The implementation of precision oncology (PO) in Africa, which stands as a transformative approach tailoring treatments based on patient genetic profile and/or tumour molecular characteristics, remains challenging. This chapter presents an in-depth review of the current state of PO across Africa, delving into key components such as omics studies, polygenic risk scores (PRS), cancer prediction tools, pharmacogenomics, and cancer care infrastructure. Across Africa, breast (in women) and prostate cancers (in men) are the most prevalent and deadly, particularly in Egypt and Nigeria, where incidence and mortality rates are highest. Many studies have generated omics data and identified region-specific cancer biomarkers. However, most of them focused on top diagnosed malignancies, and additional efforts are needed to expand the landscape to the under-investigated tumour types. PRS and cancer prediction tools show promise for assessing cancer risk, but their effective application requires consideration of the genetic diversity of Africa and the development of population-specific models. A comprehensive analysis of existing infrastructure revealed several gaps throughout the patient journey including human resources, limited bioinformatics capabilities, and challenges in data storage and sharing platforms. Advancing PO in Africa requires a comprehensive approach that integrates omics data within a well-established infrastructure and trained human resources. Collaborative efforts at both regional and international scale are crucial to ensure the implementation of PO across diverse populations in Africa.