United by Unique: reimagining future cancer care through precision health and prevention

Cancer care is undergoing a quiet revolution: the centre of gravity is shifting from treating late-stage disease to intercepting cancer much earlier, guided by precision health rather than one-size-fits-all protocols. As we mark World Cancer Day 2026 under the theme ‘United by Unique’, it is an opportune moment to consider how a people-centred, precision approach can help prevent more cancers, enable earlier diagnosis, and reduce—rather than widen—global inequities. UNITED BY UNIQUE RISK World Cancer Day 2025–20271 calls on us to recognise that each person’s cancer journey and risk of ever developing cancer are unique. Behind population statistics, there are layered differences in inherited susceptibility, environmental exposures, infections, behaviours and social determinants that shape both risk and outcomes. Precision health begins by taking these differences seriously and using them to tailor prevention and care, not as an afterthought but as the organising principle of cancer control. Globally, an estimated 20 million new cancer cases and 9.7 million deaths occurred in 2022, with close to 70% of deaths in low- and middle-income countries. At the same time, 30%–50% of cancer deaths are thought to be preventable through modification of behavioural and environmental risk factors and infections, if effective prevention can be delivered at scale.2 Precision prevention is not about replacing population-level measures such as tobacco control or human papillomavirus vaccination; it is about layering targeted strategies on top of these foundations, particularly for those at the highest risk. Singapore is beginning to show what this future might look like. Through national precision health initiatives such as Precision Health Research Singapore (PRECISE),3 we are building large-scale genomic and chronic disease datasets to map the distinct patterns of risk across a multiethnic population and to translate these insights into better prevention and care. As evidence accumulates that germline testing for conditions such as BRCA1/2-associated hereditary breast and ovarian cancer and Lynch syndrome is clinically valuable and cost-effective, we can expect these tests to be incorporated more routinely into practice, expanding access to timely risk identification and targeted prevention for Singaporean families. From precision oncology to precision prevention Over the past decade, precision oncology has transformed cancer treatment, with nearly half of approved oncology therapies in some markets now linked to specific biomarkers detectable by next-generation sequencing. Tumour-agnostic therapies for rare genomic alterations, advances in small-molecule inhibitor design, and the use of liquid biopsies, organoids and artificial intelligence (AI)-enabled analytics exemplify how deeply molecular information now shapes treatment decisions. These same tools are beginning to migrate upstream into risk assessment, early detection and prevention. Emerging ‘precision prevention studies’ take a biologically driven approach to interception in high-risk groups, such as testing vaccines, targeted drugs or other interventions in individuals with specific genetic or pre-malignant lesions. Rather than enrolling tens of thousands of average-risk individuals and waiting years for cancer endpoints, these trials focus on smaller, well-characterised high-risk cohorts, use surrogate biomarkers, and are designed to be faster and more efficient. In hereditary cancer syndromes, modelling suggests that individualised preventive strategies can avert substantial numbers of cancers and deaths over a lifetime, with profound human and economic impact. Reimagining screening and early detection Traditional screening programmes are designed for individuals with average risk: a fixed starting age, uniform interval and standard test offered to all who meet simple criteria. Precision health challenges this paradigm. Information technology-enabled precision prevention frameworks propose using integrated data—genomics, family history, lifestyle and environmental exposures—to move from age-based to risk-based screening. This could mean starting breast cancer surveillance earlier and more intensively for those with a strong family history or pathogenic variants, while safely de-escalating for those at lower risk, or tailoring lung cancer screening to individual risk profiles rather than focusing on smoking history alone. At the same time, advances in multi-omics, imaging and AI are reshaping early detection itself. Single-cell and spatial technologies are improving our understanding of early tumour evolution and the microenvironment, opening windows for earlier, biology-informed interception. Liquid biopsy approaches—from circulating tumour DNA to methylation signatures—are moving from monitoring to potential roles in screening and risk stratification, although questions of clinical utility, overdiagnosis and implementation remain. A people-centred agenda demands balancing technological enthusiasm with careful evaluation, transparent communication and respect for individuals’ values and preferences. Putting people at the centre of precision health The ‘United by Unique’ campaign reminds us that precision cannot be defined solely in molecular terms. True precision health for cancer must also account for the lived realities that shape risk and care: income, education, gender, geography, culture and trust in institutions. Without this lens, precision tools risk reinforcing existing inequities—concentrated in well-resourced centres, reaching the already-advantaged and leaving behind those who stand to benefit most. People-centred precision health means designing services around the person, not the technology. This includes ensuring that genetic and genomic services are embedded within culturally sensitive pre- and post-test counselling, where risk information is communicated in ways that support autonomous decision-making, and that preventive options are accessible and affordable. It also means involving patients and communities in co-creating research priorities, trial designs and care pathways, particularly in diverse settings across Asia and other regions undergoing rapid epidemiologic transition. Building systems for precision prevention To realise the promise of precision prevention, we need systems capable of generating, curating and acting on high-quality data across the cancer continuum. This begins with robust cancer registries and surveillance; global initiatives to strengthen cancer registration and national control programmes illustrate how essential this infrastructure is, especially in low- and middle-income countries. Layered onto this are electronic health records, biobanks and digital platforms that can integrate genomic and clinical data, support risk algorithms and enable learning health systems. Yet technology alone is not enough. Implementation science, health services research and thoughtful evaluation frameworks are necessary to understand how information technology-enabled precision prevention performs in real-world settings, who benefits and at what cost. Workforce development—from primary care to oncology, genetics, data science and public health—will be critical, as will ethical and regulatory frameworks that address privacy, data sharing, consent and potential algorithmic bias. For countries like Singapore, with strong digital infrastructure and multicultural populations, there is a unique opportunity to pioneer models of precision prevention that are both scientifically rigorous and socially responsive. A CALL TO ACTION The projections are sobering: global cancer incidence is expected to rise substantially by 2050, driven by ageing populations, changing lifestyles, infections and environmental exposures. It is also well established that a significant proportion of cancer deaths are preventable, and that tools for earlier, more targeted and humane interventions are within reach if we choose to invest in and organise around them. On this World Cancer Day, being ‘united by unique’ should mean committing to a future where no person’s risk is invisible, and no community is left last in line for innovation. For clinicians, this may involve integrating structured family history and risk assessment into routine care, referring appropriate patients for genetic evaluation and engaging in shared decision-making around preventive options. For researchers, it means designing trials that reflect the diversity of our populations, including prevention and interception studies, and prioritising outcomes that matter to patients and families. For policymakers and health system leaders, it requires aligning financing, regulation and workforce planning to support equitable access to precision prevention and care, not just precision therapeutics. Singapore is well-placed to make this a reality as a nation well-tuned for all-of-nation action. If we succeed, the story we tell on World Cancer Day a decade from now will be less about late-stage heroics and more about cancers that never occurred, diagnoses made earlier and patients treated more gently, and lives lived fully because we chose to recognise and act on the unique risks and needs of every person. Financial support and sponsorship Nil. Conflicts of interest Ngeow J is a member of the SMJ Editorial Board and was thus not involved in the peer review and publication decisions of this article.