Dec 1, 2025
Bridging the Detection-to-Diagnosis Divide: A Framework for Active Surveillance and Navigation After MCED Detection
Executive Summary
Multi-cancer early detection (MCED) tests represent one of the most exciting advances in modern cancer prevention. But while these blood-based tools can detect cancer signals earlier than ever before, a fundamental gap remains: what happens next?
For patients receiving an MCED-positive signal suggesting possible colorectal cancer (CRC), there is still no consistent, coordinated path from detection to diagnostic confirmation.
Aton Health believes that closing this gap is essential. The system needs a unified, patient-centered framework that ensures every MCED-positive individual receives timely, guided follow-up—and that the data generated along the way strengthens clinical understanding for the future.
1. The Challenge We Must Address
MCED technologies can identify early signs of CRC long before symptoms appear, but the positive signal itself is not diagnostic. Confirmation requires colonoscopy—and too often, that crucial next step is delayed or missed entirely.
The current system lacks a shared infrastructure for managing this period of uncertainty. In contrast, prostate cancer has long benefited from validated “active surveillance” models that balance vigilance with clinical prudence.
It’s time to apply similar rigor and coordination to MCED-positive CRC patients.
2. What an Effective Framework Should Look Like
We envision a national model—open, collaborative, and scalable—that connects the moment of detection with timely, trusted diagnosis.
Active Surveillance with Purpose
Surveillance should not mean passive observation. It should mean structured, proactive engagement:
Proactive Diagnostic Scheduling within guideline-based timeframes.
Dynamic Risk Stratification informed by comorbidities, demographics, and behavioral data.
Digital Monitoring through patient-friendly platforms that prompt, remind, and reassure.
Clinical Feedback Loops that close the gap between detection, colonoscopy, and documentation.
Escalation Protocols when follow-up is delayed or missed.
Navigation that Meets Patients Where They Are
Human connection is critical. Navigators—supported by smart technology—should guide each patient from test result through colonoscopy, addressing emotional and practical barriers along the way:
Personalized outreach and education.
Help with logistics, authorizations, and costs.
Culturally and linguistically adapted communication.
Consistent, empathetic reassurance during an uncertain time.
Real-World Data Integration
Every interaction—from MCED result to colonoscopy outcome—should contribute to a growing body of knowledge:
Standardized, interoperable data capture using open models (e.g., OMOP, FHIR).
Predictive and equity analytics to identify risks and disparities in follow-up.
Regulatory-grade evidence generation to guide policy, reimbursement, and future research.
3. Partnerships that Make It Possible
Creating this model will require collaboration among diagnostics companies, GI networks, advocacy groups, pharmacies, and payers.
Organizations such as Fight Colorectal Cancer and national pharmacy networks could play key roles in patient communication and adherence.
A distributed GI referral network could provide prioritized diagnostic access and close the loop on outcomes reporting.
In short: we already have the components. What’s missing is a unified structure and shared commitment to connect them.
4. Learning from Proven Precedents
Prostate cancer’s AQUA Registry has shown how standardized surveillance protocols and EHR integration can transform care.
Applying those principles to MCED-positive CRC cases can minimize loss to follow-up, reduce unnecessary anxiety, and enable continuous improvement through real-time feedback.
5. The Opportunity Ahead
A shared post-MCED framework benefits every stakeholder:
Patients: Faster answers, fewer missed diagnoses, less uncertainty.
MCED Innovators: Greater trust in test outcomes and real-world validation.
Clinicians: Clearer pathways and stronger collaboration across specialties.
Payers: Reduced downstream costs through earlier, coordinated intervention.
Researchers: A living dataset that advances precision prevention.
6. A Call for Collective Action
Early detection alone is not enough.
If we fail to ensure timely diagnosis and coordinated follow-up, we risk eroding the promise of MCED innovation and the trust of patients who rely on it.
Aton Health believes the time has come to build a national framework for active surveillance and navigation—one that is inclusive, data-driven, and rooted in empathy.
We invite diagnostics leaders, health systems, and advocacy organizations to help define and activate this next critical step in cancer prevention.