This introductory chapter gives an overview of the context in which the book was written, and goes through the central themes being addressed. The book is a result of long-held collaborations between oncologists, clinicians, philosophers, STSers, anthropologists, economists, ethicists, and media studies scholars, who, for the most part, are affiliated to the Centre for Cancer Biomarker (CCBIO), in Bergen, Norway. In addressing the issues at stake and matters of concern around precision oncology and cancer biomarker research, the authors come to see precision oncology as a sociotechnical imaginary, around which a high degree of confusion between hope and reality is observed, and where debates around the feasibility and desirability of precision medicine are altogether political, social, ethical, scientific and medical. The contributions to this book variously approach the culture of biomarker research, powered to a significant extent by a sociotechnical imaginary of precision oncology, with a focus on the following overarching themes: (i) the uncomfortable knowledge that comes to undermine the legitimacy of precision oncology by point at its shortfalls, and the lack of ambivalence in the discourses and practices around precision oncology; (ii) the dynamics of framing and overflowing, when trying to control biological, social and ethical complexity; and (iii) the role of the economy of hope in legitimising and sustaining the imaginary of precision oncology, and the starch dichotomy between illness and disease it leads to.