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Sarah Duff and her colleagues (March 2004 JRSM1) report on the difficulties in meeting waiting time targets for treatment of colorectal cancer. An important cause of delay was shortage of staff and equipment for preoperative radiotherapy. Others have noted the contribution of delays before referral.2 The Government's targets are based on a belief, rather than scientific evidence, that earlier treatment will produce more cures. A scientific approach would consider not only the entire clinical course but also the phenomenon of ‘biological predeterminism’,3 whereby tumour behaviour is determined early in the pre-clinical phase. Indeed, ACPGBI guidelines4 on bowel cancer referral raise the question ‘whether early diagnosis in an anatomical sense can be achieved by earlier symptomatic diagnosis in the temporal or chronometric sense... ’.