Imagine this. You are a doctor in Tanzania. Annual health expenditure is $4 (£2.50) per head; malaria, tuberculosis, and maternal death are pressing problems; 150 000 people died from AIDS last year; and 9% of adults are infected with HIV.1 Life expectancy is 53 years. As an oncologist in the country's only cancer centre, you saw 1650 new cases last year. This probably represents about 10% of the total—your centre is inaccessible to the rest of the population. Around 90% of patients present with late stage, incurable disease. How do you begin to tackle cancer in such a context? This was the stark challenge posed by Twalib Ngoma of the Tanzania Cancer Center to a conference on “Cancer Strategies for the New Millennium.”2 This report synthesises selected themes from the discussion on how best to combat cancer in the developing world.