Intended for healthcare professionals

Clinical Review Recent advances


BMJ 1999; 318 doi: (Published 13 February 1999) Cite this as: BMJ 1999;318:445
  1. Martin H N Tattersall, professor (,
  2. Hilary Thomas, professor of oncology
  1. aDepartment of Cancer Medicine, University of Sydney, Sydney, NSW 2006, Australia
  2. bEuropean Institute of Health and Medical Sciences, University of Surrey, Guildford GU2 5XH
  1. Correspondence to: Professor Tattersall

    Cancer is an increasing cause of morbidity and mortality in most countries. It has recently overtaken heart disease as the commonest cause of death in the United Kingdom. “Breakthroughs” in cancer research are reported regularly in the media. Some reports are based on new results that show potential for improved treatments, but others are premature or publicity seeking, and the motivation behind them is questionable. The public has high expectations that basic science cancer research will translate into improved cancer cures and care. Yet awareness and understanding of the clinical trials that are essential in establishing the effectiveness of new treatments is limited. Recruitment to randomised clinical trials evaluating new cancer treatments is often slow, partly because people are convinced that all new treatments are likely to be an improvement and partly because of unease about the process of randomisation. Better public education about categories of evidence in relation to health interventions might contribute to speedier and more appropriate evaluation of promising treatments.

    Public confidence that cancer care in the United Kingdom is optimal has been shaken by reports that outcomes for some common cancers differ in countries in western Europe, and that survival rates in Britain for 18of 25cancer types studied are poorer than in most other European countries. 1 2 Better than average outcomes were seen in Switzerland, Finland, and Holland. These reports, together with evidence that cancer survival rates differ within a country according to the pattern of care, prompted review of the provision of care for cancer patients in the United Kingdom and in parts of Australia.36 Optimal organisation of cancer care might achieve appreciable gains. In the case of breast cancer, this could amount to a 5% improvement in the survival rate at five years. Such a gain would be viewed as …

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