Abstract Background Personalized medicine has been found to be highly promising in the prevention or early detection of cancers. Despite the advantages, the scope and potential of personalized health care are under-appreciated and underrealized in health systems. Taking into account the advantages that personalized medicine can bring to cancer prevention and treatment, and acknowledging at the same time the trends happening outside of the field of oncology, Sciensano Cancer Centre conducted research on the use of personalized medicine in the Belgian healthcare system. Methods By applying foresight methodology, we first conducted desk research and sent a survey to experts; this was then followed by two stakeholder meetings where we discussed the importance and uncertainties of the factors that have an influence on the implementation of precision medicine in (routine) cancer care in Belgium in a fair and equitable way and developed future scenarios accordingly. Results The main influential factors are concerned with economic issues, such as the allocated budget in the healthcare system. Similarly, technological factors around precision medicine should not be neglected: especially issues concerning digitalization will be decisive to determine the future of precision medicine in Belgium. Conclusions With the increasing prevalence and incidence of cancer in Belgium, several factors should be considered to implement precision medicine for cancer prevention and treatment in a fair and equitable way. Strategic foresight on precision medicine can support decision-makers in these tasks and help them develop future-oriented policies.