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✦ Cancer Screening: The $60 Billion SegmentNarrow moat

Abbott Laboratories (ABT) — the future bets

Abbott paid about 6.3 times sales for Exact Sciences to enter a $60 billion US screening market; the bet pays only if its global channel carries the tests abroad.

Abbott's largest bet for the next decade is that cancer screening becomes a growth business the size of its glucose sensors. When it completed the Exact Sciences purchase on 23 March 2026, it said the deal established "leadership in the fast-growing $60 billion U.S. cancer screening and precision oncology diagnostics segments"1. At the announcement it said Abbott's total diagnostics sales "will exceed $12 billion annually"2.

Abbott Cancer Diagnostics sales by region, Q2 2026 ($M)890United States29InternationalAbbott Q2 2026 earnings release, Diagnostics sales table
Almost all American so far.

The base is Cologuard, the subject of the Cancer Diagnostics page in The Moat. The bet is what comes beside it. Abbott said second-quarter Cancer Diagnostics growth also reflected "contributions to growth from the precision oncology and international businesses"3. Those are small today: Cancer Diagnostics sold $890 million in the United States and $29 million abroad in the second quarter of 20264.

The price was about $20.6 billion5, against Exact's 2025 sales of $3.247 billion6, about 6.3 times7. To earn that back the business needs years of double-digit growth.

What Abbott brings is distribution. It sells diagnostics in more than 160 countries8, while Exact sold $102 million outside the United States in 20259. If Abbott's international laboratory channel can carry Exact's tests abroad, the bet changes size.

The announcement framed the deal as a growth vertical. Abbott said Exact added "a new growth vertical" to its expectations10, and that the combination would take its total diagnostics sales above $12 billion a year11.

The early international numbers are small but moving. Cancer Diagnostics grew 13.8% on a comparable basis outside the United States in the second quarter12. The purchase also left $774 million of unrecognized share-based compensation at 30 June 2026, expected to be recognized over about three years13, part of the cost of keeping Exact's people. Abbott completed the deal on 23 March 202614, so 2026 includes only part of a year.

The first test is international. Give the channel until the end of 2027. If Cancer Diagnostics still sells less than $50 million a quarter outside the United States by then, Abbott's reach has not travelled with the product.

Moat trajectory: Widening

Cancer Diagnostics +13.3% comparable in Q2 2026; international sales $29M.

The number that tests this moat
Reported
Cancer Diagnostics international sales, latest quarter
$29M (Q2 2026), of $919M total

Whether Abbott's channel takes Exact abroad; still below $50M a quarter by end-2027 would mean it has not.

Source: Abbott Q2 2026 earnings release ↗
References
  1. ReportedWhen it completed the Exact Sciences purchase on 23 March 2026, it said the deal established "leadership in the fast-growing $60 billion U.S. cancer screening and precision oncology diagnostics segments".
    Abbott Laboratories release of 23 March 2026, Form 8-K exhibit 99.1 - Abbott completes the acquisition of Exact Sciences, entering the $60 billion US cancer screening and precision oncology diagnostics segments. — March 2026 · publ. 23 March 2026 · source ↗
  2. ReportedAt the announcement it said Abbott's total diagnostics sales "will exceed $12 billion annually".
    Abbott Laboratories release of 20 November 2025, Form 8-K exhibit 99.1 - agreement to acquire Exact Sciences at a total equity value of about $21 billion and an enterprise value of about $23 billion, with total diagnostics sales expected to exceed $12 billion a year. — November 2025 · publ. 20 November 2025 · source ↗
  3. ReportedAbbott said second-quarter Cancer Diagnostics growth also reflected "contributions to growth from the precision oncology and international businesses".
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Diagnostics sales by business, Cancer Diagnostics and Cologuard. — Q2 2026 · publ. 16 July 2026 · source ↗
  4. ReportedThose are small today: Cancer Diagnostics sold $890 million in the United States and $29 million abroad in the second quarter of 2026.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Diagnostics sales by business, Cancer Diagnostics and Cologuard. — Q2 2026 · publ. 16 July 2026 · source ↗
  5. ReportedThe price was about $20.6 billion, against Exact's 2025 sales of $3.247 billion, about 6.3 times.
    Abbott Laboratories Form 10-Q for the quarter ended 30 June 2026 - segment sales and operating earnings, the Exact Sciences acquisition and purchase-price allocation, the $20.0 billion of notes, remaining performance obligations, goodwill by segment, expected amortization, legal reserves and the NEC litigation, and the balance sheet at 30 June 2026 - the Exact Sciences acquisition, purchase-price allocation, goodwill by segment and expected amortization. — Q2 2026 · publ. 28 July 2026 · source ↗
  6. ReportedThe price was about $20.6 billion, against Exact's 2025 sales of $3.247 billion, about 6.3 times.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Diagnostics sales by business, Cancer Diagnostics and Cologuard. — Q2 2026 · publ. 16 July 2026 · source ↗
  7. Moat Explorer calcThe price was about $20.6 billion, against Exact's 2025 sales of $3.247 billion, about 6.3 times.
    Moat Explorer calculation from Abbott Laboratories reported figures ($ millions unless stated; calendar years). Medical Devices: share of total reportable segment operating earnings 3,011 / 6,916 = 43.5% (2017), 4,533 / 13,422 = 33.8% (2021), 7,212 / 11,800 = 61.1% (2025); first half 2026 3,862 / 6,122 = 63.1%. Share of segment sales 21,387 / 44,311 = 48.3% (2025); first half 2026 11,392 / 23,750 = 48.0%. Segment margin 3,011 / 10,325 = 29.2% (2017), 3,038 / 11,787 = 25.8% (2020), 4,533 / 14,485 = 31.3% (2021), 7,212 / 21,387 = 33.7% (2025); Q2 2026 1,969 / 5,853 = 33.6%, Q2 2025 1,796 / 5,369 = 33.5%. Sales growth 2017-2025 (21,387 / 10,325)^(1/8) - 1 = 9.5% a year; operating earnings 2025 7,212 / 6,153 - 1 = +17.2%; sales 2025 21,387 / 18,986 - 1 = +12.6%. Diabetes Care 7,998 / 1,414 = 5.66 times (2017 to 2025); share of Medical Devices 1,414 / 10,325 = 13.7% (2017), 2,524 / 12,239 = 20.6% (2019), 4,328 / 14,485 = 29.9% (2021), 5,761 / 16,887 = 34.1% (2023), 7,998 / 21,387 = 37.4% (2025); share of company 7,998 / 44,328 = 18.0%; CGM share of Diabetes Care 7.6bn / 7.998bn = 95%. CGM growth 2019-2025 (7.6 / 1.842)^(1/6) - 1 = 26.6% a year. Abbott CGM sales over DexCom revenue 7,600 / 4,662.0 = 1.63 times. DexCom distributor share 3,959.0 / 4,662.0 = 84.9%. Product lines 2017 to 2025: Electrophysiology 2,764 / 1,353 = 2.04 times; Structural Heart 2,523 / 1,083 = 2.33 times; Heart Failure 1,448 / 643 = 2.25 times; Rhythm Management 2,649 / 2,132 - 1 = +24.2%; Neuromodulation 1,010 / 808 - 1 = +25.0%; Vascular 2,995 / 2,892 - 1 = +3.6%. Rhythm Management, Heart Failure, Vascular and Neuromodulation together 2,649 + 1,448 + 2,995 + 1,010 = 8,102 (2025) against 2,390 + 1,279 + 2,837 + 962 = 7,468 (2024), +8.5%. Diagnostics: margin 1,912 / 7,713 = 24.8% (2019), 6,237 / 15,526 = 40.2% (2021), 6,640 / 16,469 = 40.3% (2022), 2,433 / 9,988 = 24.4% (2023), 1,740 / 8,937 = 19.5% (2025); Q2 2026 499 / 3,092 = 16.1%, Q2 2025 372 / 2,173 = 17.1%. Share of segment operating earnings 6,640 / 12,831 = 51.7% (2022), 1,740 / 11,800 = 14.7% (2025). Sales 2025 8,937 / 9,341 - 1 = -4.3%. COVID testing share of Diagnostics sales 2022 8.4bn / 16.469bn = 51%, about half. Core Laboratory 5,360 / 4,063 - 1 = +31.9%. Rapid Diagnostics 2,454 / 10,061 - 1 = -75.6% (2022 to 2025). Point of Care 606 / 550 - 1 = +10.2%. Molecular 2020 peak 1,438 / 463 = 3.11 times 2017. Cancer Diagnostics share of Diagnostics Q2 2026 919 / 3,092 = 29.7%. Exact Sciences US share of 2025 sales 3,145 / 3,247 = 96.9%; purchase price over 2025 sales 20.6bn / 3.247bn = 6.3 times. China net sales 1,907 / 2,253 - 1 = -15.4% (2023 to 2025); China share of company 2,253 / 40,109 = 5.6% (2023), 1,907 / 44,328 = 4.3% (2025). Nutrition: margin 1,741 / 6,975 = 25.0% (2015), 1,705 / 7,409 = 23.0% (2019), 1,763 / 8,294 = 21.3% (2021), 706 / 7,459 = 9.5% (2022), 1,333 / 8,154 = 16.3% (2023), 1,558 / 8,451 = 18.4% (2025); Q2 2026 368 / 2,144 = 17.2%, Q2 2025 418 / 2,212 = 18.9%. Q2 operating earnings 368 / 418 - 1 = -12.0%. Sales 2021 to 2025 8,451 / 8,294 - 1 = +1.9%. Share of company sales 6,925 / 27,390 = 25.3% (2017), 7,409 / 31,904 = 23.2% (2019), 8,294 / 43,075 = 19.3% (2021), 8,154 / 40,109 = 20.3% (2023), 8,451 / 44,328 = 19.1% (2025). US Pediatric 2022 1,562 / 2,192 - 1 = -28.7%. International Adult 3,029 / 1,782 - 1 = +70.0% (2017 to 2025); share of Nutrition 3,029 / 8,451 = 35.8%. International Pediatric 1,816 / 2,112 - 1 = -14.0%. Sturgis: recalled brands 479 / 1,200 - 1 = -60%; Nutrition operating earnings 706 / 1,763 - 1 = -60%. Established Pharmaceuticals: margin 658 / 3,720 = 17.7% (2015), 848 / 4,287 = 19.8% (2017), 904 / 4,486 = 20.2% (2019), 889 / 4,718 = 18.8% (2021), 1,206 / 5,066 = 23.8% (2023), 1,290 / 5,536 = 23.3% (2025); Q2 2026 382 / 1,499 = 25.5%. Sales 5,536 / 3,720 - 1 = +48.8% (2015 to 2025); (5,536 / 4,287)^(1/8) - 1 = 3.2% a year (2017 to 2025). Key Emerging Markets share 4,167 / 5,536 = 75.3%. Segment sales growth 2025: Medical Devices +12.6%, Established Pharmaceuticals 5,536 / 5,194 - 1 = +6.6%, Nutrition 8,451 / 8,413 - 1 = +0.5%, Diagnostics -4.3%; net sales 44,328 / 41,950 - 1 = +5.7%. US share of 2025 net sales 17,126 / 44,328 = 38.6%; international share Q2 2026 7,377 / 12,593 = 58.6%. Further: Structural Heart compensation payments 89 / 2,523 = 3.5% of 2025 line sales. Diabetes Care added 7,998 - 6,805 = 1,193 in 2025. One point of CGM growth on 7.6bn = about 76. Medical Devices share of segment assets 10,689 / (3,540 + 4,791 + 8,273 + 10,689 = 27,293) = 39.2%. Total debt over total assets 32,608 / 109,215 = 29.9% (30 June 2026), 12,929 / 86,713 = 14.9% (end 2025). Net debt over Abbott shareholders' investment 27,005 / 51,110 = 0.53. Market value 173.21 / 217.86 - 1 = -20.5% (end 2025 to 5 October 2026). Second pass: US Structural Heart first half 2026 449 / 1,175 = 38.2%. Rapid Diagnostics 2,454 / 4,376 = 56% of 2020. Diagnostics Q2 2026 operating earnings 499 / 372 - 1 = +34.1%. Nutrition sales (8,451 / 6,925)^(1/8) - 1 = 2.5% a year (2017 to 2025); 8,451 / 7,409 - 1 = +14.1% (2019 to 2025). US Adult Nutrition 1,448 / 1,254 - 1 = +15.5% (2017 to 2025). Adult nutrition 3,029 + 1,448 = 4,477; pediatric 2,158 + 1,816 = 3,974 (2025). Total segment operating earnings 11,800 / 13,422 - 1 = -12.1% (2021 to 2025); Medical Devices 7,212 / 4,533 - 1 = +59.1%. First half 2026 dividends over operating cash flow 2,200 / 3,803 = 57.9%. DexCom revenue 2023 3,095.6 + 526.7 = 3,622.3; 4,662.0 / 3,622.3 - 1 = +28.7%; Abbott CGM 7.6 / 5.3 - 1 = +43.4% (2023 to 2025). US share of first half 2026 sales 9,490 / 23,757 = 39.9%. Diagnostics RPO 6,200 / 8,937 = 69% of 2025 Diagnostics sales; 6,200 / 5,360 = 1.16 times Core Laboratory sales. Libre 7.6 / 1.128 = 6.7 times (2018 to 2025). Medical Devices and Established Pharmaceuticals RPO 455 + 243 = 698, / 6,898 = 10.1%. Cash, debt and dividends: free cash flow 9,566 - 2,171 = 7,395 (2025), 8,558 - 2,207 = 6,351 (2024), 7,261 - 2,202 = 5,059 (2023); after dividends 7,395 - 4,116 = 3,279, about $3.3 billion. Dividends paid over free cash flow 4,116 / 7,395 = 55.7%; over net earnings 4,116 / 6,524 = 63.1%; 2025 dividend per share over adjusted EPS 2.40 / 5.15 = 46.6%; annual dividend 4 x 0.63 = 2.52 over trailing EPS 3.09 = 81.6%. Dividend per share 2.40 / 0.98 = 2.45 times, (2.45)^(1/10) - 1 = 9.4% a year (2015 to 2025). Total debt 3,033 + 9,896 = 12,929 (end 2025), 3,005 + 29,603 = 32,608 (30 June 2026); net debt 12,929 - 8,522 - 417 = 3,990 (end 2025), 32,608 - 5,104 - 499 = 27,005 (30 June 2026), 14,679 - 7,279 = 7,400 (end 2023), 14,125 - 7,967 = 6,158 (end 2024); 27,005 / 3,990 = 6.8 times. Remaining performance obligations 6,200 + 455 + 243 = 6,898, about $6.9 billion; Diagnostics share 6,200 / 6,898 = 90%; beyond 36 months 100% - 52% - 18% = 30%; over trailing twelve-month sales 6,898 / 46,585 = 14.8%, about 15%. Trailing twelve months to June 2026: net sales 44,328 - 21,500 + 23,757 = 46,585; net earnings 6,524 - 3,104 + 2,005 = 5,425; diluted EPS 3.72 - 1.77 + 1.14 = 3.09. Expected amortization 1.5bn (2030) / 2.6bn (2026) - 1 = -42%. Analyst target 120.26 / 100.10 - 1 = +20.1%. 2026 adjusted EPS guidance midpoints (5.55 + 5.80) / 2 = 5.675 (January), (5.38 + 5.58) / 2 = 5.48 (April), (5.45 + 5.60) / 2 = 5.525 (July). Year-end market value (stockanalysis) over net earnings and net sales: 2015 66.99bn / 4,423 = 15.15, / 20,405 = 3.283; 2016 56.55 / 1,400 = 40.39, / 20,853 = 2.712; 2017 99.34 / 477 = 208.26, / 27,390 = 3.627; 2018 127.04 / 2,368 = 53.65, / 30,578 = 4.155; 2019 153.61 / 3,687 = 41.66, / 31,904 = 4.815; 2020 194.06 / 4,495 = 43.17, / 34,608 = 5.607; 2021 248.87 / 7,071 = 35.20, / 43,075 = 5.778; 2022 191.43 / 6,933 = 27.61, / 43,653 = 4.385; 2023 191.09 / 5,723 = 33.39, / 40,109 = 4.764; 2024 196.18 / 13,402 = 14.64, / 41,950 = 4.677; 2025 217.86 / 6,524 = 33.39, / 44,328 = 4.915; 5 October 2026 173.21bn / 5,425 = 31.93, / 46,585 = 3.718 - Diagnostics, COVID testing, Exact Sciences, China and remaining performance obligations. — FY2015-Q2 2026 · publ. October 2026 · source ↗
    Method: Arithmetic on figures reported in Abbott Laboratories Forms 10-K and 10-Q and earnings releases, the DexCom Form 10-K, and stockanalysis.com market values; each operand is stated in the source line.
  8. ReportedIt sells diagnostics in more than 160 countries, while Exact sold $102 million outside the United States in 2025.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Diagnostics sales by business, Cancer Diagnostics and Cologuard. — Q2 2026 · publ. 16 July 2026 · source ↗
  9. ReportedIt sells diagnostics in more than 160 countries, while Exact sold $102 million outside the United States in 2025.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Diagnostics sales by business, Cancer Diagnostics and Cologuard. — Q2 2026 · publ. 16 July 2026 · source ↗
  10. ReportedAbbott said Exact added "a new growth vertical" to its expectations, and that the combination would take its total diagnostics sales above $12 billion a year.
    Abbott Laboratories release of 23 March 2026, Form 8-K exhibit 99.1 - Abbott completes the acquisition of Exact Sciences, entering the $60 billion US cancer screening and precision oncology diagnostics segments. — March 2026 · publ. 23 March 2026 · source ↗
  11. ReportedAbbott said Exact added "a new growth vertical" to its expectations, and that the combination would take its total diagnostics sales above $12 billion a year.
    Abbott Laboratories release of 20 November 2025, Form 8-K exhibit 99.1 - agreement to acquire Exact Sciences at a total equity value of about $21 billion and an enterprise value of about $23 billion, with total diagnostics sales expected to exceed $12 billion a year. — November 2025 · publ. 20 November 2025 · source ↗
  12. ReportedCancer Diagnostics grew 13.8% on a comparable basis outside the United States in the second quarter.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Diagnostics sales by business, Cancer Diagnostics and Cologuard. — Q2 2026 · publ. 16 July 2026 · source ↗
  13. ReportedThe purchase also left $774 million of unrecognized share-based compensation at 30 June 2026, expected to be recognized over about three years, part of the cost of keeping Exact's people.
    Abbott Laboratories Form 10-Q for the quarter ended 30 June 2026 - segment sales and operating earnings, the Exact Sciences acquisition and purchase-price allocation, the $20.0 billion of notes, remaining performance obligations, goodwill by segment, expected amortization, legal reserves and the NEC litigation, and the balance sheet at 30 June 2026 - the Exact Sciences acquisition, purchase-price allocation, goodwill by segment and expected amortization. — Q2 2026 · publ. 28 July 2026 · source ↗
  14. ReportedAbbott completed the deal on 23 March 2026, so 2026 includes only part of a year.
    Abbott Laboratories release of 23 March 2026, Form 8-K exhibit 99.1 - Abbott completes the acquisition of Exact Sciences, entering the $60 billion US cancer screening and precision oncology diagnostics segments. — March 2026 · publ. 23 March 2026 · source ↗
Sources
Generated October 6, 2026