Jul 27, 2026
Why finding disease is only the beginning of better care.
By Tom Sanders
"Detection begins a clinical journey. It does not complete one."
A recent essay in The Cancer Letter posed an important question: Is it time to rethink the role of screening colonoscopy? Drawing on the American Cancer Society's updated 2026 colorectal cancer screening guideline, the article argues that the answer is yes. With one in three eligible Americans still unscreened and colorectal cancer now the leading cause of cancer death among adults under 50, relying on colonoscopy as the primary screening strategy alone is unlikely to close the gap. Greater use of high-performing, noninvasive screening tests, the authors argue, can expand access, improve participation, and allow limited colonoscopy capacity to focus where it is needed most—diagnosis and treatment.
The mathematics of access are difficult to ignore. If more people are willing to complete a simple, at-home screening test than schedule an invasive procedure, healthcare should meet patients where they are. Expanding participation is unquestionably a step forward.
But reading both the article and the updated guideline raised a different question. What if we've become so focused on improving detection that we've begun to overlook everything that has to happen afterward?
Screening begins the journey. It doesn't finish it.
One of the quieter observations within the American Cancer Society guideline is also one of its most important. A positive noninvasive screening test is not, by itself, a completed screening process. It must be followed by timely diagnostic colonoscopy if the patient is to receive the full benefit of screening. Without that next step, the clinical pathway remains unfinished.
That distinction is easy to miss because screening technologies naturally attract attention. New diagnostics are measured by sensitivity, specificity, patient acceptance, and participation rates. Those metrics are essential, and they deserve careful scrutiny.
Yet patients experience screening differently. For them, the important question isn't whether an abnormal result was detected, but whether that result ultimately led to an answer.
Detection begins a clinical journey. Resolution determines whether the journey mattered.
The space where healthcare struggles
This is where the conversation becomes larger than colorectal cancer. Several studies have demonstrated that many patients receiving positive stool-based screening results never complete the recommended follow-up colonoscopy. The precise numbers vary across healthcare systems, manufacturer-supported navigation programs, and independent real-world analyses, but the broader pattern remains remarkably consistent: a meaningful proportion of patients fail to reach diagnostic resolution after an abnormal screening result.
This should concern all of us. Not because the screening technology has failed, but because the technology has done exactly what it was designed to do. The healthcare system simply struggled with everything that came next.
A referral must be placed, appointments coordinated, insurance questions resolved, patients reassured, and communication maintained across multiple providers.
Every transition introduces another opportunity for delay, confusion, or loss to follow-up. None of these steps is particularly visible, but collectively, they determine whether screening fulfills its promise.
Colorectal cancer is teaching us something larger
This matters because colorectal cancer may be preparing us for the next generation of cancer detection.
Multi-cancer early detection (MCED) technologies promise the ability to identify signals associated with dozens of cancers through a single blood draw. The scientific potential is extraordinary, and it deserves the excitement it has generated.
But it also raises an important operational question. If healthcare sometimes struggles to guide patients from one positive stool test to one clearly defined follow-up procedure, how prepared are we for diagnostic pathways that may involve multiple specialties, advanced imaging, laboratory evaluation, and extended diagnostic workups before a definitive answer can be reached?
In colorectal cancer, the next step is generally understood. In MCED, the journey may only be beginning.
That isn't an argument against innovation, but rather an argument for preparing healthcare systems to support it.
Measuring what matters
Healthcare has historically celebrated better tests, however, the next decade will require us to become equally good at measuring better pathways.
Participation rates remain important. Test performance remains important. Earlier detection remains important. But none of these, by themselves, improve patient outcomes.
Only completed diagnostic journeys do. That suggests a subtle but meaningful shift in perspective. Rather than asking how many patients were screened, we might also ask how many patients successfully reached diagnostic resolution.
Rather than celebrating the moment disease was suspected, we should also measure the moment uncertainty ended. Those are very different metrics and they reflect very different philosophies. And only one follows the patient all the way through care.
Designing for what comes next
At Aton Health, we've increasingly come to believe that the future of screening will depend, not just on finding disease, but on helping patients successfully navigate what follows. As diagnostics continue to advance, the greatest opportunity may no longer lie in improving the signal itself, but in strengthening the systems that connect that signal to timely specialty care, coordinated evaluation, and diagnostic resolution.
Healthcare has never lacked innovation. Its greatest challenge has always been helping innovation become routine care.
Screening is no exception, and detection is certainly an important beginning. But for patients, it is never the destination.
A Question Worth Asking: Is the purpose of screening to find disease or to ensure that every patient reaches a definitive answer?
For readers interested in the supporting research, current evidence, and practical implications, we've also prepared a companion paper that examines the topic in greater depth.
About the Author:
Tom Sanders is CEO and co-founder of Aton Health. Through this ongoing essay series, he explores the systems, operational realities, and clinical pathways that determine how healthcare innovation becomes better patient care.