Page 42 - DIGITAL e-Book RCPH 2026

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1 REGIONAL CONFERENCE onon O r g a n i s e d b y :
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PRECISION HEALTH
P P R E C I S I O N H E A L T H

Abstracts for 1st Regional Conference on Precision Health (RCPH)
15-16th April 2026, Royale Chulan Kuala Lumpur
Precision Oncology at Scale: What Works, What Breaks & What We Fixed
Dr. Tang Shir Ley
Hospital Kuala Lumpur, Malaysia
ABSTRACT
Precision oncology has changed how we think about cancer treatment, moving care from a one-size-fits-all
approach towards therapies guided by molecular and genomic information. Technologies such as next-
generation sequencing, biomarker testing, and molecular tumour boards have made it possible to match
patients to more targeted and potentially more effective treatments. In many high-income settings, these
approaches are now part of routine care. In middle-income health systems like Malaysia, however,
translating precision oncology into everyday clinical practice remains challenging. In Malaysia, elements of
precision oncology are already in place. Molecular testing is available in selected public and private
centres, and clinicians are increasingly using genomic information to guide treatment decisions in cancers
such as lung, breast, and colorectal cancer. Multidisciplinary discussions around complex cases are also
becoming more common. Despite this progress, these activities often function as individual projects, pilot
programmes, or institution-specific services, rather than as part of a coordinated national healthcare
system. As a result, access to precision oncology remains uneven, turnaround times are variable, data are
fragmented, and treatment availability is inconsistent across different hospitals and regions. This keynote
draws on practical experience from public oncology services and national service planning to reflect on
what has worked, what has not, and what we have learned from attempting to scale precision oncology
within a real-world health system. Several enabling factors have proven useful in practice, including
focusing testing on clear clinical indications, introducing reflex molecular testing through pathology
workflows, centralising more complex testing to specialised laboratories, sharing costs through public–
private partnerships, and using multidisciplinary molecular tumour boards to support clinical decision-
making. These approaches have shown that precision oncology can be delivered within existing resource
constraints when it is closely aligned with clinical needs. At the same time, recurring challenges continue to
limit impact. Molecular tests are sometimes performed without guaranteed access to the corresponding
treatments. Research-driven testing may not translate into service delivery. Funding models remain
uncertain, data systems are poorly integrated, turnaround times can be too slow to influence clinical
decisions, and there is a shortage of dedicated personnel to coordinate molecular workflows. Perhaps
most importantly, there is a real risk that precision oncology may widen existing inequalities, benefiting
patients in urban or well-resourced centres while leaving others behind. The presentation also outlines an
ideal service model for the future, based on viewing precision oncology as a healthcare system rather than
a collection of technologies. This includes clear clinical entry criteria for testing, a tiered national testing
pathway, coordinated molecular tumour boards, integrated outcome data, and a defined workforce for
molecular oncology. These elements are presented not as an existing national reality, but as a practical
direction of travel. By distinguishing between what is currently happening and what still needs to be built,
this session aims to offer a realistic and honest perspective on scaling precision oncology. Ultimately, the
success of precision oncology will depend less on how advanced our technologies are, and more on how
well we design systems that are accessible, equitable, and sustainable for the populations we serve.