The National Institute for Health and Clinical Excellence (NICE) will have existed for 10 years on April 1, 2009. Over the past decade, the institute’s methodological approach to the development of guidance and assessment of the value of health-care interventions has received international interest and acclaim. Furthermore, individual decisions, in particular those made on new cancer drugs, have generated enormous controversy. An early example was the appraisal of irinotecan and oxaliplatin for colorectal cancer in 2002. In 2003, NICE described the rationale behind its decision making. The 10th anniversary of the institute provides an opportunity to review some of the key issues affecting cancer appraisals and to explain the development of other NICE guidance programmes relevant to the provision of cancer services.