The Spearhead Primary Care Trusts (PCTs) are designated as those areas that face the greatest health challenges in England. They are intended to be the focus of interventions designed to reduce health inequalities, including those for cancer. One- and five-year relative survival estimates for cancer patients diagnosed between 1998 and 2004, and resident in a Spearhead PCT area, have been compared with those in the rest of England to assess the baseline trends in inequalities in cancer survival. Survival is consistently lower for patients resident in Spearhead PCT areas than for those resident in the rest of England, although trends in the difference between Spearhead PCTs and the rest of England suggest that the gap in survival has narrowed for most cancers.