Colorectal cancer remains one of the most common and preventable cancers, yet many adults miss recommended screenings. In May 2026, the American Cancer Society (ACS) released an updated set of colorectal cancer screening guidelines aimed at increasing early detection and saving more lives. These changes reflect new research and advances in technology that make screening easier and more accessible for people at average risk.
Why Screening Matters
Colorectal cancer starts as a growth in the colon or rectum called a polyp. Over time, some polyps can become cancerous. Finding and removing polyps early dramatically lowers the chance of cancer developing or progressing.
Without screening, colorectal cancer may not cause symptoms until it’s advanced and harder to treat. Early detection leads to much better outcomes. For example, if cancer is found at an early stage, five-year survival rates can exceed 90 percent, compared with much lower survival once the disease spreads.
Despite these benefits, many eligible adults have not been screened as recommended.
What Has Changed in the 2026 Guidelines
The updated 2026 ACS guidelines reaffirm that adults at average risk of colorectal cancer should start regular screening at age 45 and continue through age 75, as long as they have more than a ten-year life expectancy.
The key updates focus on expanding the types of screening tests recommended so adults have more options that fit their preferences and lifestyles. This reflects both scientific evidence and a public health strategy to improve overall screening rates.
The guideline now includes:
New and Expanded Testing Options
- Blood-based screening tests (e.g., Shield): These tests look for tumor DNA in the blood. They are recommended only for people who decline or do not complete other preferred screening tests because blood tests are less sensitive at detecting early, small cancers and precancerous lesions compared with stool-based tests.
- Updated at-home stool tests:
- Next-generation multi-target stool DNA test (e.g., Cologuard Plus): Detects specific DNA and hemoglobin markers in stool and is recommended every 3 years.
- Multi-target stool RNA test (e.g., ColoSense): A new at-home test that identifies RNA and hemoglobin markers, also recommended every 3 years.
These newer at-home tests have high sensitivity for detecting colorectal cancer and moderate sensitivity for advanced precancerous lesions, making them strong options for people who prefer noninvasive screening.
Tests That Remain Recommended
- Colonoscopy: Still considered the gold standard because it allows doctors to both detect and remove polyps during the same procedure. Typically recommended every 10 years for average-risk adults.
- Flexible sigmoidoscopy: Examines the lower part of the colon and is recommended every 5 years.
- CT colonography: Also called virtual colonoscopy, recommended every 5 years.
- High-sensitivity stool tests:
- Fecal immunochemical tests (FIT) and high-sensitivity guaiac-based tests (gFOBT) remain options for yearly screening.
- Multi-target DNA/RNA tests are recommended every 3 years.
No matter which test is chosen, any positive result should be followed promptly with a colonoscopy to complete the screening process. Timely follow-up is essential to confirm findings and remove suspicious tissue.
Who Should Get Screened and When
The updated guideline applies to adults at average risk of colorectal cancer — that is, people without a personal history of colorectal cancer, certain types of polyps, hereditary cancer syndromes, or other high-risk conditions.
- Start screening at age 45 for average-risk adults.
- Continue screening through age 75 if life expectancy is greater than ten years.
- For adults 76–85, screening decisions should be based on overall health, prior screening history, and patient preference.
- Screening is generally not recommended after age 85.
People with a higher or increased risk due to family history, personal medical history, or genetic conditions may need to start screening earlier and follow a different schedule. These recommendations are best discussed with a healthcare provider.
Why These Updates Are Important
Several factors influenced the 2026 guideline update:
- Colorectal cancer is still common and often preventable with early detection.
- Recent data show rising rates of colorectal cancer in younger adults, including those under age 50.
- Many eligible adults are still not being screened, especially those aged 45–49.
- Offering more flexible and less invasive options can help more people complete screening, which in turn can catch cancers earlier or prevent cancer by finding and removing precancerous polyps.
The message from ACS experts is straightforward: the best screening test is the one that gets done. Whether it’s a home stool test, a blood test for those who prefer it, or a colonoscopy, completing regular screening gives people the best chance of preventing colorectal cancer or finding it early — when treatment is most effective.
Source
American Cancer Society. American Cancer Society Updates Colorectal Cancer Screening Guideline: Major Changes Emphasize Blood-Based and At-Home Stool Testing. Pressroom. 2026 May 27. Available from: https://pressroom.cancer.org/colorectal-cancer-screening-guideline-update-2026
American Cancer Society. Colorectal Cancer Screening Guideline Details. American Cancer Society. Available from: https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
