Establishment of progress against cancer is assessed mainly by the reduction of mortality. This reduction can emerge from a decrease in cancer incidence, increase of proportion of early stages and/or better treatment of clinically detectable cancer. We review and compare time trends in incidence, screening (mammography, endoscopy), early detection and case-mortality in the USA and Japan.

We discuss the reasons for the differences in the rates of minimally invasive treatment (breast- and axilla node-preserving surgery for breast cancer and endoscopic mucosal resection for gastric cancer) and extent of conventional surgery for gastric cancer between USA (D2 dissection rate of 10% only) [NEJM 2001;345;725-30] and Japan (routine use of D2 dissection). Prophylactic surgery with bilateral mastectomy on BRCA1/BRCA2 mutations carriers (J Natl Cancer Inst 2001;93:1633-7] and most recently with total gastrectomy on CDH1 gene (E-cadherin) mutations carriers [NEJM 2001;344:1904-9] has been established effective to reduce significantly the risk of breast and gastric cancer, although several issues need further prospective evaluation.

Postoperative (adjuvant) treatment has been established effective to improve survival for breast cancer [J Natl Cancer Inst 2001; 93: 979-89], whereas for gastric cancer hopes provides a most recent randomized trial [NEJM 2001;345;725-30] in contrast to the negative up until now available results.

New multimodality treatments of advanced-stages cancers are too expensive with a rather small expected survival benefit. We discuss whether the design of strategies for prevention (see also Genetics - Molecular Targets) and early detection can be realistic, more effective and less expensive than treatment to control breast and gastric cancer.

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