The optimal management of adolescent and young adult cancer has been the subject of vigorous debate in paediatric and adult cancer community for many years. This debate is rapidly coming to the boil. There is international recognition that not only is cancer in young people on the rise but also that improvements in outcomes of cancer in young people lag well behind the advances that have been achieved for both children and older adults in the past 30 years. The underlying problems appear to relate to a complex set of interactions between the health-care system and the prevalence of cancer in this age group and the unique psychosocial and educational needs of this population. This article explores why we should be concerned about Australian health outcomes in this group and considers how best we might respond to these concerns.