African Americans have the highest death rates and shortest survival rates of any racial/ethnic group in the US for most cancers. A precision medicine approach to cancer prevention, diagnosis, and treatment can potentially eliminate many gaps because genetics also plays a role, as African Americans are also more likely to have specific genetic mutations that increase their risk of certain types of cancer. Multiple studies confirm that when controlled for uniform stage, treatment, and follow-up, African American sex-specific cancers (breast, ovarian, and prostate) still did worse. The colon cancer incidence and death rate is so high in the African American community that the American College of Gastroenterology recommends screening begin at age 45. Studies also showed an increased occurrence in African Americans for right-sided colon cancer tumors, prompting recommendations against sigmoidoscopy in these patients because a majority of tumors would be missed. Prostate cancer in African American men is the most prevalent cancer, and the second most common cause of overall cancer deaths. European American male smokers consume 30–40% more cigarettes than their African American counterparts, but African American male smokers are 34% more likely to develop lung cancer. These and other curious cancer differences are more closely examined.