Implementation of Precision Oncology in the United States: A Scoping Review of Genomic Testing Access, Health Equity, and Cancer Care Delivery

Author

• Jaqueline IniguezFollow

Date of Graduation

Winter 12-17-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Public Health (MPH)

College/School

School of Nursing and Health Professions

Department/Program

Public Health

First Advisor

Kyle Knight, MSN, MPH

Abstract

Background and Objective:

Cancer remains a leading cause of morbidity and mortality in the United States, with more than two million new cases and over 600,000 cancer-related deaths expected annually. Precision oncology uses genomic information to guide treatment selection and improve patient outcomes; however, unequal access may widen existing cancer disparities. The purpose of this study was to examine the implementation of precision oncology and genomic testing in U.S. cancer care delivery systems and identify disparities, implementation challenges, and research gaps affecting equitable access.

Methods: 

This scoping review was guided by the Joanna Briggs Institute methodology and the PRISMA Extension for Scoping Reviews. PubMed was searched for peer-reviewed U.S. studies published from 2014 through 2026. The initial search identified 158 records, of which 72 remained after limits were applied. Following title, abstract, and full-text screening, 15 studies met the eligibility criteria (n = 15). Quantitative findings were summarized descriptively, qualitative findings were analyzed through thematic synthesis, and the evidence was narratively integrated and organized using the Social Ecological Model.

Findings:

Access to and utilization of genomic testing differed by race and ethnicity, socioeconomic status, insurance coverage, and geographic location. Major barriers included fragmented care, limited provider preparedness, inadequate testing infrastructure, financial and administrative obstacles, and reduced specialist availability in rural and lower-resource communities. The evidence was concentrated in academic cancer centers, with limited representation of rural, community, and safety-net settings and of uninsured and non-English-speaking populations. Few studies evaluated interventions intended to reduce these disparities.

Public Health Significance: 

Equitable precision oncology requires coordinated, multilevel healthcare and policy strategies that strengthen genomic-service capacity while reducing organizational, geographic, financial, and administrative barriers.

Recommended Citation

Iniguez, Jaqueline, "Implementation of Precision Oncology in the United States: A Scoping Review of Genomic Testing Access, Health Equity, and Cancer Care Delivery" (2026). Master's Projects and Capstones. 2086.
https://repository.usfca.edu/capstone/2086