American Cancer Society Updates Colorectal Cancer Screening Guidelines

Colorectal cancer (CRC) is a leading cause of cancer and mortality in the United States. While the overall rate of people being diagnosed with colon or rectal cancer has dropped since the mid-1980s, in part due to the American Cancer Society (ACS)’s commitment to championing screening guidelines to reduce incidence and mortality, a new and unsettling trend has emerged.¹

CRC incidence has risen sharply among adults younger than 65 years old. In 2018, in response to early-onset CRC, the ACS updated their guidelines to lower the recommended screening age for individuals at average risk from 50 to 45 years old.

The 2026 updated report, published in CA: A Cancer Journal for Clinicians, reaffirmed the recommended screening strategies, including visual examinations—such as a colonoscopy, the gold standard—and computed tomography colonography, as well as stool-based tests.² Now, the updated guidelines included improved and newer tests for at-home multi-target stool testing, which identify specific DNA or RNA markers (mt-sDNA and mt-sRNA) and hemoglobin, and blood-based screening assays designed to detect tumor DNA.

“No matter which test you choose, what’s most important is to get screened, and that includes underserved, rural, and minority populations,” said William Dahut, chief scientific officer at the ACS, in a press release. “These changes were developed to add to the colorectal cancer screening arsenal and help ensure preventive cancer care is available to all.”

A multidisciplinary team of volunteers, comprising clinicians, methodologists, public health experts, and patient representatives, developed and updated these guidelines. Notably, they presented evidence that the newly available mt-sRNA test and the updated, next-generation mt-sDNA test exhibited similar accuracy to the original multi-target stool test, suggesting that either is an appropriate screening option.³

The blood-based screening tests detected advanced precancerous lesions with low sensitivity.⁴ However, the report noted that, compared with stool-based tests, blood-based tests have reduced sensitivity for detecting these lesions and stage I cancers so are therefore not currently the preferred screening options. Additionally, the effectiveness of both stool-based and blood-based screening tests depends on timely follow-up after a positive result, with a colonoscopy ideally being performed within six months to complete the screening process.

While there is no single preferred test for all individuals, the authors emphasized that the most effective screening test is the one that the patient completes. “We need to increase our emphasis on colorectal cancer as a highly preventable disease as much as a treatable one,” added Robert Smith, a cancer epidemiologist and senior vice president of Early Cancer Detection Science at the ACS, in a press release. With this expanded arsenal of tools, the authors hope to close the screening gap and catch more cancers at an earlier and more treatable stage.