After 40 years in oncology practice has my experience lived up to initial expectations? My answer is a big YES! On the scientific front the explosion in the understanding of genomics and the defective genes that initiate cancer growth has led to new therapies which target the defective genes and generally have fewer toxic effects than chemotherapy. These so-called targeted therapies are likely to have their main impact on suppressing cancer growth rather than eradicating the disease but prolonged suppression of cancer can be very beneficial and can be compared to the prolonged suppression of the HIV virus in AIDS. Patients with advanced cancer that will ultimately prove fatal are now living several years longer than previously due to better cancer controlling therapies. The rapid progress in the understanding of cancer genetics will ensure there will be a proliferation of new cancer interventions over the next 20 years. Other advances include the identification of defective genes that cause familial cancer which then allows preventive action including screening to be undertaken. Another recent cancer prevention strategy is the use of vaccines against viruses that can cause cancer such as cervical and liver cancers.