I want to tell you something unusual coming from a MedTech CMO.

When I accepted the role at VerAvanti, I made a private commitment that goes beyond the commercial roadmap: I will not build out every other clinical indication for our Scanning

Fiber Endoscope and leave ovarian cancer early detection on the shelf. The market is small. I know that. But the people who need this technology are not abstractions — they are people I love. And the tools to help them may already exist. They just need the right clinical partnerships to prove it.

This article is about why that matters right now, what the science actually says, and what we are doing about it.

The Problem That Numbers Cannot Capture

Ovarian cancer has the lowest one-, three-, and five-year survival rates of any gynecological cancer. But the statistic that stops me every time I see it is this: when ovarian cancer is caught early — localized to the ovary — the five-year survival rate is 91%. When it is caught late, after it has spread, that number drops to 30%.

Ninety-one percent. Thirty percent. The difference is not in the biology, the treatment, or the patient. It is entirely in when the disease is found.

And yet most cases are caught late.

The reason is simple and devastating: there is currently no validated screening tool for early-stage ovarian cancer. The two tests most commonly used in surveillance — the CA-125 blood marker and transvaginal ultrasound — have been shown repeatedly in clinical studies to fail at preventing late-stage diagnosis. They lack the sensitivity and specificity the task requires. Women with known genetic risk factors — mutations in the BRCA1 or BRCA2 genes — are surveilled regularly and still diagnosed late, because the tools are not good enough.

Approximately 19,000 American women die of ovarian cancer every year. The majority are diagnosed at Stage III or IV. This is not a biology problem. It is a detection problem.

[Visualization 1: The Survival Gap — 91% vs. 30%]

Where the Disease Actually Starts

A significant scientific consensus has built over the past fifteen years around a discovery that fundamentally changes how we think about ovarian cancer screening. Most high-grade serous ovarian carcinomas — the most common and lethal type — do not originate in the ovary at all. They begin as pre-cancerous lesions in the fallopian tube, specifically in the distal (far) end near the fimbriae.

These lesions are called serous tubal intraepithelial carcinomas, or STIC lesions. They are clusters of cytologically abnormal cells that can be present and detectable for years before they progress into invasive ovarian cancer. They have distinct optical properties: altered fluorescence signals when illuminated with specific wavelengths of light, and distinct cellular and molecular signatures detectable through cytology.

This means, in principle, that ovarian cancer is detectable years before it becomes life-threatening — if you have an imaging device capable of reaching those lesions and visualizing those optical changes.

The proximal opening of the fallopian tube — where it connects to the uterus — is approximately 1 millimeter wide. The tube is between 10 and 12 cm long, tortuous, and lined with tissue folds that catch and trap conventional endoscopes. The primary target zone, the distal ampulla and fimbriae where STIC lesions form, is the widest and most accessible part of the tube once you are inside — but getting inside is the engineering challenge that has defeated every device that has attempted it at scale.

The State of the Field: Two Devices, One Fundamental Limitation

As of early 2026, two categories of device have attempted to address this problem.

The FemDx FalloView is the only Food and Drug Administration-cleared intrafallopian imaging device on the market. It uses a chip-on-tip design with white light only — no fluorescence capability. Its physical size limits imaging to the proximal (near, uterine) segment of the tube. It cannot reach the distal ampulla and fimbriae where STIC lesions preferentially form. For early detection of ovarian cancer precursors, it solves the wrong problem.

The CAFE (Cell-Acquiring Fallopian Endoscope) from the University of Arizona is the most scientifically advanced fiber-bundle device in this space. In a peer-reviewed paper published in Biophotonics Discovery in March 2026, the research team documented the second-generation CAFE’s performance across an exhaustive design matrix: sub-millimeter diameter, 7.81-micrometer image resolution, 60-degree field of view, multimodal fluorescence, and successful ex vivo imaging of human fallopian tubes. It is rigorous, serious science.

It is worth noting that the paper's senior author, Dr. Jennifer Barton, is a colleague of Eric Seibel — the University of Washington inventor of the Scanning Fiber Endoscope — and the CAFE paper cites Seibel's own conference work on fallopian tube imaging. The SFE inventor and the competing research team are part of the same scientific conversation. That connection is relevant to how we interpret the gap the CAFE paper documents.

And it has exactly one failed specification, documented explicitly in the paper: depth of field. The requirement was 1 mm of in-focus range. The as-built measurement was 0.65 mm — 35% short. The authors confirm this failure is a structural consequence of shortening the working distance within a fixed GRIN lens system. It is not an engineering fix within the fiber-bundle architecture. The gap between what the camera sees and what the narrow, collapsing tube demands is built into the technology class.

To understand why that matters clinically: the fallopian tube collapses around an endoscope as it is advanced. The distance from the endoscope tip to the tissue varies continuously. In a tube that narrows to 1–2 mm in the isthmus and widens to 2–10 mm in the ampulla, a camera that loses focus within 0.65 mm of tissue will spend a significant portion of any procedure imaging out of focus. For a diagnostic application where the signal is a subtle autofluorescence ratio change in a small lesion, that limitation is clinically material.

What the Scanning Fiber Endoscope Does Differently

VerAvanti’s Scanning Fiber Endoscope works on a fundamentally different principle. Rather than imaging through a bundle of optical fibers with a fixed-focus lens — the architecture that produces both the honeycomb pixel pattern and the close-range blurring — the SFE uses a single vibrating fiber that sweeps a laser spot across tissue in a continuous spiral pattern, constructing images pixel by pixel.

The practical consequences are significant:

• No fixed focal plane. Because the image is constructed from a scanning laser rather than captured through a static lens, there is no intrinsic close-range blurring. Depth of field is not compressed by reducing working distance. This is the structural advantage the CAFE paper identifies as missing and cannot provide.

• No honeycomb pixel artifact. Fiber-bundle images carry a permanent lattice pattern from the fiber array — visible in the CAFE paper’s own fluorescence images and explicitly noted as pixel imperfections. The SFE’s continuous scan produces artifact-free images. For a diagnostic task that depends on detecting subtle optical intensity changes, artifact-free fluorescence is not cosmetic.

• •Simultaneous multimodal acquisition. The SFE captures reflectance and fluorescence in a single scan pass. The CAFE requires sequential image captures, introducing potential motion artifact between frames — an issue the paper identifies as contributing to ratio measurement variability in multiple patients. Simultaneous acquisition eliminates that source of error.

• Sub-millimeter, highly flexible. The current VerAvanti SFE has been validated in clinical cardiology use in coronary arteries under 2 mm in diameter with acute bends, using guidewire-first navigation technique — the same technique the CAFE adopted to address the identical plicae-catching problem in the fallopian tube.

A directly relevant clinical analog is now active: VerAvanti is collaborating with Dr. Adam Templeton, a gastroenterologist at the University of Washington Medical Center, on the use of the Scanning Fiber Endoscope for fluorescence imaging of indeterminate biliary duct strictures — narrow, tortuous anatomy requiring sub-millimeter navigation and optical tissue differentiation at close range. This application, developed in collaboration with IVMT (a University of Michigan spinout producing fluorescent targeted peptides), is the closest active procedural analog to the fallopian tube challenge. It is ongoing at UW. It is not a future plan.

What the SFE does not yet have is published fallopian tube performance data. We have not imaged STIC lesions. We have not run the same protocol the CAFE used in the University of Arizona’s ex vivo study. The scanning architecture addresses the DOF constraint on paper. Whether it does so in actual fallopian tube tissue is the scientific question that bench sessions are designed to answer. We are not claiming solved; we are claiming ready to test.

The Funding Environment: Why Industry Partnership Is Not a Compromise Right Now

The federal research funding environment for cancer research has changed dramatically since early 2025. The National Cancer Institute’s proposed 2026 budget represents a 37% reduction from 2025 levels — from $7.22 billion to $4.53 billion. In the first three months of 2025 alone, approximately $2.7 billion in NIH grants were cut. The NCI is now funding only 1 in 25 grant applications for the remainder of fiscal year 2025, down from 1 in 11. The NIH’s small business innovation grant programs — which historically funded early-stage device development — have had their legislative authority expire as of October 2025.

The researchers doing the most important work in ovarian cancer early detection are not failing because of inadequate science. They are resource-constrained in ways that were not true two years ago.

This creates a genuine opening for industry-academic collaboration that is different in character from the usual “company wants to validate its device” arrangement. When a company arrives with a device, technical support, and a willingness to help prepare a grant application for a federal funding source that remains active and well-funded — the Department of Defense Ovarian Cancer Research Program is fully funded for 2026 and explicitly includes early detection technology as a priority area — that is not a compromise for the researcher. It is a lifeline that advances science that might otherwise wait years for a federal grant cycle to open.

I want to be transparent about what we are offering: the device, Juan’s time, and support for the grant application data package. The researcher writes the science, owns the data, and publishes the results including negative ones. VerAvanti’s interest is in knowing whether the device performs as the architecture predicts. If it does not, a well-designed negative study is valuable to the field and honest about what the SFE can and cannot do.

The Path Forward: Three Phases, Starting With Two Afternoons

We are proposing a staged collaboration structure that any researcher can say yes to incrementally, without committing to more than the evidence at each stage warrants.

Phase 1: Lab Bench Testing (Months 1–6, $0 or Sloan Ignition $75K)

Two bench sessions. Surgical discard fallopian tube tissue from routine procedures, already collected under existing patient consent. No new patient contact, no ethics board review required, no formal research agreement needed for discard tissue. We bring the SFE. The researcher brings specimens. We image together using the same protocol the CAFE study used, enabling direct comparison of depth-of-field performance and fluorescence ratio metrics. Either the SFE’s structural DOF advantage holds in this anatomy, or it does not. We publish the result either way.

Phase 2: Fresh Tissue + Pathology Correlation (Months 6–18, DoD Pilot Grant $350K)

If Phase 1 data is compelling, the researcher applies as lead investigator for a Department of Defense Ovarian Cancer Research Program Pilot Award — $350K, 1 year, explicitly funding proof-of-concept early detection technology studies. VerAvanti contributes device access as in-kind. Fresh post-surgical specimens with histopathologic correlation, mapping optical signals to confirmed tissue pathology (benign vs. STIC).

Phase 3: First Human Study (Months 18–36+, DoD Clinical Grant $1.4M–2.8M)

If Phase 2 data supports it: an ethics board-approved, VerAvanti-sponsored first-in-human study in women with BRCA gene mutations under surveillance in the researcher’s clinic. Safety and feasibility as primary endpoints. Publication pathway toward FDA clearance application.

The entire path — from bench sessions to a validated screening tool — is five to six years of sustained work. That timeline is consistent with comparable diagnostic device development. The work that cannot wait is the bench data that either validates the approach or tells the field to invest elsewhere. Two afternoons of imaging generates that data. That is the ask we are making.

Who We Are Looking For

I am writing this publicly because the right clinical partners for this work are not always findable through a company’s existing network. If you are in any of these categories, I want to hear from you directly:

• Gynecologic oncologists specializing in ovarian cancer early detection, particularly those working with high-risk patient populations (BRCA1/2 mutation carriers, Lynch syndrome, other hereditary risk factors).

• Academic researchers in women’s health, falloposcopy, or optical biopsy who are looking for industry partnerships to advance early detection work during a difficult federal funding period.

• Pathologists and tissue biologists with expertise in fallopian tube histopathology and STIC characterization who could contribute to study design or Phase 2 tissue analysis.

• Clinician-scientists at comprehensive cancer centers with active salpingo-oophorectomy surgical programs and access to fallopian tube tissue from prophylactic procedures in high-risk patients.

• Device engineers and optical scientists who have worked on microendoscopy, falloposcopy, or sub-millimeter imaging and who see the technical gap we are describing.

The goal is not a single flagship collaboration. It is a clinical network — a group of researchers who are testing the same device in their own institutions, generating comparable data, and publishing independently. That is how scientific confidence is built. That is what makes a case for FDA clearance.

The Part That Is Personal

I have written this article in the register of a CMO building a clinical development program. That is accurate. But it is not the whole story.

The whole story is that I think about my sisters, daughters, wife, and stepdaughters every time I look at the 30% survival statistic for late-stage ovarian cancer. I think about the women in my extended family spread across multiple countries who will never be part of a clinical trial in a Seattle Cancer Center. I think about the fact that the detection window exists — that the pre-cancerous lesion is there, in the fallopian tube, years before the diagnosis — and that the only thing standing between that window and the women who need it is engineering and clinical partnerships.

VerAvanti will build this program because the technology may be ready and the clinical need is undeniable. But I will push it forward because I cannot in good conscience build out every other indication and leave this one on the shelf.

If that resonates with you — reach out. The conversation starts with the science. The motivation is personal.