All diseases are a combination of nature versus nurture. In the former understanding of the inherited genetics through genomics is vital to understanding the predisposition to diseases and in some cases prognosis and response to therapy. The application of genome wide analyses studies identify several diseases has been particularly helpful especially in Crohn's disease, Diabetes and Psoriasis. Outside autoimmune diseases genomics whilst improving the understanding of cancer and its etiology has not made a difference in the clinical management of diseases. As an exemplar the progression from oesophagitis to metaplasia to esophageal adenocarcinoma presents challenges which are generalizable to other cancers. These include delineating differential genomic drivers for premalignant intermediates from those for the subsequent neoplastic lesions. In addition developments in cancer genomics by Exome sequencing or whole genome sequencing don't readily match with inherited genomic changes from GWAS. Moreover genomics has yet to reveal robust pathways for the design of new targets.

When these issues are coupled with failure in many cases to assess other factors responsible for inherited variation including CNVs and methylation patterns, it seems likely progress will be slow and need very large sample sets.

Citation Format: Janusz A. Jankowski. Genomics and cancer management: Mind the gap! [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr CN05-01.