The most important changes in the operating environment in the year in review concern the delay in social and health care restructuring, changes to Veikkaus’ operations, and the start-up of the Comprehensive Cancer Center. All of these have an impact on the work of the CSF. There is also mounting concern about the impact of climate change on the planet as a whole and the uncertainties of the global economy that need to be taken into account in our activi-ties. Prime Minister Juha Sipilä’s government resigned before the parliamentary elections, when the long-prepared social and health care reform and the related provincial reform did not receive sufficient support in Parliament. Subsequent governments — led by Antti Rinne and then Sanna Marin — have undertaken to pursue the reform under changed criteria. Free-dom of choice will not be realised in line with the goals of the previous government, and an organisational role for Uusimaa is being sought that differs from the provincial model. The role of organisations as service providers and as the partners of service providers in the new structures remains unclear. In August 2019, an extensive public debate got underway on Veikkaus’ responsibility in combating gambling harm. Veikkaus and the state as the owner-manager decided on several measures aimed at reducing gambling addiction and the disadvantages caused by it. These measures will have a significant impact on Veikkaus’ revenues in the coming years and thus also on the operations of those who receive state subsidies from Veikkaus’ profits. The Comprehensive Cancer Center Finland (FICAN) was officially launched in autumn 2019, with the signing by all parties involved in its activities of the founding document. The CSF is not a signatory to this, but works closely with both regional cancer centres and the national coordinating body. The CSF has been involved in the planning from the outset and has provided its own services to support the operation of the FICAN. These services are related to cancer screening, on the one hand, and the implementation of psychosocial support for the patients and their relatives on the other. FICAN is the most important reform measure in the organisation of cancer treatment in Finland for a long time. The CSF carried out its strategy to 2020 using both flagship projects and the organisation’s development plan. Both the implementation of the recommendations of the development plan and the flagship projects progressed according to the planned schedule and were real-ised almost to their original extent already in 2019. During 2019, however, the main focus was already on preparing a new strategy, which was approved at the meeting of the CSF council in December. The data system projects of the Cancer Registry and the Mass Screening Registry progressed as planned. In gathering clinical cancer data, written notifications on paper were abandoned and replaced by an easy-to-use electronic cancer written notification, which was also done in Swedish and English. However, this was only an intermediate step, as the aim is to obtain clinical cancer data in a structured form directly from specialist care providers. The Finnish Cancer Registry was able to offer services to researchers and others needing data more efficiently and in a customer-oriented manner. Required statistical data is accessible by information retriever from the web app. The Cancer Registry, together with its partners, prepared for the introduction of colorectal cancer screening. A number of measures were taken at the CSF’s central office to increase the effectiveness and efficiency of operations. In 2019, extensive project manager training was arranged and a clear model and guidelines were created for the CSF’s projects. In the spring, an assessment by the European Foundation for Quality Management (EFQM) was carried out to identify areas for improving the quality of operations, and in the summer, an operational risk mapping and evaluation was carried out with the support of LähiTapiola. The central office’s management system was renewed by creating one organisational-level management group and three management teams (Cancer Society of Finland, Cancer Foundation and Finnish Cancer Registry). The CSF was involved in regular cooperation between the Ministry of Social Affairs and Health (STM), and the National Institute for Health and Welfare (THL), as well as the Finnish Non-Communicable Disease (NCD) Alliance, which promotes the implementation of the World Health Organisation’s programme on non-communicable diseases in Finland. The One Life project, which was launched as one of the results of cooperation among a number of organisations, continued for the second year, and the CSF took part especially in national advocacy work and provincial inter-organisation cooperation. The goals set for the year were met and the cooperation and coherence within the CSF was further strengthened through the preparation of a new strategy. Good operational and financial results provide a robust foundation for further work and preparation for the new strategy period.