Improving cancer survival rates is a UK priority and equity of access to high quality cancer irrespective of geography is a key principle. Surgery, radiation therapy and systemic therapy remain the cornerstone of the multidisciplinary management of cancer. However, costs of cancer care continue to escalate. A recent review (1) estimated the global costs of cancer care caused by death and disability as US $895 billion (excluding indirect medical costs and based on 2008 figures). Approximately 49% of patients are cured by surgery, 40% by radiotherapy alone or in combination with other treatments and 11% by systemic therapy. With > 90,000 patients per annum treated with curative intent by radiotherapy in the UK, one would anticipate that access to modern radiotherapy techniques would have a high priority. However, there are substantial differences in the NHS uptake of new anti-cancer agents and advanced radiation technologies. In this article, these differences are explored and recommendations made for addressing them.