The 50th anniversary of COSA is both cause for celebration as well as a time to reflect on the extraordinary progress in the science and practice of oncology and the lessons learned. My interest in oncology was sparked in 1978 as a rotating registrar in the new field of medical oncology. I rapidly enrolled in the nascent specialist training program and attended my 1st COSA conference in 1979. My clinical and research focus on breast and gynaecological cancers began early during my training and encouraged by excellent mentors. I will focus on how things have changed in the management of ovarian cancer as there are parallels with most other cancers. I believe that it is worthwhile looking back not simply to reminisce but rather to learn from what we got right and what we got wrong, as the past can and should inform how to plan for future success. I will briefly review the ‘bad old days” which is an apt description of treatment in the 1970’s due to our limited understanding of the biology of ovarian cancer and inadequate management that was not underpinned by strong evidence or a multidisciplinary approach that we now take for granted. I will illustrate the steady improvements that occurred over the next 3 decades and the key drivers for progress and the secret sauce will be revealed. I will end with the transformational events that have occurred over the last decade and use the experiences of the past to project on what’s ahead in the next decade. There have been many missed opportunities along the way and mistakes made which we should learn from. Despite the undisputable progress, it is sobering that some things have not changed including the inequities in access to optimal management which remains a universal problem which science will not fix and requires political solutions.