Disease-specific oncology units —breast, pancreas, thyroid and similar units— spread across Europe two decades ago to organise care for complex tumours at a time when structured multidisciplinary mechanisms were largely absent. An analysis in the Journal of Cancer Policy revisits that model and asks whether, with multidisciplinary tumour boards (MTBs) now in place and regional cancer networks operating, units remain justified in their current configuration.
What was known
The paper acknowledges the historical role of these units: they were the practical route to embedding multidisciplinary practice and concentrating expertise in tumours with complex management. At the same time, MTBs are now mandated structures in the cancer networks of the United Kingdom, France, Australia and across Italian regional legislation, with a robust evidence base on their independent clinical value. The question is not whether multidisciplinary care works, but how it should be organised.
What this work adds
This is a critical appraisal, not a patient study or an outcomes dataset. The author examines the organisational justification of disease-specific units in systems that have already developed boards and networks, and compares NHS England, France and Australia to see how they have reconciled both structures.
Main findings
The article identifies four structural problems. First, a paradigmatic tension with network-based care: the unit is organised around an organ, the network around pathways and territories. Second, a tendency to reduce complex pathways to their surgical phase, leaving systemic treatment, radiotherapy or follow-up in the background. Third, the absence of formal administrative accountability. Fourth, an equity gap between tumour types with a dedicated unit and those served only by the board.
The international comparison shows that mature systems have resolved this tension by integrating organ-specific expertise within the board framework rather than maintaining parallel structures. On that basis, the author sets out four operational recommendations to reposition the board as the primary organisational subject for all oncology pathways.
What it means
The message is not to abolish disease-specific units but to integrate them within the network rather than place them alongside it. For clinical teams, this means asking where decisions are actually made and who is accountable for them; for managers, reviewing duplication and ensuring that equity across tumour types does not depend on whether a dedicated unit exists. For patients, the underlying issue is that expertise should be available throughout the pathway, not only at the surgical stage.
A view from the breast unit
Spanish breast units have been an example of concentrated expertise and multidisciplinary work. This analysis invites a review of how they fit into the cancer network and a guarantee that the board also covers the systemic phase, radiotherapy and follow-up, with explicit responsibilities.
Reference: Iannopollo M. Disease-specific oncology units or multidisciplinary tumour boards? A critical appraisal of an organisational model in the era of cancer networks. Journal of Cancer Policy, 2026. DOI
