Several obstacles have been encountered in the development of astatine-based radiopharmaceuticals for cancer treatment. World War II delayed research for close to a decade. Results of early experiments indicated that a cancer-selective carrier would need to be developed and it was not until the 1970s that monoclonal antibodies became available for this purpose. Unlike iodine, astatine shows a tendency to dehalogenate from molecular carriers such as these, particularly at sp3 carbon sites (less so from sp2 sites). Given the toxicity of astatine accumulated and retained in the body, this emphasized the need to ensure it remained attached to its host molecule. While astatine carriers that are slowly metabolized can be assessed for their efficacy, more rapidly metabolized carriers remain a significant obstacle to the evaluation of astatine in nuclear medicine. Mitigating the effects of astatine-induced radiolysis of labeling chemistry and carrier molecules is another area requiring further development. A practical application for astatine as a cancer treatment would potentially be suitable for a "staggering" number of patients; production of astatine in the quantities that would be required remains an issue.