The science exists; the question is who gets to reach it.

There is a distance between a discovery and a patient that is measured not in miles, but in systems—in laboratories that cannot share data, in clinics that cannot afford tests, in countries where the science exists but the infrastructure does not. Precision oncology has advanced with remarkable speed, offering the promise of treatments tailored to the genetic fingerprints of individual cancers. Yet for much of the world, that promise remains exactly that: a promise, waiting on the other side of a gap no single breakthrough can bridge.

Professor Mark Lawler of Queen's University Belfast joined a special podcast episode of The Lancet Oncology to discuss the findings of the journal's latest Commission on accelerating equitable cancer genomics and precision oncology in health care and research. He was joined by Dr. Raffaella Casolino of the University of Glasgow and the International Cancer Genome Consortium, in conversation with Dr. Cheryl Lai, Acting Deputy Editor at The Lancet Oncology .

The Commission, published on September 25, 2026, brought together more than 50 commissioners from 21 countries and 48 partners across multiple disciplines. Its central finding was stark: approximately four out of five cancer patients globally who require biomarker testing do not receive the testing needed to guide their diagnosis or treatment. Between seven and eight million cancer patients worldwide require established standard-of-care molecular testing annually, and the vast majority are not getting it .

Lawler described the data as difficult to accept. "Four out of five? We couldn't believe it when we saw that data coming out of our work," he said in the podcast. "Just not acceptable. Precision oncology must be for all cancer patients, not just for the privileged few" . The Commission's research found that life-changing molecular testing and precision oncology treatments remain largely available in the wealthiest countries, while access is challenging even in some high-income settings .

The Commission also examined the research ecosystems that support precision oncology, finding them deeply unequal, fragmented, and insufficiently representative. Genomic research, biomarker-driven clinical trials, and health data remain disproportionately concentrated in high-income countries and Western populations . A linked commentary in The Lancet Oncology described the problem as "ecological neglect," noting that health-system infrastructure currently supports only limited interoperability of data across cohorts, platforms, and institutions, resulting in siloed datasets that lack statistical power .

Lawler framed the challenge as one of implementation rather than discovery. "We're very good at breakthrough, but now we need to be equally good at follow-through," he said . The Commission offers a context-responsive approach to implement cancer genomics and precision oncology effectively, equitably, and sustainably, with a focus on strengthening health-system infrastructure so that data can be generated, integrated, governed, and used to improve care . The Commission also involved people with lived experience of cancer from the outset, whose perspectives Lawler described as the "bedrock" of the work .

Professor Mark Lawler discussed the Lancet Oncology Commission's findings in a new podcast, revealing that four out of five eligible cancer patients globally lack access to biomarker testing. The Commission calls for equitable implementation of precision oncology, emphasizing health-system strengthening and patient involvement.

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Sources: The Lancet Oncology, The Lancet, Peoples Gazette Nigeria, Queen's University Belfast