Australia currently has three national cancer screening programs in breast, cervical and bowel cancer. There are also new opportunities and challenges as interest in risk stratified screening intensifies in breast cancer, following on from some level of risk stratification already embedded in the cervical screening renewal. Policy issues also arise from the bowel screening program related to both low investment in public education about participation and in the context of de-facto and expensive use of colonoscopy. Calls for targeted screening in lung and liver cancer for high risk individuals intensify and further challenge population approaches. The emergence of blood tests for circulating tumour cells and the potential of these tests to be directly marketed to consumers will also set new challenges for policy and practice. These challenges occur in the context of lower than desired participation in existing screening programs. This paper will explore the policy implications of these emerging issues in screening and will consider the role researchers and non-Government organisations play in building the evidence base and creating the arguments for changes to existing programs and the funding of new programs. This policy debate sits against a backdrop of low investment in cancer prevention and early intervention compared to investment in treatments for late stage disease in a health system struggling for economic sustainability.