Exact Sciences at William Blair Conference: Vision for Cancer Eradication

On Tuesday, 03 June 2025, Exact Sciences (NASDAQ:EXAS) presented its strategic vision at the 45th Annual William Blair Growth Stock Conference. The company emphasized its mission to eradicate cancer through prevention, early detection, and treatment guidance. While CEO Kevin Conroy highlighted the robust commercial engine and technological advancements, CFO Aaron Bloomer discussed financial growth and profitability challenges.

Key Takeaways

• Exact Sciences aims to leverage its technology and commercial infrastructure for sustainable growth.
• The company projects mid-teens revenue growth and over 20% adjusted EBITDA margin.
• New product launches, including Cologuard Plus and CancerGuard, are expected to drive expansion.
• The company increased its revenue guidance by $40 million after a strong Q1 2024.
• Exact Sciences is focusing on productivity improvements and G&A optimization for margin expansion.

Financial Results

• Overall Performance:

- Sustained double-digit growth over the past five years, with a 16% growth rate.

- Increased revenue guidance by $40 million after a strong Q1 2024.

• Revenue Growth:

- Screening portfolio projected to grow 14% in 2024.

- Long-term revenue objective set at mid-teens growth (15%).

• Profitability:

- Adjusted EBITDA turned positive two years ago, with nearly 50% growth in 2023.

- Projecting nearly 300 basis points of margin expansion this year.

- Long-term adjusted EBITDA target is over 20%.

• Gross Margins:

- Gross margins are nearly 75% across the portfolio.

• G&A Optimization:

- Achieved over 500 basis points of margin expansion in Q1 2024 from G&A alone.

Operational Updates

• Cologuard:

- 20 million people have been screened, with a three-year rescreening interval.

- 55% rescreen rate within a year of the due date, aiming to increase to over 75%.

- Expected to surpass daily screening colonoscopies next year.

• Care Gaps:

- Significant growth opportunity, estimated at $0.5 billion, potentially reaching $1 billion.

- Collaborating with 9 of the top 10 payers, with a recent order for over 100,000 tests.

• Oncotype DX:

- 75-80% penetration in the US market, 25-30% outside, with high double-digit growth expected.

• New Product Launches:

- Cologuard Plus, OncoDetect launched; CancerGuard to launch in the latter half of the year.

- Cologuard Plus boasts 95% sensitivity and 94% specificity.

Future Outlook

• Screening Growth:

- Aiming to increase annual tests from 4 million to at least 14 million.

- Addressing the 55 million people in the US not up to date with colon cancer screening.

• CancerGuard:

- Multi-cancer screening test launching in the back half of the year in the US and globally.

• Blood Test Data:

- Data on a colon cancer blood test to be released mid-summer.

• Cologuard Plus Transition:

- Contracts with payers over the next 12-24 months, then Cologuard will be sunset.

For more detailed insights, readers are encouraged to refer to the full transcript below.

Full transcript - 45th Annual William Blair Growth Stock Conference:

Andrew, Conference Organizer, William Blair: Alright. Hi, everyone. Good morning. Thanks for joining us, at this year’s William Blair Growth Stock Conference. This is my ninth year doing the conference, but, it’s always a pleasure to have Exact Sciences joining us here, again for for for this year’s conference here in Chicago.

With us, we have the chairman and CEO, Kevin Conroy CFO, Aaron Bloomer and VP of investor relations, Derek Lekow. Format for today, I’ll turn it over to Kevin to do a formal presentation, and then we’ll do a breakout session afterwards. Lastly, for a full list of research disclosures, please visit WilliamBlair.com. With that, I’ll turn it over to Kevin. Thanks, Kevin.

Kevin Conroy, Chairman and CEO, Exact Sciences: Thank you, Andrew, and thank you, William Blair, for having us back for the sixteenth time. Can’t believe it’s been that, that short of a period of time. It seems like it has flown. It was sixteen years ago that I had the good fortune of having a meeting at the Mayo Clinic where I met with doctor David Alquist, and he had this, at the time, seemingly crazy vision of being able to solve the number two cancer problem by screening and looking for DNA shedding from colon cancer into a stool sample and that you could accurately detect colon cancer from a sample collected at at home. That was the first, I I would call it, hour, two hours of the conversation.

The second part of the conversation was even more far out there, which is the idea of one blood test to detect all cancers. And that was probably his even bigger passion because he says, look. The the prevalence of cancer broadly in a population over fifty percent is one to three percent, you know, growing with age, growing with risk level. And he said that cumulative prevalence, if you screen a whole person in addition to individual organs, you have the ability to intervene early. And one thing we know about cancer is that early detection, earlier detection, changes outcomes.

So that is the genesis sixteen years ago. Not a lot has changed in terms of the overall vision. So the vision you see here, our purpose is to help eradicate cancer by preventing it, detecting it earlier, and guiding treatment. What we want to cover today is, you know, kind of how that vision, extends into a business model. What is our business model?

What is our technology platform? How does our technology platform that is extendable to customers, both consumers, patients, and, and health systems, and also payers, so the whole ecosystem. How is this platform that we’ve invested well over a billion dollars into, how is that going to fuel growth and and the purpose in the future? Our pipeline, we’ve talked for a long time about the tests that are coming, and, here we are now with three product launches this year that we couldn’t be more excited about. And then also, Aaron Bloomer, our CFO, will talk a little bit about our growth drivers and our our profitability growth.

Let’s see here. Can we advance the slide? One thing I do not have is a clicker. So here’s our safe harbor statement. Thank you, sir.

Our safe harbor statement, we will be making forward looking statements. So we have a 7,000 person team of cancer fighters whom, during the first presentation, I think we had about 10 people. So there’s been tremendous growth. We start with our our people. They’ve been able to do incredible things, and it really starts with our science and our scientists.

Everything that has come out of Exact Sciences, whether it’s Cologuard, Cologuard Plus, OncoDetect, CancerGuard, is because of unbelievable unbelievably talented scientists and then a business model that has allowed us to grow. We expect this year to generate more than 3,000,000,000 in revenue and growing profitability. So the value drivers that we have that we’ll touch upon here is this technology platform, and we’re able to access these kind of large populations of of people that need to get screened, that need to get a better test to help guide therapy. And one of the things that we have built that is truly differentiated is our commercial engine. We have a large field force that calls on every square inch of The US.

So if you’re in a state, you you have reps that call on primary care physicians, PAs, nurse practitioners in that state. We cover all of that, and that has driven Cologuard growth. And one of the things we’re proud of is this value, it iners to shareholders. It also iners to the population. If you take a look at where screening rates were in colon cancer when we started this journey sixteen years ago, roughly sixty percent of the population was up to date with screening.

This over the age of 50. Today, that is over seventy percent. Last we checked, seventy two percent. That is almost entirely due to Cologuard utilization. 20,000,000 people has have been screened with Cologuard, and it’s protected for three years.

So Cologuard’s it is on a three year interval. You’ll hear about this. That too is a significant driver of growth, and it’s a powerful part of our business model. It leads to this double digit revenue growth, and we’re on that cusp of continued growing profitability, which Aaron will talk about. This is what we call our flywheel.

It is how we think about our business. It starts with unbelievably great people. Think our, our scientists, think our salespeople, our marketing people. They’re fundamental to who we are and what we do. And we develop tests that act actually change clinical practice.

We see tests being developed in our field that don’t necessarily fundamentally change clinical practice. For example, with Cologuard, you get a Cologuard test. If it’s positive, we help you go get a colonoscopy. It’s very important to do that follow-up step. That’s the step where you can intervene and find and remove a precancerous polyp preventing cancer, which which is the goal of screening.

You generate rock solid evidence. I think we’re up to six New England Journal of Medicine publications between Oncotype DX and Cologuard and Cologuard Plus. Nobody’s ever really taken this approach to just drive this fundamental value through strong clinical trials. That allows us to get access to payers. It allows us to drive adoption in the clinic, in the primary care setting, in the oncology setting, in the specialty setting.

And then you add the accelerator of our technology platform, electronic connectivity between the physician and the patient and also the payer. This is a powerful platform. We did not have it when we launched Cologuard eleven years ago. Today, we have a platform that actually extends, has applications, and power that we will talk about here. And it drives Cologuard, and it drives Oncotype DX.

So this is our pipeline of of products on the screening side and precision oncology. So two think two different businesses, one primarily in the primary care setting, one primarily in the oncology setting of, you know, a surgical oncologist, a medical oncologist, pathologist, serving people who are actually being treated for cancer. This is all of these products are powered by our scientific platform and then also this technology platform, which we call Exact Nexus. What is Exact Nexus? Exact Nexus is a platform that is built on Epic, which is the leading platform, EMR system, billing system, you name it, system in health care.

If you get a chance, listen to Acquired and the four hour podcast about Epic. If you’re interested in health care or an investor in health care, it’s kind of a must listen to. It’s the operate it has become the operating system for health care. We built about, several hundred applications on top of this platform, which allow us to do a multitude of different things. A basic thing that we can do because we built our our company on Epic allows us to do billing, to payers, and it allows us took us from sixty days down to twenty two days to collect.

That’s that’s powerful. It’s powerful also because we’re able to do it in an automated way without a lot of people dedicated to this function, and we’re able to deploy that capital in other areas. We’re able to do electronic ordering and resulting. Eleven years ago when we launched Cologuard, doctors actually or their staff had to fill out a piece of paper and fax it to us. Today, believe it or not, 30% of Cologuard orders still come in that way.

It’s a big step up in ease of use and ordering frequency when a physician has access to electronic ordering, electronic resulting. And now for a patient, if you go to our website, Cologuard.com, if you are not up to date with with screening, do yourself a favor. Go to Cologuard.com while you’re in this meeting. If you listen listen to the presentations too, but go to Cologuard.com and order a test. See how easy it is.

And every three years, you’ll be reminded. One thing that you can put out of your mind is you don’t have to worry about getting screened because Cologuard will take care of you. It’s really truly protected. Over time, this allows us to do powerful things like close care gaps. Well, what what is a care gap?

Well, it’s a big payer or a big health system that looks and sees that thirty percent of their members or patients are not up to date with screening. And over the last couple, two and a half years, we have grown this capability in large part because of the quality of our test that is good for three years and that you can generate these test orders through directly initiated by the payer or directly initiated by the large health system at scale. We had one of our largest care gap orders in our history with over a hundred thousand test orders about a month ago for one payer. We’re working with nine of the top 10 payers, and and we expect that to be 10 out of 10, and we expect it to be 800 out of 800 payers that we work with generally over time. Why do they do this?

They are highly incentivized by commercial insurance plans and Medicare Advantage plans to have high colon cancer screening rates because it helps them qualify for Medicare Advantage and commercial bonuses. It’s a fundamental part of their business model to drive their preventive scores. Our ExactNexus platform allows us to do this in a very differentiated way. Others can’t build this capability out of thin air. It takes time and investment.

And every year, we see another 50 to a hundred health systems connect with the exact nexus, and then they can u utilize some of the capabilities that they have in their EMR systems to generate campaigns to alert people that they’re due for screening. This is a powerful tool tool. If you ask us, are we a cancer diagnostic company, or are we a technology company? It’s hard to answer that question. We’re both.

And both are equally important to being able to achieve the purpose ultimately of earlier detection as we extend into other areas. Colon cancer this year may be overtaken as the number two cancer killer only by pancreatic cancer and lung cancer. Lung cancer far outstrips all cancers in terms of mortality. It’s still a big problem. Fifty three thousand people a year die from colon cancer.

A hundred and fifty away. In Europe, it’s not fifty thousand deaths. It’s a hundred and fifty thousand deaths. There’s a global need for screening, and there’s really no better way to do that than in the privacy of your own home with a highly accurate test. And test accuracy is critically important.

In The US, there are fifty five million people who are not up to date with colon cancer screening. This isn’t if there is a bigger growth opportunity in health care, I don’t know what it is. The team is working incredibly hard to continue to grow from approximately four million people tested last year to we believe we can get to at least 14,000,000 people tested on an annual basis. We’re really proud of the lab capability, the IT capability, and the quality of the test. Cologuard Plus is a big step up in performance from Cologuard.

So Cologuard Plus launched this year. Medicare awarded it a price of $592 per test, still significantly below the fall in cost of colonoscopy. So it’s great a great value for the health system. It’s a great value for people, and it leads to earlier detection. It detects ninety it detected ninety five percent of cancers in our big pivotal clinical study with only a six percent false positive rate in people with no findings in their colon, no small polyps, nothing, just what we would call a clean colon.

So ninety five percent sensitivity and ninety four percent specificity, detecting forty three percent of precancerous polyps. Precancerous polyps take ten to fifteen years to turn into cancer. So if you get this test every three years, over time, per these models, you eventually find that, and the sensitivity of the test grows as the polyp increases in size because it sheds more DNA, easier to detect. So over time, per these models, you end up detecting over ninety percent of those precancerous polyps intervening and actually preventing the disease. That is the the power of the science.

You can see the growth here. A lot of people ask, you know, well, is Cologuard an thing? Do people not wanna do it? Yeah. And I have to say sixteen years ago when I first joined the company, it might have been my biggest worry.

Over the last so monthly, we do a survey asking people on an unbranded basis, how would you get screened for colon cancer? In four of the last six months, for the first time, more people say Cologuard than colonoscopy. It’s changing. And sometime next year, we believe there will be more daily Cologuard tests than screening colonoscopies. We’re at that point where the power of the brand is driving great outcomes in health care, and we think that we’re just getting started here.

That this next second decade of Cologuard, led by Cologuard plus technology platform, the commercial organization, will lead to sustainable grow growth. Part of the story is rescreens and automating the the rescreening process. So what you see here are the number of people who come due each year for their third year rescreen. Either their first third year rescreen or or those the purple or gray at the top is is the second purple gray third. And that starts to stack in a quadratic way.

It grows and grows and grows over time. Today, we are successful in getting fifty five percent of these people screened within a year of their due date. Over time, our goal is to drive this to well north of seventy five percent of people. So think about how this leads to sustainable recurring growth from our, again, our business model perspective, which is the single biggest driver of growth if you stack up all of our growth drivers out over the next five years. Right here is the biggest growth driver.

Very little friction. We’re able to drive this growth, put this into your model, look out over five years. It’s pretty exciting, and that enables us to invest in other areas. As I mentioned, care gaps continue to be a big part of our growth over time driven by payers, partly Medicare Advantage plans, maybe mainly Medicare Advantage plans, but also commercial plans and large health systems. They all care about their quality scores.

And colon cancer is usually one of the worst scores. How do they drive it? They reach out to us, or we reach out to them. We run a program together, and we get their unscreened people screened. Over time, we think these programs will continue to grow.

It’ll be a half a billion dollar opportunity for us. Over time, it will become a billion dollar opportunity. Oncotype DX, it’s changed the way breast cancer is treated. Early stage HR positive HER two negative breast cancer standard of care to get an Oncotype DX test. It it is both predictive of benefit of chemotherapy, allowing about eighty percent of patients not to undergo chemotherapy.

Think about the power of that test by peering inside the cells and looking at the RNA activity. And and the evidence here are two studies that are about ten year studies randomized, hard to replicate this level of evidence. Just 90% market share, but we we have about 80% penetration 75 to eighty percent penetration in The US, only about 25 to 30% penetration outside The US. So outside The US is growing in its high double digit way, and we expect that to continue over time. It also gives us reach into the oncology setting, which is very important for some of the products that we listed earlier that are being used to help patients guide treatment who’ve already been diagnosed with cancer, including OncoDetect.

How do we do this? We do it with great science. We look at DNA, RNA, proteins. We have experts in all of these categories. Next generation sequencing, our proprietary technology, which we call TALKUS, which allows accurate detection and the ability to intervene early.

We also have deep collaborations with the best clinical research universities in the world, and we expect that will continue. We are have increased our utilization of AI, of large language models, of machine learning to help us guide to the to better performance. As I mentioned, we are launching three new products this year, and we will also be releasing data on a colon cancer blood test. So we’ve already launched Cologuard Plus. Tens of thousands of people are getting tested with Cologuard test plus.

First, starting with Medicare fee for service patients, and that will change to Medicare Advantage patients and commercial patients and Medicaid patients. We will contract with those payers over the next twelve to twenty four months and then sunset Cologuard. We also launched OncoDetect this quarter. We expect reimbursement yet this quarter, so sometime this month. Excited about that.

And CancerGuard is our multi cancer screening test, which goes back to that very first meeting we had with Dave Alquist back in February where we he laid out the vision of one blood draw, all cancers. This will be differentiated and available not only in The US, but we also expect to launch it globally. So we’ll launch CancerGuard in the back half of this year. We talked a real step up in performance. Just to put this data in perspective, there’s just never been a screening test.

You think about PSA screening, mammography, cervical cancer screening that has that level of sensitivity and that level of specificity. You just don’t have it. Mammography is in the, has over a ten percent false positive rate, probably about a thirteen percent false positive rate. This is a six percent false positive rate. Detects ninety five percent of cancers.

The best estimate for what colonoscopy detects is ninety five percent of cancers. Colonoscopy is better at detecting precancerous polyps, but you only do it once every ten years. Cologuard, you do every three years, so you have that chance to come back and pick up the interval cancer or the interval polyp. It it’s very protective. So OncoDetect is a powerful test for patients that have already been diagnosed with cancer.

Their diagnosis it’s important to ask the question, are they likely to recur? OncoDetect addresses that question. It’s a it’s a fast growing field, and we expect this over the next decade to this it to become standard of care for patients to get a test looking at DNA in their blood to detect recurrence. CancerGuard, also, today, only fourteen percent of all cancer cases are detected through screening. We believe CancerGuard and other cancer screening tests that are in our pipeline that we don’t spend a lot of time talking about will also become part of this landscape.

That is how we get back to achieving our our purpose. And I’m gonna get through oh, our blood test data, we expect out in the middle of summer, and so we’re excited about this. Just to put blood testing in perspective, you can take a look. The AGA was involved in a couple of different studies, I think three papers altogether, an opinion piece, where they said, look. The the performance of blood testing for colon cancer screening just isn’t there yet.

And mainly because blood testing is essentially blind to precancerous polyps. Thirteen percent precancer detection, ten percent false positive rate. So it’s just above background. It’s it it just doesn’t see precancerous polyps. And and so we think the guideline groups are gonna be very cautious about recommending it as a frontline screening test ahead of Cologuard or ahead of colonoscopy.

It may be years before the most important guideline group weighs in. That’s the USPSTF. So it’s also pretty expensive to to screen. This model was based on $500 a test, but this is all publicly available data for you to take a look at. And with that, I’ll hand it over to Aaron with four minutes left.

Thanks, Kevin.

Aaron Bloomer, CFO, Exact Sciences: Morning, everybody. Just to kinda recap and and distill everything Kevin said in terms of our financial profile. So we’ve laid out growth drivers for the future, but maybe take a step back. What have we delivered over the last five plus years? We’ve delivered on that promise of sustained, durable, double double digit strong growth.

So a 16 growth rate over the course of the last five years. You can see what that’s meant in terms of growth across both our screening as well as our precision oncology portfolio. What we’ve done this year with the strong start that we had in q one and visibility that we had into the second quarter from some of the commercial changes that we’ve made and the momentum that our sales force has created out into the field is we actually increased our guidance already by $40,000,000, just after the the first quarter. All of that really coming from our screening portfolio, which is slated to grow 14% this year. The exciting thing as a CFO is that not only are we driving top line growth at that mid teens level, it’s that we’re rapidly expanding profitability.

If you look at we turned adjusted EBITDA positive just two years ago. And from that time, from 2023 to where we’re estimating the midpoint of our guide this year, we will double our profitability in a two year period. Last year, we grew our profitability nearly 50%. This year, we’re projecting another nearly 300 basis points of margin expansion. And if you look at out into the future, there’s several levers that we have at our disposal.

It starts with top line growth. When we’re growing the top line at that mid teens level, it allows us to be able to not only reinvest back in future growth, but to be able to deliver leverage and and EBITDA expansion to the bottom line. Second is productivity. Really, really proud of the work that our lab, manufacturing, and supply chain team have done to deliver margin expansion and unit cost reduction. You see that in our world class gross margins that we have, nearly 75% gross margins on the portfolios that we have.

The launch of Cologuard Plus, Kevin talked about that before. Through the Medicare process and clinical lab fee schedule, we got an elevated price level due to the value that Cologuard Plus is gonna deliver to the health system. That will be a driver of both growth and margin expansion into the future. And then one of the areas that we see as a large opportunity is g and a optimization. The team is already hard at work at this.

We delivered more than 500 basis points of margin expansion in q one from G and A alone and more to come, into the future. What that’s gonna allow us to do is deliver on our long term commitments. We have a long term revenue objective of mid teens growth, 15% growth, and to reach that 20% plus adjusted EBITDA level. We are well ahead of our projections at this moment in time and really excited about what this means for the future of Exact. With that, I’ll flip it back to Kevin to close.

Kevin Conroy, Chairman and CEO, Exact Sciences: I think the important thing that you heard today is maybe that what where we started, which is there is a way to bring cancer mortality down, and it is through earlier detection and, better guiding of the treatment of cancer. We have the tools to do that now because we understand what is going on inside those tumor cells, looking at DNA activity, RNA activity. That allows us to screen and intervene and, hopefully, find cancers earlier when they’re treatable frequently with surgery alone. We’ve built a platform, a technology platform, a commercial platform to deliver these incredible tests to physicians and patients who need them. And then we have a business model that allows us to generate profits, reinvest profits, invest in r and d, invest in our science, and our scientists to lead to sustainable growth for a long time.

Thank you, and look forward to our conversations.

This article was generated with the support of AI and reviewed by an editor. For more information see our T&C.