Cancer in Australia represents a paradox: survival outcomes are among the best globally, yet incidence remains high, inequities persist, and costs are rising. In 2025, ∼170,000 new cases are projected nationally, with age-standardised mortality estimated at ∼194 deaths per 100,000, declining over three decades yet still representing a substantial absolute burden. The most common diagnosed cancers, breast, prostate, colorectal, melanoma, and lung, reflect both demographic ageing and improved detection, as well as preventable risk factors and structural gaps in early detection and care. Lung cancer remains the leading cause of death, underscoring the importance of Australia’s National Lung Cancer Screening Program, which commenced on 1 July 2025 to provide targeted low-dose CT screening for high-risk populations. We argue that Australia’s cancer system is at a crossroads: policy must strengthen prevention, embed equity, and sustain innovation simultaneously. Priorities include scaling effective prevention, ensuring equitable participation in population and targeted screening (including the new lung program), improving timely diagnostic pathways, expanding fair access to evidence-based therapies, and investing in survivorship and supportive care. Without explicit equity safeguards and value-based principles, rising incidence and high-cost therapies risk undermining sustainability. The Australian experience offers important lessons for other high-income countries balancing progress with equity in cancer control. We emphasise data-driven improvement, including the public reporting of stage, diagnostic timeliness, treatment, outcomes, and out-of-pocket (OOP) costs stratified by geography, socioeconomic status, and Indigenous status, to reduce unwarranted variation and improve health equity; forthcoming programs (e.g., lung screening; risk-stratified melanoma) should be designed for equity from inception. Although survival has improved, high incidence, driven by population ageing, detection practices, and modifiable risks, persists; inequities and rising costs also persist. Outcomes and equity are tightly linked to early detection, through screening and timely diagnostic pathways for symptomatic patients, because delays in time-to-diagnosis drive avoidable advanced-stage presentation and poorer survival. Screening participation remains suboptimal and inequitable; in breast cancer, incomplete capture of privately obtained mammography outside BreastScreen can obscure true participation among higher-income groups. Addressing prevention, diagnostic timeliness, and unwarranted variation is essential to improve outcomes, equity, and value. Australia’s rising cancer burden reflects demographic ageing and detection practices, compounded by preventable risk factors and inequities in timely diagnosis and care; policy responses should integrate prevention with diagnostic timeliness, equitable access, and value-based investment.
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