{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:18:35Z","timestamp":1787915915687,"version":"build-2784847793"},"reference-count":126,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"unspecified","delay-in-days":58,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Exeter Biomedical Research Centre, Department of Clinical and Biomedical Sciences","award":["NIHR203320"],"award-info":[{"award-number":["NIHR203320"]}]},{"name":"PREDI-LYNCH, European Union, Horizon Europe Mission on Cancer","award":["101213916"],"award-info":[{"award-number":["101213916"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjonc"],"accepted":{"date-parts":[[2026,8,12]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Genomic testing has the potential to transform cancer care across the patient pathway. However, its benefits remain unevenly realised across populations and health systems. Precision oncology is characterised by a strong promissory discourse, with expectations of improved outcomes and cost-effectiveness, yet real-world implementation remains variable and context dependent. This review examines how patient and public awareness interacts with, and is constrained by, structural, organisational and political-economic factors that shape equitable access to genomically driven cancer care across five themes: (1) the power of patient and public advocacy; (2) learning from the patient perspective; (3) culturally responsive communication; (4) structural and personal barriers and facilitators and (5) political economy of health. Examples are mapped across global regions to highlight how health system, structural and societal factors continue to limit the universal realisation of genomic medicine\u2019s benefits. We present four recommendations to strengthen the translation of awareness into equitable access and clinical impact: (1) expand and adequately power genomic studies in underserved populations; (2) improve risk communication and decision-making across the cancer pathway; (3) equitable validation and interpretation of emerging genomic technologies and (4) generate real-world evidence on access, uptake and outcomes of genome-matched therapies. Embedding awareness, trust, access and equity in future initiatives is imperative to realise the promise of precision medicine for all patients.<\/jats:p>","DOI":"10.1136\/bmjonc-2025-000856","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:50:22Z","timestamp":1787914222000},"page":"e000856","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Aligning awareness, systems and policy to increase equitable access to genomically driven cancer care"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9852-2872","authenticated-orcid":false,"given":"Kelly","family":"Kohut","sequence":"first","affiliation":[{"name":"Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK"},{"name":"South West Thames Centre for Genomics, St George\u2019s University Hospitals NHS Foundation Trust, London, 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