Disease-specific oncology units or multidisciplinary tumour boards? A critical appraisal of an organisational model in the era of cancer networks.

Disease-specific oncology units - Breast Units, Pancreas Units, Thyroid Units and analogues - were introduced across Europe over two decades ago as organisational responses to the growing complexity of cancer care and the documented absence of structured multidisciplinary mechanisms for managing complex malignancies. Their historical role in establishing multidisciplinary practice is well recognised. However, Multidisciplinary Tumour Boards (MTBs) are now mandated structures in the cancer networks of the United Kingdom, France, Australia and across Italian regional legislation, and a robust evidence base documents their independent clinical value. This paper critically examines whether disease-specific oncology units remain organisationally justified in healthcare systems that have fully established MTBs and regional cancer networks. We argue that oncology units, in their current configuration, exhibit four structural problems: a paradigmatic tension with network-based care logic; a tendency to reduce complex oncological pathways to their surgical phase; an absence of formal administrative accountability; and a systematic equity gap between tumour types with disease-specific units and those served only by MTBs. International comparisons (NHS England, France, Australia) demonstrate that mature cancer systems have resolved this tension by integrating disease-specific expertise within the MTB framework rather than maintaining parallel structures. We propose four operational recommendations to reposition the MTB as the primary organisational subject for all oncological pathways. The reform is not about abolishing disease-specific structures, but about integrating them within the network rather than alongside it.