Why the expansion of non-invasive screening is creating a new clinical and operational imperative around diagnostic follow-up
A position paper on colorectal cancer screening, follow-up, and clinical resolution
Executive Summary
Colorectal cancer screening is undergoing one of the most significant transformations in its history. Between 2024 and 2026, four non-invasive screening tests received FDA approval, blood-based screening entered clinical practice, and the American Cancer Society formally incorporated blood-based testing into its colorectal cancer screening guideline. Together, these developments have the potential to reach millions of people for whom traditional screening approaches have proved difficult or unacceptable.
That expansion is an important public-health achievement. It also moves one of the most significant challenges in colorectal cancer screening downstream.
A positive non-invasive screening result does not complete the screening journey. It initiates a diagnostic pathway that ultimately requires colonoscopy. Yet across U.S. healthcare systems, only about half of patients with a positive stool-based test complete follow-up colonoscopy, with substantially lower completion rates reported in some safety-net and Medicaid populations. Patients who do not complete follow-up face meaningfully greater risk of colorectal cancer mortality.
As non-invasive screening expands, this gap becomes increasingly consequential. Every additional patient reached by screening creates value only if the healthcare system can successfully manage what happens next.
At Aton Health, we have begun to think of the growing ecosystem around that challenge as the resolution marketplace: the clinical, operational, and economic activity required to carry a screening signal through to diagnostic resolution.
The resolution marketplace is not a new screening modality or a single technology platform. It is the increasingly important space between detection and completed care. A space involving laboratories, primary care providers, specialists, health plans, technology partners, and patients themselves.
Three observations shape our perspective:
First, detection and prevention are not synonymous. Non-invasive tests can identify patients who require further evaluation, but their preventive value remains dependent on downstream diagnostic care.
Second, colonoscopy capacity may be less constrained than commonly assumed. Recent modeling suggests that reallocating existing capacity from lower-yield primary screening toward higher-yield follow-up of positive non-invasive tests could significantly improve cancer detection and prevention without increasing total procedure volume.
Third, implementation can be as consequential as the screening technology itself. Evidence from organized screening programs demonstrates that systematic outreach, navigation, tracking, and streamlined follow-up can materially improve screening completion and patient outcomes.
Together, these trends point toward a different way of thinking about the next phase of colorectal cancer screening. The opportunity is no longer simply to expand access to testing. It is to build systems capable of carrying every positive result through to resolution.
The next decade of screening innovation may therefore be defined as much by what happens after detection as by detection itself.
1. The Access Revolution
For a generation, one of the central challenges in colorectal cancer screening has been participation. Colonoscopy remains an exceptionally effective screening and preventive procedure, but its preparation, invasiveness, and logistical requirements have historically created barriers for many patients. The rapid expansion of non-invasive screening is changing that equation.
Stool-based testing and blood-based approaches make it possible to reach patients who might otherwise remain unscreened. A 2024 randomized trial cited in the source material, for example, found that offering a blood-based test to patients who had not completed FIT increased screening completion from 13.0% to 30.5%.
This represents real progress. But expanding the front door of screening also increases the importance of what happens behind it. The access problem is being transformed. The resolution problem isn't.
2. Detection Is Not Resolution
Colonoscopy occupies a unique position within colorectal cancer screening because detection and intervention can occur within the same procedure. Precancerous lesions can be identified and removed before they progress.
Non-invasive tests play a different role. They identify a signal indicating that additional diagnostic evaluation is necessary.
That distinction becomes particularly important as blood-based screening expands. The evidence summarized in this paper indicates substantial differences between screening modalities in their ability to identify advanced precancerous lesions. Regardless of modality, however, the operational implication of a positive non-invasive result is the same: The patient still requires diagnostic resolution.
The value of the initial test therefore depends in part on the healthcare system's ability to complete what the test begins. And as screening becomes easier to distribute across more settings, the distance between those two moments—detection and resolution—becomes increasingly important.
3. The Resolution Gap
Current follow-up performance suggests that this is far from guaranteed.
The evidence summarized in this paper indicates:
Median follow-up colonoscopy completion after a positive stool test: 53.4%
U.S. Multi-Society Task Force benchmark: 80%
Estimated proportion of patients with a positive non-invasive test who never complete colonoscopy: 30–40%
Increased six-year colorectal cancer mortality risk associated with failure to complete follow-up: approximately 1.8×
These figures reveal an important distinction between screening access and screening completion.
A healthcare system may successfully deliver a test, identify an abnormal result, and still fail to deliver the clinical value that screening was intended to create. The gap between those moments is the resolution problem.
As the number and accessibility of screening modalities increase, the ecosystem required to address that problem will grow with them. That emerging ecosystem—the providers, systems, technologies, workflows, and organizations responsible for moving patients from signal to resolution—is what we describe as the resolution marketplace.
4. Reconsidering Colonoscopy Capacity
One of the most consequential findings in the emerging evidence concerns colonoscopy capacity. Approximately 15 million colonoscopies are performed annually in the United States. Current estimates suggest that roughly one-third of that capacity is devoted to primary screening of average-risk patients, while approximately 9% is used to follow up positive non-invasive screening results.
Recent modeling asks what would happen if total colonoscopy volume remained unchanged but the mix shifted.
The modeled results are striking: reallocating capacity toward positive-test follow-up increased cancer detection by 84%, prevented 49% more cancers, and reduced costs by $7.2 billion, without increasing the overall number of procedures performed.
If these findings hold as screening patterns evolve, the future relationship between non-invasive testing and colonoscopy may be less competitive than complementary. Non-invasive approaches can expand the population reached. Colonoscopy can increasingly be concentrated where its diagnostic and therapeutic value is greatest.
The challenge is connecting the two reliably. That connection, rather than procedure capacity alone, may prove to be one of the most important opportunities within the resolution marketplace.
5. When the Same Test Produces Different Outcomes
The source material also highlights an important risk associated with substitution. Modeling cited by the American Society for Gastrointestinal Endoscopy suggests that the population in which blood-based screening is deployed, and whether positive patients complete follow-up, can materially alter its overall clinical impact.
A blood-based test used to reach someone who would otherwise remain unscreened can create meaningful benefit. The same test used instead of another screening modality that a patient would have completed may produce a very different result if diagnostic follow-up subsequently fails. The implication extends beyond any particular test.
Technology creates potential. Implementation determines how much of that potential healthcare ultimately captures.
That places navigation, tracking, scheduling, and follow-up closer to the center of the screening conversation. It also helps explain why the resolution marketplace is larger than any single screening technology. The need exists regardless of which test produces the initial signal.
6. Policy Will Accelerate the Shift
Coverage expansion is likely to increase the urgency. Medicare already covers qualifying blood-based colorectal cancer screening, while future USPSTF recommendations could broaden no-cost-sharing coverage among commercially insured populations. Emerging policy pathways for multi-cancer early detection could eventually amplify the same dynamic across multiple cancer types.
As access expands, the number of abnormal screening results requiring coordinated follow-up will expand with it.
Organizations that begin developing the necessary workflows only after that volume arrives may find themselves attempting to build infrastructure while simultaneously managing increasing patient demand.
The alternative is to prepare for resolution at the same time we prepare for access. This is another reason we believe the resolution marketplace will become increasingly consequential. Expanding screening creates not only more opportunities for detection, but more responsibility for what happens afterward.
7. What Effective Implementation Can Accomplish
Kaiser Permanente Northern California provides an instructive example. Beginning with a coordinated FIT screening program, the organization combined mailed screening kits with automated reminders, structured follow-up, and equity-focused outreach. Over time, screening adherence increased from approximately 37% to roughly 80%, colorectal cancer mortality declined by about half, incidence declined by approximately one-third, and racial disparities in mortality narrowed substantially.
No single component explains those results and that's precisely the point. The value came from the system surrounding the screening test: identification, outreach, follow-up, and continuity working together over time. Better implementation made the test more consequential.
As diagnostic technologies proliferate, that implementation layer becomes increasingly important—and increasingly complex. More tests, more points of entry, and more organizations participating in screening create more opportunities for patients to enter care, but also more handoffs that must be managed successfully.
That is the environment in which the resolution marketplace is emerging.
8. The Resolution Marketplace
The resolution marketplace describes the growing clinical, operational, and economic ecosystem required to connect a cancer screening signal with completed diagnostic care. It exists because no single participant owns the entire journey.
Laboratories generate results. Primary care providers initiate screening. Specialists provide diagnostic evaluation and treatment. Health plans influence access and quality. Technology companies increasingly support identification, engagement, and coordination. Patients move among all of them.
The opportunity is not to replace those participants. It is to make the pathway between them more reliable.
That requires infrastructure capable of maintaining continuity across organizations and over time: identifying abnormal results, engaging patients, coordinating next steps, tracking unresolved cases, and creating visibility into whether diagnostic resolution actually occurred.
At Aton Health, our work is designed around that principle. We support screening and diagnostic navigation, patient engagement, clinical workflow coordination, and the generation of longitudinal real-world evidence across the patient journey.
Our approach is deliberately test-agnostic and vendor-neutral because diagnostic resolution is ultimately a shared problem. No single test manufacturer, provider organization, health plan, or technology platform owns the entire patient journey.
The infrastructure connecting them therefore has to work across those boundaries.
The resolution marketplace isn't a new category of test or a single technology solution. It is the ecosystem forming around an increasingly visible need: making sure detection leads somewhere.
9. Preparing for a Resolution-Driven Future
The evidence suggests several priorities for organizations preparing for the next phase of colorectal cancer screening.
Screening programs should establish clear processes for identifying and tracking every abnormal result through diagnostic completion. Follow-up should be incorporated into existing clinical workflows rather than treated as an adjacent administrative task. Organizations should anticipate that expanding non-invasive screening may change the mix of colonoscopy demand, increasing the proportion devoted to higher-yield diagnostic follow-up. And measurement should increasingly focus not only on whether screening occurred, but on whether the patient's diagnostic journey reached resolution.
The broader lesson extends beyond colorectal cancer. As diagnostic technologies become easier to deploy and increasingly distributed across healthcare, the number of signals healthcare can generate will continue to grow. So will the ecosystem required to act on them.
That is why we believe the resolution marketplace deserves greater attention. It represents the providers, technologies, workflows, partnerships, and infrastructure that determine whether a diagnostic signal ultimately becomes better care.
The next phase of diagnostic innovation will therefore require more than better detection. It will require resolution by design.
Selected Sources
Market data above is drawn from Scope Forward’s August 2026 research report, “Beyond the Scope: The Non-Invasive Revolution Reshaping Colorectal Cancer Screening,” and its underlying peer-reviewed and regulatory sources. Strategic interpretation is Aton Health’s own. Key primary sources referenced:
• Fendrick AM et al. Colonoscopy capacity reallocation modeling. Gastro Hep Advances, 2026.
• Ladabaum U et al. Comparative effectiveness and cost-effectiveness of blood-based CRC screening. Ann Intern Med, 2024.
• ASGE Position Statement on blood-based CRC screening. August 2025.
• Wolf AMD et al. American Cancer Society 2026 CRC Screening Guideline. CA Cancer J Clin, 2026.
• Follow-up colonoscopy completion across 39 healthcare organizations. JAMA Network Open, 2023.
• Coronado GD et al. Blood-based test uptake among FIT non-completers. Gut, 2024.
• Corley DA et al. Kaiser Permanente 20-year screening outcomes. DDW 2025 / JAMA Network Open.
• Follow-up non-completion and 6-year CRC mortality risk. Preventive Medicine Reports, 2023.
Disclaimer. This white paper is provided for educational and informational purposes and does not constitute medical, legal, reimbursement, or investment advice. Figures reflect the state of the field as of the cited sources; readers should verify current guidelines, coverage, and clinical evidence before acting. All company and product names are the property of their respective owners; their use does not imply endorsement or affiliation.