Health Evidence Bulletins - Wales


After many years of limited progress, but also with some notable successes, (as in childhood leukaemia and testicular cancer) the prospects for cancer treatment and care are improving. We are beginning to see death rates fall for many cancers, especially for lung cancer in males and breast cancer in females. These falls have resulted from a number of factors including reduction of risk factors, earlier presentation and better diagnosis and treatment.
There is beginning to be a better understanding of the biological basis of cancer cell development and behaviour.1 This opens up possibilities for increased accuracy of diagnosis and prognosis, and, within the forseeable future, for development of specifically targeted treatment.2
To provide a consistently high standard of cancer care, each discipline will face its own unique challenge in ensuring that knowledge and clinical performance conform to best practice and is evidence based. The education, training and workforce implications of the DOH Report on Commissioning Cancer Services (1995) are considerable. 3 The increasing use of protocols and guidelines based on reputable research evidence and carried out meticulously by all who are involved in cancer care should eventually improve outcomes. Improved communications between health professionals will also ensure that the most effective treatment is carried out. Better provision of information to patients will help them to approach their treatment and care with confidence and optimism.
For all of the cancers, the ultimate aim must be prevention of the disease. With one third of cancers being related to smoking and another one third closely related to diet and nutrition, some of the remedies are obvious. Achieving the required changes in lifestyle, in the environment, and in industrial and commercial processes, requires a major effort and not a little ingenuity.
Whilst we can confidently expect to be able to defeat many cancers, there may be some that are beyond cure. It is on these occasions that we must look to the best possible palliative care and treatment to be provided for those who need it.4


  1. Lane D. The promise of molecular oncology. Lancet 1998; 351(SII): 17-20.
  2. Habier DA, Fearon ER. The promise of cancer genetics. Lancet 1998; 351 (SII): 1-8.
  3. Department of Health. A Policy Framework for Commissioning Cancer Services: A report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. London: Department of Health, 1995.
  4. Emanuel EJ, Emanuel LL. The promise of a good death. Lancet 1998 ; 351(SII): 21-29


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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: