Access to clinical cancer genomics and precision oncology-based care in North America

Despite the scientific and technical capacity for precision oncology in North America (Canada, the United States, and Mexico), its implementation is deeply uneven across the region. Our narrative synthesis of precision oncology implementation found that delivery consistently fails at four operational steps: biomarker testing, molecular interpretation, reimbursement, and access to matched standard-of-care therapy or clinical trial. These failures arise along disparity axes that differ by country but converge on a single outcome: patients whose cancers harbor actionable biomarkers do not receive precision oncology-based care. We conclude that precision oncology must be treated as essential cancer-care infrastructure rather than an optional research-based service and propose a tri-national implementation agenda. Acting now is particularly urgent given the rapid emergence of artificial intelligence (AI) models trained on precision oncology-derived datasets, which risk entrenching existing inequities into clinical decision-making before implementation reform can catch up.