Exact Sciences generated 73% of total full-year 2023 revenue from its flagship Cologuard brand. The at-home test, a multi-target stool DNA (mt-sDNA) diagnostic, detects blood in the stool and abnormal genetic signatures shed by precancerous lesions and tumors. It notched $1.82 billion in sales in 2023 and remains the only genetic test to eclipse $1 billion in annual revenue.

After an acquisition binge during the liquidity bubble that started in 2020, the business has significantly improved its operating efficiency by keeping expenses in check and driving high-margin growth for Cologuard. Exact Sciences recorded its second-ever year of positive operating cash flow and its healthiest operating margin ever at just negative 8.6%. A sudden hiring spree in early 2024, as well as new competition from Guardant Health and Geneoscopy, might delay its ability to achieve cash flow and profits.