What is Best for the Patient? A United States View

Significant progress has been made in the treatment of cancer in the past 25 years, so that in the USA 49% of patients with disease diagnosed in 1976–1981 survived for at least five years, compared with an estimated 38% in 1960–1963 [5]. However, the number of patients that have state-of-the-art therapy available to them is still relatively small because of the great variability in the expertise and resources within our health care system. The National Cancer Institute (NCI) has set a goal of 50% reduction in cancer mortality by the year 2000, which depends on three factors; success in cancer prevention (i.e. reducing tobacco use and changing dietary habits), achieving recommended cancer screening measures, and wider application of the gains that have been made from new cancer treatment methods [6,7].