Early lessons from the implementation of a pan-African clinico-genomic cancer platform: The African Cancer Atlas.

10602 Background: Limited representation of African populations in cancer genomics constrains the clinical applicability of precision oncology. We describe the establishment and early outcomes of The African Cancer Atlas (TACA), a multi-site platform integrating genomics, harmonized clinical data, and community engagement for adult breast cancer research across Africa. Methods: TACA, led by Yemaachi Biotech, has so far been implemented across five countries (Ghana, Nigeria, Côte d’Ivoire, Kenya, and Seychelles). In early 2025, foundational activities included institutional review board (IRB) approvals, execution of memoranda of understanding and material transfer agreements, site activation, and structured engagement with clinicians, patient advocates, and community stakeholders through Yemaachi’s African Cancer Network to support trust-building and study uptake. Participant recruitment began in July 2025. Breast cancer patients were enrolled following IRB approval, with informed consent supported by site-based education on genomics research. Clinical data were captured in UVOSYO-Yemaachi’s clinical database. Peripheral blood was collected at recruitment, and formalin-fixed paraffin-embedded (FFPE) tumor tissue was obtained subsequently and shipped to our central laboratory in Accra. Blood and tissue underwent DNA extraction and quantitative and qualitative quality control (QC) prior to sequencing. Results: To date, 236 participants have been recruited across the five TACA sites. Blood-derived DNA demonstrated acceptable quality for downstream sequencing, whereas FFPE tumor tissue quality varied substantially, leading to exclusion of cases that failed QC. Among enrolled participants, 97.9% were female, with a mean age of 50.8 years (SD 13.1). A total of 26.7% reported a family history of cancer, with participants in Seychelles having the most significant family history of 87% (p < 0.001) Triple-negative breast cancer accounted for 38.1% of tumors overall, ranging from 21.1% in Kenya to 68.1% in Nigeria. Significant between-country variation was observed for triple-negative breast cancer (p < 0.001) and hormone receptor status (all p < 0.001). Key implementation challenges included prolonged IRB approval timelines related to limited familiarity with cancer genomics, cross-border biospecimen transport constraints necessitating in-country DNA extraction in some settings, and variability in FFPE tissue quality impacting sequencing yield. Conclusions: TACA demonstrates the feasibility of coordinated multi-country recruitment and clinical data harmonization for adult cancer genomics in Africa, while highlighting critical regulatory, logistical, and biospecimen quality barriers.