A narrative review examines biobanking and genomic research infrastructure in sub-Saharan Africa and its implications for precision oncology, highlighting that locally governed, sustainable biobanks and equitable international partnerships are fundamental prerequisites for Precision Oncology Without Borders.
Abstract
Cancer mortality in sub-Saharan Africa is projected to double by 2030. African populations exhibit the highest genetic diversity worldwide, impacting cancer susceptibility, tumor biology, and therapeutic response, yet remain critically underrepresented in biomedical research. This narrative review examines biobanking and genomic research infrastructure in sub-Saharan Africa and its implications for precision oncology, highlighting that locally governed, sustainable biobanks and equitable international partnerships are fundamental prerequisites for Precision Oncology Without Borders.
Precision oncology has revolutionized cancer care in high-income countries, but its implementation in Latin American low-resource settings faces profound bioethical dilemmas. This study analyzes these challenges through the lens of social justice and equity. An integrative review was conducted following the Whittemore and Knafl framework. A systematic search was performed across PubMed, Scopus, SciELO, and LILACS (2015–2025). Thematic synthesis was applied to integrate empirical data with normative bioethical theories. Four major analytical themes were identified: 1) The innovation paradox and financial toxicity, where prohibitive pricing (exceeding 100,000 USD/year) violates distributive justice and leads to a biological penalty in survival; 2) Infrastructure deficits and epistemic injustice, highlighted by a 9.4% access rate to next-generation sequencing (NGS) and the risks of applying Eurocentric genomic data to admixed LA populations; 3) Research vulnerability, where clinical trials serve as survival strategies, compromising autonomy and informed consent; and 4) The judicialization dilemma, where individual court orders for high-cost drugs threaten systemic sustainability and equity. To prevent a genomic apartheid, Latin America must transition toward genomic sovereignty and frugal precision oncology. Bioethical frameworks in the region must prioritize protection ethics and social justice to ensure that scientific innovation does not exacerbate existing health inequities.
Alcides Chaux· Exploration of Targeted Anti...· 0 citations
Breast cancer represents a major public health burden in Sudan, where most patients are diagnosed at advanced stages and access to comprehensive diagnostic and molecular services remains limited. Current treatment strategies are largely extrapolated from non-African populations, despite the substantial genetic diversity across African populations that may significantly influence drug response, efficacy, and toxicity. Pharmacogenomics offers a promising approach to optimize breast cancer therapy through genetically informed treatment decisions; however, its clinical application in Sudan and across Africa remains limited. This narrative review synthesizes published evidence on pharmacogenetic determinants influencing breast cancer treatment, with a particular focus on African and Sudanese populations. Relevant studies published between 2005 and 2026 were identified through searches of PubMed, Google Scholar, and PharmGKB. A qualitative synthesis was conducted to summarize key pharmacogenes, population-specific genetic variability, and their potential clinical and therapeutic implications. Considerable interethnic variability has been reported in pharmacogenes involved in drug metabolism and transport, including CYP2D6, CYP3A4, CYP2B6, DPYD, and ATP-binding cassette transporter genes. African populations exhibit distinct allele frequency patterns that may substantially affect drug disposition, therapeutic efficacy, and toxicity, particularly for endocrine therapies and commonly used chemotherapeutic agents. These differences limit the direct applicability of pharmacogenomic data derived from European and Asian populations and underscore the need for population-specific evidence. Integrating pharmacogenomics into breast cancer management has the potential to improve treatment effectiveness and safety in Sudan. Achieving this goal requires the generation of locally relevant pharmacogenomic data, strengthened diagnostic and laboratory infrastructure, and a stepwise, context-appropriate incorporation of pharmacogenomic principles into clinical practice. Such an approach is important to support equitable and effective precision oncology for Sudanese and African populations.
K. E. M. Elhaj, M. Mudawi· JCO Global Oncology· 0 citations
This study aims to clarify how frontline healthcare professionals transform the imbalance between clinical outcomes and patient needs—arising from the transitional implementation phase of cancer genomic medicine, a core domain of Precision Medicine (PM)—into meaningful value. Since its introduction in the United States in 2015, PM has been promoted across advanced nations as a "forward-looking promise" to create the next generation of standard care (Ackerman 2022: 197). Meanwhile, Japan entered a unique implementation phase in 2019, integrating cancer genomic medicine into its universal healthcare system. Currently, a large-scale national survey (Sunami et al. 2022) reveals a structural imbalance: the success rate of identifying therapeutic drugs (the primary objective) remains at 7.7%, whereas the detection rate of genetic risks (secondary findings, or SF), a by-product, is higher at 10.3%. Based on qualitative research at two facilities in Japan, this study utilizes Bogicevic et al.'s (2021) mode classification and Ackerman's (2022) concept of "invisible labor" for analysis. The findings indicate that the "labor of connection" performed by healthcare professionals serves to humanize and personalize the otherwise undesirable outcomes of finding no targeted treatments or disclosing SFs affecting patients' families. From a service engineering perspective, this study visualizes the value transformation process and proposes a framework for human-centered medical service design.
Simple Summary Integration of pharmacogenomic results with an oncology patient’s tumor molecular test results using Flype, a software developed at our institution, led to the identification of actionable genomic alterations to determine therapy options in patients with advanced cancers for whom standard therapies had been exhausted. Software enhancements to Flype supported the Kellogg Cancer Genomic Initiative, improved molecular test report turnaround times, while providing tools for molecular tumor board patient reviews. Integrating pharmacogenomic results into the molecular tumor board review led to improved therapeutic efficacy, such as avoiding the use of tamoxifen due to an increased risk of treatment failure and better pain management by detecting reduced CYP2D6 activation.
D. Helseth, Nicholas Miller, Mathew Yang et al.· Cancers· 0 citations
PURPOSE
Cancer care capacity in sub-Saharan Africa (SSA) is constrained by late diagnosis and limited treatment access. Few funding mechanisms support innovative, locally led programs to address these challenges. A collaborative initiative was developed to strengthen oncology care through quality improvement (QI) projects.
MATERIALS AND METHODS
The program was developed by Global Bridges Oncology (GBO) at Mayo Clinic, Pfizer Global Medical Grants, and the African Organisation for Research and Training in Cancer. A committee composed primarily of African oncology experts guided the process. An RFP was disseminated across SSA in English, French, and Portuguese, inviting applications to improve diagnostic and therapeutic cancer care. Applications underwent a structured, two-stage review, with GBO providing technical support, expert guidance, and training resources.
RESULTS
The RFP generated 218 applications reflecting strong demand for oncology QI funding in SSA. After review, 17 projects representing 10 African countries were selected and awarded $1.1 million USD. Funded initiatives reflected four themes: oncology training and clinical practice improvements, early detection and accurate diagnostics, pediatric cancer care, and oncology nursing and palliative medicine. As of March 2026, 11 (65%) of 17 projects are complete, with 4,565 health care professionals engaged through direct training, conference dissemination, system adoption, and sensitization activities, and program-supported services were delivered to more than 47,300 patients.
CONCLUSION
This initiative demonstrates the feasibility of a competitive, regionally guided grant program to strengthen cancer care capacity. Early implementation outcomes, including measurable improvements in diagnostic delay, treatment adherence, and care network expansion, confirm that locally led QI initiatives can generate meaningful results across diverse institutional settings. By centering African leadership and supporting diverse QI projects, it advances equitable access to funding, capacity building, and sustainability planning.
Kenneth W. Merrell, Ben Kamdem-Talom, Hannah Naa Gogwe Ayettey Anie et al.· JCO Global Oncology· 0 citations
Omics biomarkers comprise several molecular entities, including genomic, epigenomic, transcriptomic, proteomic, and metabolomic signatures. They play an essential role in oncology drug development and clinical settings by enabling personalized medicine. In precision oncology, validating biomarkers is a greater challenge than discovering them. The biomarkers discussed here span a wide evidentiary spectrum, from those endorsed in clinical guidelines to those that remain investigational.
Mai Mehanna, H. Mody, Joy C Hsu et al.· Clinical and Translational S...· 0 citations
