowel Cancer Screening Program (NBCSP) aims to reduce deaths by detecting early signs of the disease. Australians aged 45-74 are eligible to receive a free at-home bowel screening test every two years.

Increasing the number of people who screen through the NBSCP to 60% would save 83,000 lives by 2040.

What you did  

The Australian Government worked in partnership with Cancer Council Australia in 2022, 2023 and 2024 to deliver innovative, national awareness campaigns, encouraging Australians to ‘Get2It’, and increase screening rates.

To ensure effective methodology and messaging, formative research identified three personas for under screened populations; intenders, refusers and naïve. Intenders represented the largest group, at nearly 30%.

The strategic approach and materials were tailored to address barriers and leverage motivators for these under screened cohorts, with a focus on intenders.

The strategy included an integrated campaign approach, time sensitive messaging and the creation of a reminder function. Messages came from well-known Australian ambassadors, organisations and media outlets that influence the target audience.

Annual independent evaluation, insights and learnings ensured campaign strategy, messaging and content was optimised each year.

Results  

The campaign directly resulted in an additional 330,000 screening kits being completed saving more than 1,000 lives. The campaigns have also been attributed to a 3-4% increase in the NBSCP’s annual screening rate.

Lessons  

Strategic, integrated and targeted campaign activity, public relations and media partnerships are critical to multiply the effects and reach of messaging and save lives through screening.

Australia is set to be the first country in the world to eliminate cervical cancer in 2035, but some groups in the community are screening at lower rates than others. Women and people with a cervix from First Nations, multicultural, LGBTQ+ communities and those with a disability are less likely to do their potentially life-saving cervical screening test.

For the first time in history, the Australian Government has joined forces with four of Australia’s leading health organisations (Australian Centre for Prevention of Cervical Cancer (ACPCC), the National Aboriginal Community Controlled Health Organisation (NACCHO), ACON and the Australian Multicultural Health Collaborative) to ensure no one is left behind as we work towards eliminating cervical cancer.

The first national cervical screening awareness campaign in over 20 years was funded by the Australian Government to improve cervical screening rates by highlighting Australia’s world-leading HPV self-collect test.

The campaign is co-designed and co-decided by all partners to ensure it reaches the target audiences - women and people with a cervix who are First Nations, multicultural, LGBTQ+, regional and remote and living with disability.

The campaign it tells the real life stories of 16 women and people with a cervix to encourage others to screen, and includes traditional media, influencers, HCP education as well as investment in community engagement.

Activity is underway and early results are positive, however, not everything has been smooth sailing. Some debates have been robust, and relationships have been tested, but the partnership has survived due to the shared commitment to address equity in screening.

The presentation will detail the concept, highs and the lows of this co-op approach, and will be a useful guide for those wanting to work in true partnership to achieve shared health goals.

Problem
Skin cancer is a largely preventable burden on Victorians and the healthcare system. SunSmart, a world-leading skin cancer prevention program, has successfully reduced skin cancer rates among younger Victorians and delivers strong economic returns. Despite this, complacency toward sustained funding persists, jeopardizing hard-won gains. In 2023, funding was reduced from a four-year to a one-year contract, creating uncertainty about the program's future. Ahead of the 2024 state budget, SunSmart needed to maintain visibility and advocate for continued support.

What You Did
We engaged with state government decision-makers and participated in consultations to promote the work and role of SunSmart. This was supported by new research commissioned to highlight the burden skin cancer places on Victorian hospitals and the need for ongoing prevention efforts. SunSmart had direct and tailored correspondence with key Members of Parliament (MPs) and distributed SunSmart Kits—hats, sunscreen, and social media content—to all 128 MPs for sharing via social media.

Results
Before the budget announcement, 25 MPs shared SunSmart messages on social media, five media releases included key MP quotes, and several MPs attended campaign launches or visited local SunSmart member schools. The Minister for Health and the Premier affirmed their commitment to SunSmart funding in post-budget media releases. While the announcement of two years of ongoing funding was welcomed, it represented a 60% reduction in annual funding, with no allocation for public education. The newly released Victorian Cancer Plan later committed to targeted prevention through SunSmart.

Lessons
Political engagement is crucial for securing state government funding. As one of the most successful public health programs, SunSmart resonates with MPs as an initiative that provides valuable community messages. However, we were unable to maintain prior funding levels in the current economic environment. This presentation will share key lessons from our advocacy and efforts to renew funding ahead of the 2026 election.

Introduction
Every year, 2,000 Australians lose their life to skin cancer, and melanoma diagnoses are projected to increase. The 2024 federal budget included $10 million to develop an evidence-based roadmap for a targeted skin cancer screening program. The roadmap will be informed by the Australian Centre for Excellence in Melanoma Imaging and Diagnosis (ACEMID) study, which is using risk-stratified, technology-driven monitoring and imaging to improve melanoma surveillance and early detection. These secondary prevention initiatives could integrate primary prevention to maximise health gains, as even small improvements in sun protection can bring meaningful health and economic benefits. This study aims to design and pilot a SunSmart intervention through the ACEMID study.

Methods
Two reviews were conducted to inform the intervention: a rapid review of interventions that embed primary prevention in cancer screening, and a ‘review of reviews’ of skin cancer prevention interventions. The evidence synthesis considered barriers and enablers to prevention within a health-service setting, according to the COM-B framework. Implementation science underpinned the intervention and evaluation design. Stakeholder feedback was sought from ACEMID clinicians and consumers.

Results
The rapid review identified 11 studies on primary prevention within cancer screening, mostly related to smoking cessation. Point-of-care counselling resources that minimise impact on clinicians and scheduling present promise; however, skin cancer prevention evidence is strongest for sustained and multi-component behavioural interventions. Our intervention combines personalised SunSmart advice, generated from the individual’s known risk attributes and behaviours and delivered during screening, with 2-months of text messaging to support habit formation. The intervention will be piloted in ACEMID’s Alfred Hospital site from January-April 2025 with an initial focus on optimising feasibility and acceptability.

Conclusions
This intervention is the first of its kind. It has been designed to meet real-world demands with potential for future automation and scale up within a targeted screening program.

Objectives To investigate cancer survival for Aboriginal and non-Aboriginal peoples in the Northern Territory (NT) 1991-2020, across the 15 most prevalent primary cancer sites.
Study design: Retrospective cohort study of NT Cancer Registry notifications.
Setting, participants: NT residents diagnosed with an invasive cancer over a 30 year period from 01/01/1991 to 31/12/2020.
Main outcome measures: Five-year survival for all cancer and 15 primary cancer sites by 10-year periods of diagnosis. Excess hazard ratios compared excess mortality following cancer diagnosis for Aboriginal and non-Aboriginal peoples.
Results Of 17,759 cancer registrations analysed, 3,350 (19%) were Aboriginal. Five-year survival improved significantly from 1991–2000 to 2011–2020 for all populations including Aboriginal (males 20.5%–>37.1%; females 32.3%–> 47.2%) and non-Aboriginal (males 50.0%– >65.9%; females 64.5%–>75.4%, respectively). The gap in five-year cancer survival for Aboriginal peoples closed by 12.4 percentage points for females, but only by 2.4 for males. All 15 cancer sites showed improvements in five-year survival, however Aboriginal peoples experienced excess mortality, ranging from 1.3 excess hazard of mortality following diagnosis of liver cancer to 6.1 for prostate cancer, 2011–2020.
Conclusions Cancer survival has improved for NT Aboriginal and non-Aboriginal peoples. Despite a small narrowing in the gap in survival outcomes for Aboriginal females, a large gap in survival outcomes for all Aboriginal peoples persists. Further research is required on pathways to close the gap including: improving access to care, social and cultural factors, reducing diagnostic and treatment delays, and greater equity of Aboriginal participation in clinical trials. Quality improvement approaches led by Aboriginal peoples should be prioritised to tailor culturally appropriate preventative strategies.
This research is co-authored by an Aboriginal man (CC) with experience in NT Aboriginal Health Policy and cancer care. The paper was reviewed by the NT Health First Nations Health and Wellbeing office, who are supportive of its release as contribution to: (1) understanding the improvements in health of Aboriginal people and (2) addressing the persistent cancer inequity issues.

Background:
The International Agency for Research on Cancer recently classified opium as carcinogenic to humans, causing larynx, lung and bladder cancer. We evaluated the relationship between pharmaceutical opioids and cancer incidence in a New South Wales (NSW) prospective cohort study.

Methods:
Opioid medication claims for 64,464 of 267,357 participants in the 45 and Up Study (2005-2009) were ascertained via record linkage to the Pharmaceutical Benefits Scheme (PBS; 2005-2009; provided by Services Australia). Participants diagnosed with cancer prior to baseline, participants without concessional PBS claims, and participants who died within six months of baseline were excluded. Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer incidence (via linkage to the NSW Cancer Registry to December 2019) in relation to claims in the 12 months prior to baseline. Participants were censored at death, ascertained from the NSW Registry of Births, Deaths and Marriages to December 2019. Record linkage was performed by the Centre for Health Record Linkage (CHeReL). Secure data access was provided by the Sax Institute’s Secure Unified Research Environment (SURE). Regressions were adjusted for potential confounding factors including socio-demographic characteristics, smoking, and alcohol.

Results:
Over a median 11.3 years follow-up, 12,277 (19%) participants were diagnosed with cancer. Participants with at least one opioid medication claim prior to baseline had significantly higher risk of lung cancer (HR:1.18; 95%CI:1.04-1.34), respiratory cancers combined (1.18;1.04-1.33), and urinary cancers combined (1.22;1.01-1.47) compared to participants without a claim. Risk for oesophageal, liver, and pancreatic cancer, respiratory cancers combined, and all cancers combined was increased with higher annual per person oral morphine equivalents.

Conclusions:
Opioid medication claims were associated with increased risk of several types of cancer. These data will be key to informing the Opioid Cohort Consortium (OPICO), a global pooled analysis of opioids and cancer risk.

Bowel cancer is a leading cause of cancer-related death and among the most diagnosed cancers in Australia. Despite access to free bowel cancer screening, participation in the National Bowel Cancer Screening Program (NBCSP) remains low, with Queensland at 36.9%. In response, Queensland Health’s Cancer Screening Unit launched BUMP (Bowel Under-screened Messages for Participation) an SMS based pilot that uses behavioural nudges to improve NBCSP participation rates.

Utilising the National Cancer Screening Register (NCSR), BUMP identified six under-screened groups based on screening history, due or overdue to return their Immunochemical Faecal Occult Blood Test kits. Facilitating scalability and sustainability BUMP comprises a multidisciplinary working group using a low-cost SMS intervention strategy. Each month NCSR participation data extracts are queried to identify these group cohorts, and tailored text messages are sent via the alias “QLD Health”.

Since its launch in November 2023, BUMP has grown in scope and complexity. Using behavioural economic principles, nine tailored SMS messages were developed to address known barriers and motivate screening participation. A key challenge emerged in managing participants moving between groups as screening statuses change.

NBCSP kit returns were linked directly to BUMP recipients using the NCSR data. While effectiveness varied by screening history, overall, the BUMP messages had a significant positive impact. Notably, the proportion of kits returned within three months of the corresponding BUMP SMS was 3.85% higher on average for groups contacted than control groups.

Current learnings highlight the need to further support project sustainability by exploring components for automation. These preliminary findings suggest a sustainable model that can effectively engage under-screened participants within the NBCSP, with capability to seamlessly integrate into the existing screening pathway. By increasing participation, this model could significantly enhance early cancer detection and has potential to expand to other cancer screening programs improving long-term health outcomes.

Introduction
The NSW Population Health Survey is a telephone survey conducted each year with approximately 13,000 people in NSW. A cancer screening module was included in 2019 and 2021. This analysis aimed to understand the difference in screening participation between the Culturally and Linguistically Diverse (CALD) and non-CALD NSW community in the 2019 and 2021 surveys.

Methods
Participants who spoke a language other than English at home were defined as CALD respondents and those who spoke exclusively English at home were defined as non-CALD respondents. Their self-reported bowel, breast and cervical screening behaviours are compared in 2019 and 2021.

Results
The proportion of the CALD population aged over 50 who self-reported ever having a faecal occult blood test was significantly lower than non-CALD population in both 2019 (47.7%, 95% CI: 42.5%-52.9% vs. 60.6%, 95% CI: 58.7%-62.5%) and 2021 (56.2%, 95% CI: 50.6%-61.8% vs. 70.2%, 95% CI: 68.3%-72.1%).

Self-reported ever had a cervical screening test in the CALD population aged 25-74 was also significantly lower than non-CALD population in both 2019 (71.4%, 95% CI: 66.3%-76.5% vs. 92.1%, 95% CI: 90.6%-93.6%) and 2021 (78.2%, 95% CI: 74.3%-82.1% vs. 94.7%, 95% CI: 93.7%-95.7%).

Self-reported ever had a breast screen was significantly lower in the CALD population aged 50-74 (84.9%, 95% CI: 79.0%-90.8%) than non-CALD population (93.7%, 95% CI: 92.2%-95.2%) in 2019. However, the difference was no longer significant in 2021 (84.6%, 95% CI: 78.6%-90.6% vs. 91.0%, 95% CI: 89.2%-92.8%). Reasons for not screening varied between CALD and non-CALD populations.

Conclusion
The differences in cancer screening participation between CALD and non-CALD populations in NSW highlights the need for continued work to engage CALD communities in cancer screening. The results will be used to communicate to screening program multicultural stakeholders, to inform development of multilingual audio-visual resources, to support health care planning and better allocation of resources for interpreting, and to drive evidence-based decisions for local service delivery.