Historical origins of current problems in cancer control.

Canada's provinces have some of the most highly developed cancer control systems in the world, but the recent crisis in waiting times for radiotherapy has drawn attention to many weaknesses and inadequacies. Focusing on the province with the largest cancer control system, Ontario, this paper explores the historical origins of current problems in cancer control and shows that they are directly related to policy decisions made in the early years of the system. The development of cancer control in Ontario from the 1920s to the present is outlined, and the historical origins of 3 specific problems related to patient care are discussed: fragmentation of care, which has resulted from an emphasis on radiotherapy rather than comprehensive care and from tensions between the medical profession and government; variation in practice, which can be traced to the empirical origin of much cancer treatment and the slow implementation of research programs; and inequitable access to care, which can be attributed to the emphasis on geographic centralization of services. Attempts to reform Ontario's cancer control system are unlikely to be successful unless these fundamental issues are recognized and addressed.