Evaluating AI vendors in healthcare, on the record.

GRAIL and Guardant Health both screen for cancer from a blood draw using methylation classifiers run in their own laboratories. The difference that decides between them is scope against standing, since one test looks for many cancers without FDA approval and the other for one cancer with it. GRAIL's Galleri looks for a cancer signal across more than 50 cancer types in adults at elevated risk and predicts where it started, as a prescription laboratory developed test priced at $949. In PATHFINDER 2, 60.3 percent of positive results led to a cancer diagnosis and 99.2 percent of negative results held at 12 months. The randomized NHS-Galleri trial of 142,250 people did not meet its primary endpoint of fewer late stage cancers. An FDA advisory panel voted 7 to 2 in September 2026 that benefits outweigh risks, and a decision is pending. Guardant Health's Shield, FDA approved in July 2024, screens average risk adults 45 and over for colorectal cancer and is covered by Medicare. It detected 83.1 percent of colorectal cancers in the ECLIPSE study and 13.2 percent of advanced adenomas, so it finds most cancers but few precancerous lesions, and a positive result goes on to colonoscopy. Guardant also sells blood and tissue tests for therapy selection and recurrence. A program adding a blood based colorectal screening option for average risk adults fits Shield. A program offering broader cancer screening to higher risk adults, alongside guideline screening, fits Galleri.

Foundation Medicine and Guardant Health both profile advanced cancers in their own laboratories to match patients with therapies. The comparison buyers search for is FoundationOne CDx on tissue against Guardant360 on blood, though each company now sells both kinds of test. FoundationOne CDx is an FDA approved tissue test of 324 genes with microsatellite instability and tumor mutational burden, more than 40 companion diagnostic indications and a median turnaround of eight days, with national Medicare coverage for qualifying patients. Liquid biopsy, hematologic, residual disease and germline tests sit alongside it. HRDsig, a homologous recombination deficiency signature built with machine learning, is reported as a labeled professional service outside the approved assay. Guardant Health's companion diagnostics work from blood. Guardant360 CDx and Guardant360 Liquid CDx, the second approved in May 2026, profile advanced solid tumors from a blood draw, with Guardant360 Tissue, Guardant Reveal for recurrence and a hereditary panel offered as laboratory developed tests. Its tests order and result inside Epic and Flatiron OncoEMR, with order sets and reflex testing triggered by clinical events. Shield, its FDA approved colorectal screening test, sits outside this decision. A practice that wants tissue profiling with the widest set of approved therapy matches fits Foundation Medicine. A practice that starts from a blood draw and wants ordering built into its record system fits Guardant.

Invitae and Myriad Genetics both run germline genetic testing in their own laboratories and return results to ordering clinicians inside Epic. The difference that decides between them is where each applies machine learning and how much a patient can know about cost up front. Invitae, owned by Labcorp since 2024, tests across oncology, women's health, pediatrics and rare disease, cardiology and neurology, and genetic counseling comes at no added cost. Its Evidence Modeling platform trains gene specific models on curated evidence, keeps only those that pass accuracy thresholds and hands calibrated predictions to the laboratory's scientists as one line of evidence when they classify a variant. More than five million patients have been tested, and more than 400 customer record integrations are live. Myriad Genetics sells the MyRisk hereditary cancer panel, GeneSight, Prequel, Foresight and tumor and residual disease tests. RiskScore, offered with MyRisk, combines a polygenic risk model with the Tyrer-Cuzick model to estimate a woman's lifetime breast cancer risk, weights its variants by genetic ancestry and reports results by ancestry group. Patients see assistance tiers from $0 to $249, and Myriad holds HITRUST r2 certification. A practice ordering across many specialties with counseling built in fits Invitae. A breast cancer risk program that wants a polygenic risk estimate and clear patient cost tiers fits Myriad.