In the wake of George Floyd’s highly publicized murder, a reckoning with racial injustice has swept across the United States. The health care system has begun to grapple with its role in perpetuating racial discrimination through inequitable care delivery, a sobering but essential task in the effort to generate real progress. The field of cancer care is not exempt from this process of reflection. Precision oncology represents a tremendous opportunity for the delivery of personalized, targeted cancer care, but significant gaps in research and practice threaten to exacerbate disparities for Black, Indigenous, and other people of color. In this Special Series of the Journal of Oncology Practice, several papers draw attention to these gaps. We particularly note Dr Costa’s report showing lower rates of targetable mutations among Black patients with lung cancer and Dr O’Neill’s suggestion that existing prognostic markers may carry different significance for Black and White patient populations diagnosed with head and neck cancer. The relationship between genetics and race is complex, as race is a social construct, yet we see somatic genomic differences in tumors between racial and ethnic groups. These may be driven by epigenetic changes from centuries of systemic racism and social determinants of health, rather than intrinsic biologic differences. Nonetheless, we must address known shortcomings in genomic and clinical research to maximize the benefit of precision medicine for Black and other populations of color, and we must aspire to build new systems that identify and eliminate disparities before patients are harmed. Evidence-based approaches to address these challenges are already within reach
