New Delhi

Access to genomic testing and matched treatments remains profoundly unequal within and between countries, according to a new commission by The Lancet Oncology.

It has also identified substantial inequalities in cancer genetic testing research, reporting that only 2 per cent of biomarker-based cancer trials are conducted in low- and middle-income countries (LMICs), compared to almost 81 per cent in high-income countries.

An international team of authors of the commission has warned of a "paradox of success" -- the rapid expansion of precision oncology has increased cost and complexity faster than the benefits it delivers at a population level.

Global spending on cancer medicines is estimated to have risen by around 75 per cent over the last five years, reaching approximately USD 252 billion in 2024, and is projected to reach USD 441 billion by 2029, they have said.

The researchers analysed global data on clinical trials and genomic datasets, and conducted a survey of national cancer programmes.

The team estimated that seven to eight million (70-80 lakh) people with cancer worldwide need standard-of-care molecular testing every year.

However, the coverage remains far from universal, particularly in LMICs, it has said.

For example, an estimated 3.14 lakh women with ovarian cancer are eligible for BRCA -- the breast cancer gene -- testing annually, yet around half do not receive it, a gap driven largely by a low testing coverage in LMICs, the researchers have said.

To help health systems respond, the commission has proposed a framework for prioritising which molecular tests and matched therapies to implement, alongside a system-readiness assessment tool.

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It has also set out a workforce-competency framework and principles for responsible data-sharing.

The commission has also put forth 10 core recommendations for an equitable, effective and responsible integration of precision oncology into cancer control and universal health coverage, and a phased implementation roadmap.