Breast Cancer in Sudan: The Need for Pharmacogenomics Research and Its Implications for African Precision Medicine.

Abstract

Breast cancer represents a major public health burden in Sudan, where most patients are diagnosed at advanced stages and access to comprehensive diagnostic and molecular services remains limited. Current treatment strategies are largely extrapolated from non-African populations, despite the substantial genetic diversity across African populations that may significantly influence drug response, efficacy, and toxicity. Pharmacogenomics offers a promising approach to optimize breast cancer therapy through genetically informed treatment decisions; however, its clinical application in Sudan and across Africa remains limited. This narrative review synthesizes published evidence on pharmacogenetic determinants influencing breast cancer treatment, with a particular focus on African and Sudanese populations. Relevant studies published between 2005 and 2026 were identified through searches of PubMed, Google Scholar, and PharmGKB. A qualitative synthesis was conducted to summarize key pharmacogenes, population-specific genetic variability, and their potential clinical and therapeutic implications. Considerable interethnic variability has been reported in pharmacogenes involved in drug metabolism and transport, including CYP2D6, CYP3A4, CYP2B6, DPYD, and ATP-binding cassette transporter genes. African populations exhibit distinct allele frequency patterns that may substantially affect drug disposition, therapeutic efficacy, and toxicity, particularly for endocrine therapies and commonly used chemotherapeutic agents. These differences limit the direct applicability of pharmacogenomic data derived from European and Asian populations and underscore the need for population-specific evidence. Integrating pharmacogenomics into breast cancer management has the potential to improve treatment effectiveness and safety in Sudan. Achieving this goal requires the generation of locally relevant pharmacogenomic data, strengthened diagnostic and laboratory infrastructure, and a stepwise, context-appropriate incorporation of pharmacogenomic principles into clinical practice. Such an approach is important to support equitable and effective precision oncology for Sudanese and African populations.