I Have a Dream: Universal Somatic and Germline Testing for Every Patient With Cancer

More than 60 years ago, the Rev Dr Martin Luther King spoke of a dream rooted in equity, dignity, and opportunity. In oncology today, I, too, have a dream, one grounded in science, compassion, and the belief that every patient with cancer deserves the best chance at survival, regardless of socioeconomic status, where they live, or where they receive care.

I have a dream that one day, every patient diagnosed with cancer will automatically receive comprehensive tissue genomic profiling (CGP) and germline testing at diagnosis.

Why? Because information matters. Precision medicine works only when we understand the biology of the cancer and the patient’s inherited risks. Without this knowledge, we cannot make the best treatment choice.

Somatic testing through CGP reveals the genomic alterations driving a tumor. It identifies actionable biomarkers, therapeutic targets, resistance mutations, and eligibility for precision therapies or clinical trials. At the same time, germline testing provides equally critical insight. It uncovers inherited mutations that impact the choice of surgery, chemotherapy, radiation and targeted therapies. Additionally, it may also impact screening, prevention, and cascade testing for family members. A patient with a BRCA mutation, Lynch syndrome, or other hereditary cancer risk deserves to know—not years later, but early enough to make informed decisions that may alter the course of care.

Today, too many patients never receive either test. Some are missed because of a lack of awareness, inconsistent workflows, reimbursement barriers, inadequate tissue, provider variation, or disparities in access. Patients treated far from academic centers may not have access to genomic expertise, molecular tumor boards, or the latest clinical trials. The result is a growing divide between what is scientifically possible and what is practically delivered.

This is unacceptable.

If precision medicine is the future of oncology, then equitable access to genomic information must become the foundation of care, not a privilege available only to a select few.

Of course, I recognize the challenges. Universal somatic and germline testing is not simple. Cost concerns, payer restrictions, workforce limitations, logistics, and educational gaps remain real hurdles. Not every test will immediately change management. Not every mutation will be actionable. And implementation at scale requires thoughtful stewardship.

But difficult does not mean impossible.

We have overcome major barriers in oncology before. Biomarker testing in lung cancer was once inconsistent; now it is standard. Molecular diagnostics continue to evolve rapidly, and costs are decreasing while evidence continues to grow. The question is no longer whether genomics belongs in cancer care. The question is whether we are willing to make access universal.

To make this dream a reality, we must start at the grassroots level. We must educate providers, patients, nurses, and communities on why genomic testing matters. We must advocate for policy reform and smarter reimbursement models that reward evidence-based precision care. We must build systems that integrate testing into workflows so no patient falls through the cracks. And we must run more pragmatic and real-world clinical trials that include rural, underserved, and community oncology populations.

I have a dream that one day no oncologist will wonder: Did a patient miss an opportunity because a test was never ordered?

A future in which every cancer patient receives comprehensive somatic and germline testing is ambitious, but achievable. The time to begin is now.