Reflections on the Illumina–GRAIL merger

It is well known that only a few types of cancer, such as breast cancer, cervical cancer, and colon cancer, are detectable before they become symptomatic. This, of course, is a serious health problem since cancer is often difficult, if not impossible to treat once it becomes symptomatic. Consequently, a test that could detect cancer before it becomes symptomatic would provide substantial health benefits. Recent advancements in technology have led to the development of tests expanding the range of asymptomatic cancer diagnoses. One such company, GRAIL, Inc., developed a multi-cancer early detection (MCED) test called Galleri that is able to diagnose up to fifty types of cancer, even if a patient is asymptomatic. GRAIL, however, is the only company currently producing a test that is effective at this level. Additionally, these tests require next-generation DNA sequencing (NGS) platforms and related consumables to conduct the test. Illumina, Inc. is the only producer of NGS platforms and related consumables that are adequate for the MCED test.1 While GRAIL was initially a subsidiary of Illumina, in 2016 Illumina sold off 88 percent of their shares in GRAIL. Subsequently, Illumina decided to buy back the shares that it sold.