The business of cancer: The “gold rush” of liquid biopsies
Despite not being FDA approved, multi-cancer tests are already being marketed to physicians and consumers and they are not cheap!
This is the third guest column in our series on the business of cancer from Taayoo Murray, an award-winning writer based in New York City. She regularly covers health topics, primarily inequity in healthcare and issues in aging. Her work has been published in Mayo Clinic Press, Yahoo, Essence, Cancer Today, New York Amsterdam News and many others. Taayoo is actively looking for assignments and contract work. When she’s not writing, she enjoys reading and bingeing on crime dramas. She can be reached at taayoo_murray@yahoo.com.
A paid subscription supports my efforts to support other writers and can help me maintain my subscriptions to all of the publications I need to keep up. Gift links don’t grow on trees!
The idea is seductive. A single blood draw that could detect dozens of cancers before symptoms appear. For biotech investors, physicians, and anxious patients, the promise of multi-cancer early detection has become one of the most compelling narratives in modern medicine. Companies are racing to commercialize blood tests that scan for fragments of tumor DNA circulating in the bloodstream, a technology often called a “liquid biopsy.”
But as the market grows rapidly, some cancer experts warn that commercialization is moving faster than clinical proof. Early detection, they argue, is only one part of the complex equation required to reduce cancer deaths. “It’s really important science that is coming. It is here and now, but it’s not quite ready for prime time, and the reason is because we are finding that some of these tests are very good at detecting some types of tumors, but not all,” explained Dr. Monique Gary, Breast Surgical Oncologist, DO, FACS.
A new diagnostic market takes shape
Multi-cancer blood tests attempt to detect signals from tumors by analyzing DNA fragments shed into the bloodstream. The Galleri test from GRAIL, Inc says it can screen for more than 50 types of cancer from a single blood sample. The test uses machine-learning algorithms to analyze patterns of DNA methylation, a type of chemical modification linked to cancer. The concept has drawn enormous interest because many lethal cancers, such as pancreatic, liver, and ovarian cancer, have no routine screening tools.
Several companies are now competing in this space, including Exact Sciences and Guardant Health. Industry analysts estimate the market for multi-cancer early detection tests could exceed $25 billion annually if these technologies become widely adopted. The potential scale is staggering. In theory, millions of adults could take an annual blood test as part of routine preventive care.
Few companies illustrate the commercial momentum behind the technology more clearly than GRAIL, Inc. The company’s Galleri test has been growing steadily since its launch. In 2024, the company reported more than 137,000 Galleri tests sold, helping drive $108.6 million in annual revenue, a 45% increase from the previous year. Total company revenue reached $125.6 million in 2024, reflecting growing physician awareness and consumer demand for early cancer detection. Commercial growth continued into 2025. GRAIL generated total revenue of $147.2 million in 2025, representing a 17% increase year-over-year compared to 2024, with more than 185,000 tests sold.
Investors have taken notice. Analysts increasingly view multi-cancer screening as one of the largest untapped markets in healthcare. Yet the financial success of companies like GRAIL highlights a paradox. While revenue and market adoption are rising, the clinical question that matters most remains unresolved.
The missing proof - do these tests save lives?
The gold standard for cancer screening is not simply detecting tumors earlier, it is reducing mortality.
Screening tools such as mammography and colonoscopy became standard only after large randomized trials demonstrated they lowered cancer death rates. But for multi-cancer blood tests, that evidence does not exist yet. Early studies have produced promising results. In a large clinical study of Galleri involving more than 23,000 participants over age 50, the test detected cancers seven times more often than traditional screening tests for some cancers without established screening tools.
Still, detection alone is not the same as saving lives.
Some cancers grow slowly and might never become dangerous, a phenomenon known as over-diagnosis. Others may already have spread by the time they shed detectable DNA into the bloodstream. Until long-term trials demonstrate reduced mortality, public-health experts remain cautious.
Dr. Gray however thinks this factor is not being examined in its totality. “I think that the primary endpoints are wrong,” says Dr. Gray, “I’m talking about Grail. Because it did not meet that primary goal of saying, we reduce death in stage three and four cancers, people are saying the test isn’t good. I’m saying that is not the right endpoint from an early cancer detection test, because the things that influence how long someone lives with stage three or four cancer is not related solely to the early detection, it’s related to the systems. It’s related to tumor biology. It’s related to the treatment. It’s related to all of these other things that are well and beyond the scope of an early detection test.”
The diagnostic cascade problem
Another concern involves what happens after a test detects a “cancer signal.” Unlike mammograms or colonoscopies, which examine a specific organ, multi-cancer blood tests often cannot pinpoint exactly where a tumor is located. A positive result can trigger a cascade of diagnostic procedures, imaging scans, biopsies, and specialist consultations, to locate the cancer.
The fear of cancer is real. And for years the mantra has been that early detection is key. In addition to other factors that affect mortality, MCED’s like Grail are not very effective at detecting early stage cancers. Grail has a 11.2% sensitivity rate for prostate cancer, and 30.5% for breast cancer. Even with highly specific testing for cancers like liver/bile duct at 93.5%, screening millions of people could generate large numbers of false positives. For patients, that can mean weeks or months of uncertainty and anxiety. And without greater specificity for some cancers, these multi-detection tests become a revolving door of retests every six months, the standard response for concerning results in oncology.
Commercial adoption before clinical consensus
Early commercialization ignores a regulatory gray zone. Many tests are offered as laboratory-developed tests, allowing companies to sell them before obtaining full regulatory approval. As of March 2026, the Galleri test has not been FDA approved, but has submitted a Premarket Approval (PMA) application. A screening study in the United Kingdom is evaluating the technology in hundreds of thousands of participants, while U.S. trials are examining how the tests perform in real-world healthcare settings.
Despite these uncertainties, multi-cancer tests are already being marketed to physicians and consumers. Galleri’s list price is around $950 per test, with some providers offering it for $799. This cost is largely out of pocket because most insurance plans and Medicare do not cover the Galleri test because it is not FDA approved, and has not yet been proven in large trials to improve long-term health outcomes. As of December 2024, the Galleri is primarily covered by Tricare for beneficiaries aged 50+ with elevated cancer risk. Some specific, smaller insurers and select Medicare Advantage plans also offer coverage. The test requires a doctor’s order and often pre-authorization. Patients may also be able to use Health Savings Account (HSA) or Flexible Spending Account(FSA) funds to pay for the test. The test is even more expensive in Canada, costing CDN $2100.
Early detection is not the whole solution
Even if multi-cancer blood tests prove effective, cancer researchers caution against viewing them as a silver bullet. Cancer mortality depends on far more than the moment of detection. Treatment advances, including targeted therapies, immunotherapy, and precision surgery, have already dramatically improved survival for several cancers. Prevention strategies, such as smoking cessation and HPV vaccination, have also reduced cancer incidence.
Screening, in other words, is only one component of a broader cancer-control strategy. Some public-health experts worry that the excitement around liquid biopsy could distract from proven interventions such as increasing colonoscopy rates or expanding access to HPV vaccines.
Readily available cancer screening tests take advocacy to the next level, but advocacy doesn’t stop at early detection.
My verdict
Are multi-cancer detection tests transformative technology or a premature revolution? The answer is a bit of both. According to Grail’s own website, “the test does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider.”
This doesn’t mean the technology lacks promise.
For physicians, these tests could mean treating more cancers at curable stages. For patients, it could mean years of life gained.
We also need to acknowledge the risk of exacerbating the existing disparities in cancer care. Black and Brown communities have a 40% increased mortality risk even though white people have the highest rate of new cancers. They are also more likely to be diagnosed at a later stage and less likely to have access to advanced treatments like clinical trials.
At $950 per test, out-of-pocket, Galleri will likely not improve early diagnosis rates and reduce mortality in minority communities.
If multi-cancer blood tests ultimately demonstrate a meaningful reduction in cancer deaths, they could reshape preventive medicine. But the history of cancer screening also offers cautionary lessons. Technologies that appear revolutionary at first sometimes reveal unexpected complexities once deployed at population scale.
The central question facing the liquid biopsy industry is therefore not whether early detection is possible. It is whether early detection, delivered through mass-market blood tests, will translate into longer, healthier lives for everyone, regardless of socioeconomic status or ethnicity.
Until that answer is clear, the commercialization of multi-cancer screening will continue to run ahead of the science.
© Francine McKenna, The Digging Company LLC, 2026
fm postscript: I have written about Grail more than once, in particular regarding my successful efforts to have a complaint against Illumina and its executives in Delaware unsealed/unredacted. Thanks to my efforts, we found out…
The company paid $100 million premium for $300 million of additional D&O coverage, according to the fully unredacted complaint for City of Omaha Police and Firefighters Retirement System v. Francis deSouza, et al. and Illumina, Inc., C.A. No. 2024-0172-PAF, letter op. (Del. Ch. May 15, 2024).
If you want to learn more about how some were concerned about Grail’s methods, in particular with regard to testing:
Illumina/Grail update, NYSE ITGC shenanigans, and some summer reads
It is early June, a breezy and sun-riddled Tuesday
 | A guest post by
|