From missed diagnosis to lifelong survivorship: a precision oncology roadmap for equity in pediatric and AYA cancer care.
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Cancer in children, adolescents, and young adults (AYA) remains a global health challenge, with disparities in survival and quality of life between high-resource and low- and middle-income countries (LMICs). These disparities arise across the cancer continuum, including delayed recognition, inadequate diagnostic capacity, fragmented referral pathways, treatment abandonment, limited supportive care, unequal access to molecular diagnostics, and insufficient survivorship services. Precision oncology provides an opportunity to address these challenges, but its equity potential extends beyond genomic sequencing and targeted therapies. This narrative review examines an integrated precision oncology continuum encompassing early recognition, diagnostic and pathological accuracy, molecular characterization, risk stratification, precision treatment, response monitoring, supportive care, and lifelong survivorship. Evidence from LMIC settings is used to illustrate diagnostic delay, referral barriers, treatment abandonment, health-system limitations, and outcome disparities without attempting an exhaustive country comparison. The review proposes a tiered, equity-centered framework in which foundational cancer services are strengthened alongside progressively accessible molecular and digital technologies. Regional referral networks, patient navigation, tele-oncology, pathology and laboratory networks, targeted molecular testing, multidisciplinary care, survivorship planning, and longitudinal cancer registries are emphasized as practical components. For AYA patients, fertility, reproductive health, mental health, education, employment, and transition between pediatric and adult services are incorporated into precision care. Ultimately, equitable precision oncology should connect biological precision with health-system precision, ensuring that every young person can receive timely diagnosis, appropriate treatment, continuous monitoring, and lifelong survivorship support.