This study from the Australian Northern Territory’s Cancer Registry data provides evidence for a significant decrease in incidence of gastrointestinal (oesophageal, stomach, small intestine, colon, rectum, and pancreas) adenocarcinomas over the last 3 decades in individuals aged >50 years, whilst the younger (18–50 years) cohort has remained unchanged with a (non-significant) trend towards an increase. There has been a significantly improved overall survival in both age cohorts. An insight into these trends amongst Australia’s Indigenous (who constitute 31% of the territory’s population) confirms that while the incidence was significantly lower in Indigenous patients compared to non-Indigenous patients, in both age cohorts, Indigenous patients had worse survival rates. This study calls for a concerted effort aimed at investigating the existence of modifiable sociodemographic factors underlying these disturbing trends. There is a need to enhance preventative strategies, as well as to improve the delivery of cancer care and its uptake amongst Indigenous peoples.