Cancer control and the National Cancer Control Initiative

Many countries place great importance on their strategy for cancer control. The precedent was set by former US President Nixon's "war on cancer", declared in 1971, with the goal of reducing cancer incidence by 50% by the year 2000.1 This optimistic aim occasioned an unprecedented expansion of the US National Cancer Institute, its budget reaching $3.5 billion in 2001.2 More recently, the UK National Health Service embarked on a comprehensive reform of cancer services.3 The high profile of cancer in Western countries relates to its associated high morbidity, the high level of public awareness of the disease and the rapidity of research advances.

In 1997, Dr Michael Wooldridge, the then Federal Minister for Health and Family Services, contracted the Australian Cancer Society (now the Cancer Council Australia) to establish the National Cancer Control Initiative (NCCI). The formation of the NCCI was based on a conviction that a better return for expenditure on cancer could be obtained, and that the time had come to introduce new evidence-based cancer-control measures.4 Although an array of cancer-control activities was already in place, it was envisaged that the NCCI could make these processes less capricious by applying a national focus, establishing agreed priorities and forming strategic partnerships across government and non-government sectors.5

The NCCI sees cancer control as comprising "all actions that reduce the burden of cancer in the community [including] every aspect of care, from prevention and early diagnosis to curative treatment and palliative care, all underpinned by the best scientific evidence available".6 The NCCI is concerned with assessing both existing programs and potential new developments for their clinical effectiveness, cost–benefit and equity. Its brief extends to managing strategic projects concerned with translating new findings into public health and clinical practice.

The NCCI's activities have mainly revolved around cancer care, early diagnosis, and information needs. To provide good-quality clinical care, we need to know what good care is, what care is currently being provided, what gaps exist, and what opportunities there are for improvement.

Defining good-quality care requires evidence-based clinical guidelines. The NCCI has been involved in various projects in this area, including

• production of guidelines on colorectal cancer for specialists, general practitioners and consumers;

• production of consumer guidelines on prostate cancer;

• development of guidelines for psychosocial care of patients with cancer; and

• development of an evidence-based model of optimum utilisation of radiotherapy.

The assessment of current care requires management surveys, ideally involving all relevant specialties and representative groups of patients. One of the NCCI's initiatives has been the funding, through a Commonwealth grant, of a national survey of over 2000 patients with colorectal cancer.

• a consultative project, sponsored by the NCCI in collaboration with the Cancer Council Australia and the Clinical Oncological Society of Australia (COSA), to assess the limitations of cancer care provision;

• development of a national consumers' cancer organisation to increase the scope and effectiveness of consumer involvement;

• a review, in conjunction with COSA and state and federal governments, of the infrastructure needs for cooperative group clinical trials;

• initiatives to achieve earlier diagnosis, such as (i) federally funded pilot studies of colorectal cancer screening;7 (ii) assessment of new screening methods for cervical cancer, ovarian cancer, lung cancer and melanoma; and (iii) a project to improve GPs' expertise in managing prostate cancer and using prostate-specific antigen screening.

• collaboration with State and Territory cancer registries to improve the documentation of cancer and its outcomes, particularly with regard to staging. (The NCCI has developed a core clinical cancer data set for hospitals,8 which includes information on stage of disease and primary treatment, and is designed to be compatible with data collected by population-based cancer registries.);

• development of ways to assess the frequency of non-melanoma skin cancer, Australia's commonest cancer, using survey methods similar to those used previously,9 but also considering any new methods that become available.

In the future, the NCCI will continue to take a leadership role by consensus through an inclusive, consultative approach in dealing with nationally identified priorities. The organisation's core purpose is to be an expert reference body providing timely advice, identifying appropriate initiatives and making specific recommendations to the federal government and other groups regarding the prevention, detection, treatment and palliation of cancer for all Australians.