In many countries, cancer patients have had structural pathways for a number of years. Regardless of whether these are called two-week referrals, urgent referrals or cancer pathways, they have improved the care for many patients with a suspected malignancy. In a society with limited access to medical care, however, an improvement like this may come at a cost. Unfortunately, patients with chronic disease may be among those paying the price for the structural pathways within Oncology. This price comes in many different forms, but for our Inflammatory Bowel Disease patients it particularly involves prolonged waiting times for radiology, endoscopy and surgery. Thus the improvement achieved for patients with, for example, suspected colorectal cancer may at the same time represent an impairment for patients with an increased risk of developing the same type of cancer as intervals between endoscopic surveillance sessions tend to increase.