Today (July 28, 2026) marks the first scientific article that pairs breast density with a blood test for breast cancer. To be clear, I’m not talking about the circulating tumor DNA blood test (ctDNA), advertised for 50+ types of cancer, but with unacceptable results for breast cancer. No, I’m talking about a blood test based on 15 or so RNA products from immune-type cells that “turn on” whenever cancer is present somewhere in the body (in this case, with specific patterns for breast cancer). This blood test is the product of original research emanating from Syantra, Inc (Alberta Canada), and I’m pleased to be part of the team. Today’s report is focused on cost-effectiveness, but the next project will focus more on performance characteristics of the blood test. This current paper is a tough read, but even with skimming you might be able to see why it took our Syantra team 2 years to analyze results, write the paper, and then get it published. Here’s a link to today’s article: 10.1016/j.clbc.2026.07.029

Or, if you just want the title and authors:

ORIGINAL ARTICLE, in Press July 25, 2026, CLINICAL BREAST CANCER

Cost-effectiveness of biennial breast screening in women with dense breasts: exploratory analysis of pathways incorporating an emerging blood RNA test.

Jacie T. Cooper ∙ Alan Hollingsworth ∙ Randy D. Moore ∙ … ∙ John Schneider ∙
Kristina D. Rinker ∙ Eldon Spackman et al.

My interest in this topic is documented heavily, both in formal and informal settings….just check out my recent posts on this web site. I make the claim, true or not, that I was the first clinician in the U.S. to promote blood testing as a potentially better way to select patients for MRI screening in addition to mammography. (note that there were basic scientists at work on this issue, but no clinicians to my knowledge).

Here is the sequence, so if anyone reading this can come close to 1993 in establishing this particular agenda, please contact me, and I’ll quite making the claim. 8 YEARS BEFORE THE FIRST NCI GRANT was issued to develop a blood test for early breast cancer, I started drawing up protocols for a blood test to detect early breast cancer as the BEST WAY to select patients for MRI screening. Such a study is remarkably simple in its design: If screening mammograms are negative, then blood test positive, move on to additional imaging — bilateral breast ultrasound, or better yet, breast MRI. It must have been its simplicity that made it hard to understand because the feedback I received for decades was, “Why? We already have mammography. And it’s 90% accurate.”

And if that were true (90%), we wouldn’t need anything else. So, the first step in trying to convince clinicians of the radical need for improvement was presenting the actual data for mammography, something that could NOT be done at first when mammograms were the only imaging modality (How do you compare if there is only one option?) But once US and MRI hit the scene…wow….turns out we had been missing many more breast cancers than formerly believed.

So how did I get in the game so early? Through a bizarre sequence of events that began in 1993. I attended one of the early breast cancer conferences in Dallas where Dr. Steve Harms (father of breast MRI) was showing his results, using 2 projectors for his 35mm slides even though clinical introduction of MRI was still 10 years away. But what he showed, case after case, was: “Here’s the negative mammogram on the left, then on the right, you see the obvious cancer with MRI.”

I left that conference troubled that the technology was available, but only at research sites where the pre-clinical testing was underway (plus a second form of MRI being tested in Europe). I knew this was going to revolutionize breast imaging, but I also knew that the extraordinary expense, false positives, etc., was going to create a significant downside for MRI. And, it was totally impractical to screen the entire population of women with breast MRI.

Only a few DAYS later, I walked into my Friday morning research conference where I had organized the PhDs on campus at the University of Oklahoma who were interested in research on early breast cancer. We met each Friday, at the beginning just to share and cross-educate among the different disciplines (with my interest being early cancer). And once a year, I invited myself to the noon research meeting for the entire staff of the Oklahoma Medical Research Foundation (OMRF) to recruit more members to our team. In the end, our study group was about 15 strong. But on this occasion, days after Dallas, one of our senior members, Dr. Paul MdKay, walked in waving a journal article, saying, “Hey, is there a possible use for a blood test that would detect early breast cancer?”

And there it was. It would be enough work to last the rest of my career. Through Dr. McKay prompting OMRF to help fund a visit by the blood test scientist, and an equally dedicated army of OKC women who wanted to see top-notch breast cancer research in Oklahoma, the two groups brought the author of the paper, Dr. Chaya Moroz, to OKC from Israel. I served as her host for several days, as we discussed implementation of her blood test for breast cancer into clinical trials. Negative mammos, positive blood test, then perform MRI. But because there was no MRI available to us at the time, we focused on background preparations, clinical designs, and the possible use of ultrasound. I wish I had time to go through my files and detail what happened next, but before we had to disconnect from Dr. Moroz and her test, I had volumes written on the implementation of blood testing and MRI.

If I ever get around to writing the full story, I’ll expand. but here it is in brief — OMRF was not the first visit to the U.S. to promote her blood test for breasat cancer. Dr. Moroz was already connected to the largest Intellectual Property Law Firm in the U.S. — Penny and Edmond (NYC — where 100-plus attorneys held advanced degrees in engineering, biomedical engineering, etc. And the point person with whom I would be dealing was Leslie Misrock, Number One on the list found on company stationery.

When I flew to Manhattan for my first meeting at the firm, I walked in with Mr. Misrock who introduced me to about 15 attorneys sitting around a table. There was only one other doctor present — Chairman of the American College of Radiology Task Force on Breast Cancer — Gerald Dodd, MD. (Also, the first Chairman of Diagnostic Radiology at MD Anderson.) And while Dr. Dodd was not directly responsible for the introduction of mammography in the U.S., he strongly supported its use and aided his radiologist-colleague at MD Anderson that helped make it all happen — Robert Egan, MD. I was still learning breast cancer basics at the time, self-teaching, but I was surprised when it came time to explain how a blood test would work in the current algorithms. I seemed to be the only one in the room who had given it thought. (Notably, my opinion is unchanged 33 years later.) I made several more trips to NYC and collected enough correspondence from various venture capital groups to fill my files. Yet, in the end, after 5 years, no clinical trials were accomplished and not a single sample of blood was drawn.

Skip ahead to that first patient in OKC who had her blood drawn at the same time she had her screening MRI. That was in 2003, and it would continue through nearly 2,500 volunteers over the course of the next 17 years, until the sponsoring hospital egregiously shut down my entire research foundation, and gave me and my staff our walking papers. During that 17 years, however, we shipped over 10,000 specimens to 13 different research groups, including 3 formal clinical trials. Syantra, Inc. was the 13th, and my association with them was serendipitous. I had been working with my 12th company when the results of their formal clinical trial were inadequate to proceed to commercialization. Starting to wear down (it’s a huge burden on the staff, too), I figured it was time to give it up. The years were passing quickly, and it was clear any new association would take several years to see whether or not their blood test worked. It was probably time to close it down.

When I got back to my office, there was a message for me to call Syantra, Inc., a company in Canada working on a blood test for early detection of breast cancer. They told me over the phone that when they Googled “early breast cancer detection” that my name kept popping up in multiple areas (imaging, biopsies, epidemiology, pathology, etc.) and thus began my work with Comapny #13, only days after the failure of #12. That was in late 2016, so it’s been roughly 10 years working with Syantra, the first 4 that included shipping samples from the women at OKC, where we stood to be one of the Principal Investigators of the definitive trial. But after the wrecking ball hit from our sponsoring hospital, we could no longer participate by sending samples and data. As it turned out, however, decades of experience accrued from devoting so much of my time to this project. It ended up that Syantra leadership asked me to stay on as a clinical consultant, even though I no longer had access to specimens.

So here we are. 2026. The door has been opened, and someday soon we will see a place for blood test early detection in breast cancer. Imagine this clinical trial design, so simple: A cohort of women with dense breasts (about half the female population) and negative mammograms are enrolled. Even though they are “normal” we know from the MRI studies that there will be about 20 women out of 1,000 who will have cancer detected on the first MRI. 20 cancers missed by mammography! Today, one would have to perform MRI on all 1,000 to find the 20 with cancer. But if a blood test is used, then MRI is performed only when the blood test is positive. The number of negative and false positive MRIs is drastically reduced, while most of the missed breast cancers are now identified.

For 33 years, it’s been on hold, but now, the change will gradually begin. Instead of using risk factors to select patients for MRI (when most women who get breast cancer don’t have major risks) or instead of overutilization of MRI for women with dense breasts, we have an economically sound way to approach those cancers currently being missed on mamography.

END

Thanks are due Rebecca S. Clinton, MD who headed up the breast MRI program at our hospital and took on the challening role of becoming expert at MRI.

Also, thanks to Dr. Steven Harms, “father of breast MRI,” who helped us in many ways by giving our clinic early access to new technologies that were added to the Aurora MRI, paving our way onto speakers’ panels, group projects and serving as a collaborator for many projects over the years.

Syantra, Inc. works to improve early cancer detection, starting with breast cancer as the lead product. Under the direction of Kristina Rinker, PhD and Bob Shepherd, PhD, and a host of others, it has been an honor to serve as a link between basic science and clinical outcomes.