Medicina de precisão: promessas, expectativas e desafios da medicina genômica na visão de oncologistas.

Abstract

In recent decades, precision medicine has been debated as a new paradigm in oncology, promising more effective and personalized treatments through genomics. However, the implementation of these new technologies faces economic barriers, unequal access and limitations in the clinical applicability of genetic tests. This dissertation investigates the perceptions and practices of medical oncologists in relation to the promises and socio-technical imaginaries of precision medicine, with an emphasis on the incorporation of new genomic technologies into clinical practice. To this end, the research adopted a qualitative approach, combining a systematic literature review and semi-structured interviews with oncologists working in cancer units and centers in Brazil. With regard to the systematic literature review, the databases PubMed and Portal de Periódicos CAPES were consulted, using descriptors related to personalized medicine, oncologists and expectations in relation to genomics. The analysis identified 16 relevant articles published between 2011 and 2024, which supported the theoretical and methodological discussion of the research. The second stage of the study consisted of semi-structured interviews with 27 medical oncologists, from Salvador and 10 from Rio de Janeiro. The interviews were conducted in public, private and charitable cancer centers, exploring the professionals' perception of the incorporation of genomics into clinical practice, the challenges faced and the inequalities in access to new technologies. To ensure confidentiality, participants were identified by codes, respecting the ethical guidelines of Resolution 466/2012 and Resolution 510/2016 of the National Health Council. The data collected was analyzed using Bardin's Categorical Content Analysis, following the stages of pre-analysis, exploration of the material and interpretation of the results. The findings reveal an ambivalent view of precision medicine among oncologists: although they recognize its potential for personalizing treatment and optimizing clinical results, there is concern about the accessibility of new technologies and the capacity of the Brazilian National Health System (SUS) to incorporate them in an equitable manner. In addition, doctors report difficulties in interpreting genomic tests and communicating the results to patients, especially due to the existence of variants of uncertain significance (VUS) and the lack of specific training in the area. Another point identified was the influence of the pharmaceutical industry on the dissemination of precision medicine, generating expectations that are not always compatible with clinical reality. Oncologists point out that although precision medicine is often portrayed as a revolution in cancer treatment, the effectiveness of many of the targeted therapies is still limited and depends on factors such as specific mutations and validated biomarkers. The need for public policies that guarantee equitable access to innovations, the training of health professionals and transparency in communicating the limitations of genomics are central aspects for the future of personalized oncology in Brazil.