All Eyes Are on Early Detection. Nobody Has Cracked It.

Three of the largest companies in diagnostics made moves this week.

Abbott reported earnings this morning. Its new cancer diagnostics business, built around Cologuard, did $968 million in the quarter, up 13.8%, and Abbott announced it will spin off its nutrition business, roughly $8.5 billion in sales, by the end of 2027. Abbott is choosing cancer testing over an $8.5 billion consumer business, and companies do not make that trade unless they know where their growth sits.

Labcorp agreed to pay Myriad Genetics $210 million in cash for its prenatal testing business. Myriad said plainly why it is selling: to focus on the cancer care continuum. Hologic announced Monday it is acquiring Reveal Genomics, whose test guides therapy for women already diagnosed with HER2-positive breast cancer.

Therapy selection. Monitoring. Testing volume. Revenue and distribution. All of it sits after a diagnosis. Notice what none of it does. None of it finds cancer earlier.

All of this is good for the industry. Stronger companies and better tools for patients who already have a diagnosis matter. But several underlying challenges and opportunities remain, and they sit in one place: finding cancer earlier. That is why every eye in this industry is on early detection. GRAIL took its multi-cancer blood test in front of an FDA advisory panel last month, and the panel backed approval on safety 10 to 0, while the vote on effectiveness was 6 to 4. Sit with that split for a second. Even the field's leader, with the largest studies ever run in this category, gets a divided vote on whether the test works well enough. Freenome launched a blood test for lung cancer this week. Natera took home an FDA breakthrough designation for its multi-cancer test last week. Medicare starts covering an approved multi-cancer test once a year in 2028. Billions of dollars have been raised and spent chasing this.

And it is still uncracked. Blood tests today are better at finding cancer that is already advanced than cancer that is just beginning, and the beginning is the whole point. Stage I is where survival is won and where the biology is hardest, because an early tumor sheds very little into the blood. Meanwhile the tools we already have leave gaps everyone can name. Roughly half of the women who get mammograms have dense breast tissue, and mammography is substantially less sensitive in those women. Colonoscopy works and people avoid it. Lung screening reaches a small fraction of the people who qualify for it.

I work for a company tackling this problem, so I am not neutral. I am also not guessing. Finding cancer after it declares itself is a good business, and this week proved it again. Finding it before, in people who feel fine, with a test accurate enough to trust and inexpensive enough to use at scale, is the prize. Nobody has it yet.

It will not be won with the biggest acquisition budget. It will be won on performance in defined populations with real unmet needs: the woman whose mammogram cannot see through her dense breast tissue, the smoker who will never get a low-dose CT, the patient who keeps putting off the colonoscopy. The better test, in the right patients, at a cost the system can carry, wins. It always has in diagnostics.

The goal was never to replace the screening we have. It is to make screening better and to reach the patients it misses today.