Cancer survival — and the fact that it is not improving fast enough — is in the news again in both the US and the UK. The American Cancer Society has brought it to the forefront of the news in the US by taking the unprecedented step of devoting its entire US$15 million advertising budget this year to the consequences of inadequate health insurance (http://www.nytimes.com/, 31 August 2007). If trends continue as they are, the US is not going to reach its goal of halving cancer death rates and reducing incidence rates by a quarter from their 1990 rates by 2015. Recent research has linked this to delays in detecting malignancies due to lack of insurance. What use are advances in cancer screening and treatment if 15.8% of Americans are uninsured and can't afford them?

In Europe, EUROCARE-4, the largest population-based study of cancer survival, was published in August (http://www.thelancet.com/journals/lanonc, 21 August 2007). The investigators analysed data from 23 European countries including 2 million patients who were diagnosed with cancer 1995–1999 and followed up until December 2003. The 5-year survival for all cancers was also ranked according to the total national expenditure on health. In general, 5-year cancer survival in Europe is improving, and patients in Europe are achieving outcomes closer to those seen for patients treated in the US. However, despite the fact that in the UK everyone has access to the state-funded National Health Service and the launch of a new national cancer plan for England in 2000, cancer survival in the UK is below the European average and is similar to some eastern European countries that spend much less than the UK on healthcare.

So there is some good news in Europe but considerable challenges face both the US administration and the UK government for provision of cancer care.