Advances in precision oncology have outpaced efforts to ensure equitable access, according to Neha Jain, PhD, senior director of precision medicine at OneOncology. While genomic innovations have revolutionized cancer care, systemic barriers—ranging from infrastructure costs to provider education gaps—continue to limit the reach of these breakthroughs for many patients.
The Growing Complexity of Precision Testing
“Precision medicine always starts with the right test,” Dr Jain said at the Summit on Cancer Health Disparities 2025 in Seattle. However, identifying the “right test” is more complicated than it might seem. She described a growing array of testing modalities—ranging from somatic and germline testing to circulating tumor DNA assays and minimal residual disease testing—each with specific indications depending on timing, modality, and panel size. Selecting the wrong test, she warned, could mean missing critical therapeutic opportunities for patients.
Even when appropriate testing is ordered, interpreting genomic reports adds another layer of complexity. Next-generation sequencing results produce vast amounts of information, and clinicians must distill essential findings from background data. Complicating matters further, scientific understanding continues to evolve. “Your reports are stuck in time, but science is not,” Dr Jain said, underscoring the importance of re-evaluating test results as new therapies and biomarkers emerge.
Barriers to Implementation: Infrastructure, Bias, and Education
Beyond the scientific hurdles, real-world implementation faces additional barriers—most notably infrastructure costs. Although sequencing technologies have become considerably less expensive in recent years, deploying them still requires significant institutional investment in equipment, staff training, and specialized facilities.
Dr Jain also highlighted persistent data gaps and biases that skew genomic knowledge. “The majority of patients in trials are Caucasian,” she noted, leaving huge gaps in understanding for other populations. This lack of diversity limits the generalizability of precision medicine advancements, particularly for Black, Latino, and Asian communities. “China and India are the two most populated countries in Asia, and they look nothing alike,” she added, “yet they’re often lumped into the same 1% category in our data sets.”
Provider education remains another critical challenge. Genomics has evolved at a rapid pace, but busy community oncologists—often responsible for treating multiple tumor types—have limited time to stay current. Dr Jain stressed the need for pragmatic, embedded education tools within electronic medical records to support providers without overburdening them.
Access Disparities in the Community Setting
All of these factors contribute to disparities in access. Precision oncology therapies can cost hundreds of thousands of dollars per dose, creating financial barriers for underinsured and uninsured patients. Testing itself may also be unavailable in smaller or rural clinics. Dr Jain pointed out that more than 80% of cancer care in the United States occurs in the community setting, yet many of these practices lack the infrastructure or trial access available at large academic centers. “It’s a chicken-and-egg problem,” she said. “If you want the average person with a cancer diagnosis to benefit from precision medicine, we have to make sure it reaches the community.”
Clinical trial access represents another major hurdle. Nonmedical factors, such as the inability to miss work or afford travel, often prevent patients from participating in studies that could offer cutting-edge therapies.
Opportunities for Improving Equity
Despite these challenges, Dr Jain offered an optimistic view for the future. She outlined several key areas for improvement, including expanding genetic research diversity, strengthening patient education around genomic testing (particularly the differences between germline and tumor testing), and offering linguistically appropriate materials to non–English-speaking populations. Partnerships between academic centers and community oncology practices were highlighted as critical for disseminating expertise more broadly.
Policy reform is also urgently needed to make comprehensive genomic profiling more accessible, particularly in states where coverage remains limited. Advances in technology, including artificial intelligence and telemedicine platforms, offer promising avenues to support precision oncology efforts remotely. Finally, Dr Jain emphasized the importance of investing in workforce development by creating digestible resources that allow oncologists to stay current without overwhelming their already stretched schedules.
“There’s a lot of support available,” Dr Jain concluded. She encouraged institutions to reach out to nearby community practices, invite collaboration at tumor boards, and take advantage of free resources like OncoKB and ClinVar to build institutional capacity. “Leveraging partnerships and shared expertise can go a long way toward ensuring that precision medicine benefits all patients,” she added, “not just a privileged few.”
Source
Jain N. Implementation of precision medicine and its impact on access to care and health equity disparity. Summit on Cancer Health Disparities 2025. April 25-27, 2025; Seattle, WA.