We have sought to set out the challenges to the teams who make cancer services across the world. In each nation there are few key decision makers and agents of change. They now have to face up to a new agenda. At first sight there might seem to be some rather major indeed insuperable difficulties in the way of continued progress in the twin aims of improving outcomes and quality of life. In developed countries we are already achieving 90% survival rates for most early stage cancers. There has already been a considerable expansion in screening, which has produced very clear results in cancer of the cervix, and access to chemotherapy has improved. The World Cancer Report left an abiding impression of the sheer scale of the problem with mortality of 2m a year in developed countries and 6m worldwide. On estimates for the US, 46% of men and 36% of women will be diagnosed with cancer in the course of their lives and improved survival will produce a doubling in prevalence.

We can identify two possible scenarios. In one, we use limited resources in an effective way to achieve key aims within the model of staged cancer services. There is an alternative scenario in which we simply muddle on through expanding the current disconnected modules of service.

Effective use of resources within the model of staged cancer services

The international evidence is that a number of key actions can make a real difference to mortality in developed countries.