By Tom Hicks | September 24, 2026
Editorial Note:
I’ve survived bladder cancer and melanoma. My experience is part of this story, but it cannot tell us whether a new screening test works. For that, we need the evidence.
My father saw blood in his urine and kept it to himself. He didn’t want anybody to worry. I understand the instinct, even now. But he had bladder cancer, and by the time the rest of us learned what was happening, he had lost time he could not get back. The disease eventually killed him.
Years later, I was at work when I saw blood in my own urine. I can’t tell you how much there was. I remember knowing that nothing good was going to come of it, and I called a doctor as soon as I could that day. My father’s decision was on my mind. I didn’t want my family worrying about me any more than he had wanted us worrying about him. I wanted them to still have somebody to worry about ten years later.
I needed surgery that removed my bladder, prostate, and lymph nodes. My doctor later told me that if I hadn’t had it when I did, I would have been dead within a year. I developed melanoma a couple of years afterward. I’ve lived with a urostomy bag ever since the bladder surgery, and I hate the bag. It fuels something of a Frankenstein complex in me, but it beats the shit out of being dead.
So when I hear that a blood test might detect signals associated with more than 50 cancers before symptoms appear, I pay attention. Of course I do. I also want to know what happens when it misses one.
A promising vote with a large question attached
On September 23, an advisory panel voted in favor of GRAIL’s Galleri blood test. Its ten members unanimously supported the test’s safety; they voted 6–4 on effectiveness and 7–2, with one abstention, that its benefits outweigh its risks. Those votes are recommendations. The FDA has not approved Galleri. The proposed indication reviewed by the panel is for adults 50 and older, with the test used alongside existing cancer screening. GRAIL’s account of the votes · FDA meeting information
Galleri looks for cancer-associated patterns in DNA fragments circulating in the blood. If it detects a signal, it predicts where in the body that signal may have originated so a doctor can investigate. That could be valuable for cancers without an established routine screening test. A positive result is not a diagnosis, though, and a negative result is not an all-clear. FDA meeting information · National Cancer Institute
The phrase “more than 50 cancers” can make it sound as though the test reliably catches every one of them. It doesn’t. Its performance varies by cancer type and stage, and the National Cancer Institute says multicancer tests generally detect later-stage disease better than early-stage disease. Finding cancers sooner is the promise. How often Galleri can do that is the question. National Cancer Institute · FDA review
I went looking for the bladder cancer number. In one study, Galleri detected a signal in two of seven people diagnosed with bladder or urothelial-tract cancer within 12 months of testing. In another, it detected five of 13. GRAIL reports a 35.2% weighted average across the two studies; that number is not a simple seven-out-of-20 calculation. With so few cases, the estimate is uncertain. It cannot tell me what the test would have done when I got sick ten years ago. It does tell me why I would never treat a negative result as a reason to dismiss blood in my urine. GRAIL’s briefing document submitted to the FDA, Table 33
The melanoma question deserves the same honesty. In the NHS-Galleri study, the test detected a signal in one of 29 people diagnosed within 12 months with a skin cancer other than basal or squamous cell carcinoma. That category does not give us a dependable melanoma-specific detection rate, and the numbers are small. I would not let a negative Galleri result talk me out of getting a changing mole examined. FDA review, Table A5
What the big trial did—and didn’t—show
The large NHS-Galleri trial in England gives us a reason to keep studying the test. It also gives us a reason to slow down before declaring victory. The trial did not meet its primary goal: a statistically significant reduction in the combined number of stage III and IV diagnoses for a specified group of 12 cancers during the measured follow-up period. GRAIL also reported fewer stage IV diagnoses among those 12 cancers by the third screening round. That secondary finding deserves attention. The missed primary goal does too. GRAIL’s NHS-Galleri trial results
Fewer late-stage diagnoses could be good news if the finding holds up. It is not yet proof that screening with Galleri prevents deaths. The National Cancer Institute says there are no definitive clinical trials showing that multicancer screening tests reduce overall cancer mortality. Finding a cancer sooner also does not, by itself, establish that a person will live longer or avoid more extensive treatment. Those are the outcomes people are hoping for, and they deserve answers. National Cancer Institute
I know what finding cancer in time meant for me. That’s why I want Galleri to work, and why I won’t pretend the evidence has answered questions it hasn’t.
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Then there’s the person whose phone rings after a positive result. Finding out whether there’s cancer, and where it is, can mean scans, procedures, expense, and a long stretch of fear. Sometimes the investigation finds no cancer. A negative result presents a different risk if it persuades somebody to skip established screening or explain away a symptom. National Cancer Institute
Galleri is already available by prescription as a laboratory-developed test, although it has not received FDA approval. As of September 24, GRAIL lists its price at $949 and says most health plans do not cover it. The company also offers a temporary discount through its website, and prices or coverage can vary elsewhere. If this becomes a widely used screening tool, access will matter: a test available mainly to people who can afford it is a different proposition from one everybody can use. GRAIL’s patient information · National Cancer Institute
The warning in front of us
I would love a test that reliably finds dangerous cancers before they take organs, years or lives. I have every reason to want one. But wishing Galleri had existed when I saw blood at work is different from knowing it would have helped me. Based on the evidence available today, I cannot make that claim.
My father saw blood and kept it quiet because he loved his family. I saw the same symptom years later and called a doctor because I loved mine. We both understood worry. I also knew what his silence had cost us.
If Galleri eventually proves it can give more people useful information sooner, that will be extraordinary. Until then, no test result should become an excuse to dismiss a symptom your body has already given you. If you notice blood in your urine or another concerning change, tell a clinician. I’m here to write this because I did. National Cancer Institute on negative results and symptoms
That’s the cancer story. Here are three other claims that deserve a closer look.
The Bullshit Detector
Claim: “No tax on overtime means my entire overtime paycheck is tax-free.”
Bullshit:
The federal deduction generally applies to the extra half in time-and-a-half pay, subject to limits and eligibility rules. The regular portion of that pay does not suddenly become tax-free. IRS explanation
Claim: “No tax on tips means every tip is exempt from every tax.”
Bullshit:
The law created a federal income-tax deduction for qualified tips, with an annual cap and an income phaseout. The slogan leaves out quite a bit. IRS guidance
Claim: “Inflation slowed, so prices went down.”
Bullshit:
Slower inflation means prices are rising more slowly. The August Consumer Price Index showed prices up 0.4% for the month and 3.4% over the year. If your grocery receipt still hurts, you haven’t misunderstood it. Bureau of Labor Statistics
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One Question Before You Go
Would you take a test that screens for dozens of cancers if you knew it could still miss yours? What would you want to know before deciding?
#CancerScreening #CancerSurvivor #Galleri #EarlyDetection #OffScript
Thank you, Tom. I am glad you are still on the planet for us to enjoy your wordsmith skills. No, I would pass on this test since it doesn't provide inclusive results. I do just fine listening to my body.