Guardant Health Raises 2026 Revenue Outlook as Shield Growth Lifts Q3 Sales

Guardant Health Inc. (Nasdaq: GH) raised its full-year 2026 revenue guidance after third-quarter revenue climbed 36%, with rapid adoption of its Shield blood-based colorectal cancer screening test and continued oncology growth driving the increase. The company now expects annual revenue of $1.36 billion to $1.37 billion, representing 38% to 40% year-over-year growth, compared with its previous forecast of $1.34 billion to $1.36 billion.

Revenue reached $361 million in the quarter ended September 30, 2026, up from $265 million a year earlier. Screening was the fastest-growing business, while oncology remained the largest source of revenue.

Shield adoption drives screening growth

Screening revenue rose 180% to $68 million from $24 million, as testing volume increased 246% to 83,000 from 24,000. Quarterly screening revenue also advanced from $53 million in the second quarter.

Guardant said commercial execution and expanded patient access supported Shield’s growth. Broad coverage began on August 1, and coverage policies effective by January 1, 2027, are expected to give Shield access to approximately 100 million Medicare and commercially covered patients. The company estimates that about 120 million average-risk U.S. individuals are eligible for colorectal cancer screening.

The company also reported lower Shield testing costs. Approximate non-GAAP cost per test declined to $330 in the third quarter from $410 in the second quarter, based on unaudited results. Guardant is targeting $200 per test by the fourth quarter of 2028 through workflow changes, automation and scale efficiencies.

Reflecting the third-quarter performance, Guardant increased its 2026 Shield revenue outlook to $233 million to $238 million from $218 million to $230 million. It now expects 285,000 to 290,000 Shield tests, compared with its previous projection of 270,000 to 285,000.

Oncology volume rises 58%

Oncology revenue increased 25% to $231 million, while testing volume rose 58% to 117,000. Guardant said its broader product portfolio and additions to its Smart Platform supported adoption.

Guardant360 Liquid remains on track for approximately 30% full-year growth, according to the presentation. Reveal volume more than doubled from a year earlier and remained the company’s fastest-growing oncology product, while Guardant360 Tissue was described as its second-fastest-growing oncology offering.

During the quarter, Guardant received U.S. Food and Drug Administration approval for Guardant360 CDx to monitor ESR1 resistance mutations in patients with HR-positive, HER2-negative advanced breast cancer. The test serves as a companion diagnostic for AstraZeneca’s ETCAMAH and is intended to identify ESR1 status before radiographic disease progression. Guardant said this was the first monitoring approval for Guardant360 CDx.

The company has finalized a dedicated billing code for Guardant360 Liquid CDx and submitted an Advanced Diagnostic Laboratory Test application to the Centers for Medicare & Medicaid Services. It expects an ADLT designation in the first half of 2027, though that timing remains subject to the reimbursement process.

Guardant also submitted its multi-omic tissue comprehensive genomic profiling assay for FDA review. The assay combines DNA profiling, whole-transcriptome RNA analysis and genome-wide methylation information. Separately, the company launched Reveal Ultra for biopharma partners and plans a clinical launch by the end of 2026.

Biopharma and data revenue increased 8% to $59 million from $55 million. Guardant reported 31 Guardant360 CDx approvals globally, including new approvals associated with therapies for ESR1-mutated advanced breast cancer. Licensing and other revenue was $3 million, up from $2 million.

Non-GAAP loss narrows as spending increases

Non-GAAP gross profit rose to $240 million from $174 million, and non-GAAP gross margin increased to 67% from 66%. Non-GAAP operating expenses climbed to $287 million from $229 million, including higher research and development, sales and marketing, and general and administrative spending.

Adjusted EBITDA was negative $37 million, compared with negative $46 million a year earlier. Free cash flow was also negative $37 million, improving from negative $46 million in the prior-year quarter. Cash and investments totaled $1.1 billion at September 30, down from $1.3 billion at the end of 2025.

For the full year, Guardant expects a non-GAAP gross margin of 65%, compared with its previous range of 64% to 65%. It raised its non-GAAP operating-expense forecast to $1.105 billion to $1.125 billion from $1.08 billion to $1.10 billion. The company now projects negative free cash flow of $205 million to $220 million, versus its prior expectation of negative $195 million to $205 million.

Guardant maintained its expectation for approximately 30% annual oncology growth and low-double-digit growth in biopharma and data revenue. Execution of the outlook depends in part on continued test adoption, reimbursement decisions, planned product launches, regulatory reviews and the effective dates of commercial coverage policies. The company also cautioned that its market estimates and forward-looking expectations involve assumptions and uncertainties that could cause actual results to differ materially.