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Death rates from lung cancer among men have fallen as rates of smoking have declined. Death rates from breast cancer and cervical cancer have fallen with the introduction of national screening programmes and of new and better treatments. Survival rates for some cancers have improved dramatically: almost two thirds of children with cancer are cured now, as are over 90% of men with testicular tumours.

9. At its best, cancer care in this country leads the world. Many British medical researchers are playing a leading role in extending the understanding of cancer and of ways of treating it effectively. Amongst comparable countries Britain has the most comprehensive nationwide breast screening programme. There are excellent services for children with cancer. And hospices and palliative care services in this country, largely developed by charities, are among the best in the world.

10. But there is much that needs to improve. There are real inequalities in this country in terms of who gets cancer, and what happens to them when they do. People from deprived and less affluent backgrounds are more likely to get some types of cancer, and overall are more likely to die from it once they have been diagnosed. In the early 1990s, deaths from lung cancer among men were nearly five times higher among unskilled workers than among professional groups.

11. For a number of reasons, cancer patients in England often have poorer survival prospects than in other European countries. For some cancers, such as breast cancer and bowel cancer, that is partly because patients tend to have a more advanced stage of disease by the time they are treated. This may be because they are not certain when to go their GP about possible symptoms, because GPs, who see relatively few cases of cancer, may have difficulty identifying those at highest risk, or because of the time taken within hospitals to progress from the first appointment through diagnostic tests to treatment.

12. While many cancer patients receive excellent treatment, services are patchy. Too much equipment is out of date and inadequate, and the NHS has too few cancer specialists of every type. Patients in different parts of the country receive varying quality and types of treatment - the postcode lottery of care - when they want to be confident of receiving what is best for them, wherever they live.

13. Experience of cancer care also varies. Some patients say they receive excellent care, with sensitive and thoughtful communication, clear information about their disease and its treatment, and good support when it is needed. Others report being given bad news in a deeply insensitive way, being left in the dark about their condition and badly informed about their treatment and care. Long waits and uncertainty add to their inevitable anxieties.

14. These delays and variation in cancer care are unacceptable in a 21st century NHS. Despite the best efforts of dedicated staff, decades of under-investment have taken their toll. Staff want the opportunity to provide better cancer services and patients and the public are hungry for improvement.

15. A start has been made. Since 1997, the government has pledged that it will cut the death rate from cancer in people under 75 by at least a fifth by 2010, and will aim to improve the health of the worst off in particular. The White Paper Smoking Kills launched a comprehensive tobacco control programme.

16. The government has also focused money and energy on driving up the quality of cancer services. Targeted resources totalling £80 million a year are being invested to improve standards and cut out patient waiting times. The biggest ever programme to replace and update equipment for screening, diagnosis and treatment has begun. But there is much more to do.