Two separate initiatives this week underscored the commercial and clinical push to embed circulating tumor DNA (ctDNA) minimal residual disease (MRD) assays into oncology care. Exact Sciences presented NSABP B‑59 sub‑study results showing its Oncodetect test identified triple‑negative breast cancer patients at higher risk of distant recurrence after surgery. The firm cited the evidence as support for coverage discussions and post‑surgical decision tools. Separately, Natera launched the MiRaDoR randomized Phase II trial, sponsored by MEDSIR and funded by Roche, to test Signatera Genome‑guided targeted therapies in HR+/HER2‑ early breast cancer. The trial will enroll Signatera‑positive patients into arms testing giredestrant, CDK4/6 inhibition and PIK3CA‑directed therapy; serial ctDNA will be used as an early pharmacodynamic marker. Together these moves show diagnostics firms and trialists are pushing MRD from prognostic use toward interventional, randomized testing in registrational or payer‑facing studies — a shift that could change adjuvant oncology pathways and reimbursement debates.