In 1966, Paul Carbone at the National Cancer Institute (NCI), Bethesda, pioneered the concept of «adjuvant chemotherapy» - using drugs after radical mastectomy to prevent recurrence. By 1972, Carbone shared promising results of the CMF regimen (cyclophosphamide, methotrexate, fluorouracil) with Italian oncologist Gianni Bonadonna, leading to their collaboration.

Inspired by a 2014 call to action from American oncologist Nandita Khera, Italian researchers discovered that, despite universal healthcare coverage, 26% of cancer patients reported financial difficulties before treatment, with younger patients, women, and those in southern Italy most affected. Financial distress correlated with poorer quality of life and increased mortality risk.

Cancer patients need confidence that their surgeon understands cancer and all treatment options, as well as having technical expertise in the often complex procedure they will be performing. Training and certification should play a central role in ensuring high standards, but getting agreement on a harmonised approach in Europe faces obstacles.