Colorectal Cancer Screening Guidelines Include New Alternative to Colonoscopy

• The American Cancer Society (ACS) has updated its colorectal cancer screening recommendations to include new blood and stool-based tests.
• The new guidelines reflect the availability of new disease detection technology and the need to expand access to screenings.
• The ACS states that screenings are vital as colorectal cancer rates continue to rise in adults under 50.

The American Cancer Society (ACS) has updated its guidelines for colorectal cancer screening to include new blood-based and at-home stool tests.

The new blood test screens for tumor DNA, while the at-home tests look for DNA, RNA, and blood markers in stool samples.

The updated guidelines still retain ACS recommendations for starting colorectal cancer screening at age 45 and having colonoscopies done every 10 years for people who are at average risk of colorectal cancer.

The organization published its new recommendations on May 27 in CA: A Cancer Journal for Clinicians.

ACS officials said the new guidelines reflect advances in disease detection and a shift in public health strategy to expand screening options and lower barriers to access.

“We need to increase our emphasis on colorectal cancer as a highly preventable disease as much as a treatable one,” said Robert Smith, PhD, senior vice president for early cancer detection science at the American Cancer Society and senior author of the report, in a news release.

“By offering more screening tools in our guideline update, more eligible adults will be able to participate in lifesaving colorectal cancer testing, helping to close the screening gap and catch more cancers at an earlier, treatable stage,” Smith continued.

Experts not involved in the report told Healthline that providing more alternatives to colonoscopy is a good course of action.

“I definitely think that presenting more options is better,” said Babak Firoozi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in California. “It helps to have these available. It’s important to increase the number of people who are being screened anyway we can,” he said.

Anton Bilchik, MD, a surgical oncologist, chief of medicine, and the director of the Gastrointestinal and Hepatobiliary Program at Providence Saint John’s Cancer Institute in California, agreed. “There are so many people who don’t have access or don’t want to do a colonoscopy screening,” he said. “This really will increase the number of people willing to get screened.”

New tests available for colorectal cancer screening

Two at-home stool sample tests are mentioned in the ACS report.

The first is an updated version of the DNA test sold under the brand name Cologuard. This screening analyzes stool samples for specific DNA markers and hemoglobin.

The second is a new multi-target test sold under the brand name ColoSense. This test analyzes stool samples for specific RNA markers and hemoglobin.

According to a news release, both tests “demonstrate high sensitivity for colorectal cancer and moderate sensitivity for advanced precancerous lesions.

They recommend these tests be conducted on people over the age of 45 with average risk every 3 years.

The report also lists one blood-based test. It’s sold under the brand name Shield. It was approved by federal regulators in 2024. This test is designed to detect tumor DNA in the blood.

The report authors stated that blood tests are not as effective as other colorectal cancer screenings and are recommended only for people who decline or can’t take other tests.

They noted that any positive result from a stool-based or blood-based screening should be followed up with a colonoscopy within 6 months.

The authors added that any screening is preferable to a patient not getting tested at all. “The most effective screening test is the one that the patient completes,” they wrote.

Other ACS guidelines for colorectal cancer screening remain unchanged.

Colonoscopies are still recommended for adults ages 45 and older with average colorectal cancer risk until age 75.

The guidelines recommend that people at higher risk be screened more often. Those at higher risk include people with:

• a personal or family history of colorectal cancer or certain types of polyps
• a personal history of inflammatory bowel disease
• a confirmed or suspected hereditary colorectal cancer syndrome
• prior radiation treatment to the abdomen or pelvic area to treat a prior cancer

Firoozi said colonoscopies are the “gold standard” and the best way to detect colorectal cancer in its early stages when it is more easily treated.

However, he agreed that people should get screened in any way they can. “The screenings reduce the risk of getting cancer and dying of cancer,” Firoozi said. “Screening is very important.”

Bilchik said that blood and stool-based tests are easier to administer, less expensive, and don’t require the unpleasant bowel preparation required for colonoscopies. “These are viable alternatives,” he said.

What to know about colorectal cancer

According to the ACS, colorectal cancer is the third most common and second deadliest cancer in the United States.

It’s estimated that nearly 160,000 people in the United States will be diagnosed with colon and rectal cancer in 2026. An estimated 55,000 will die from the disease this year.

Colorectal cancer is now listed as the leading cause of cancer-related death among men and women under the age of 50 in the United States.

Concerns have been raised in recent years over the increasing rate of colorectal cancer in adults ages 20 to 49 in the United States.

Factors that may be influencing colorectal cancer risk in younger adults include:

• unhealthy diets
• sedentary lifestyles
• microplastics in the human body

According to SEER data from the National Cancer Institute (NCI), early detection of localized colorectal cancer can lead to survival rates of over 90%.

However, they added that about 1 in 3 U.S. adults eligible for colorectal cancer screenings have not been tested as recommended. That adds up to about 20 million people.

“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, MD, the chief scientific officer at the American Cancer Society, in a statement.

“These changes were developed to add to the colorectal cancer screening arsenal and help ensure preventive cancer care is available to all,” Dahut said.

There are various symptoms associated with colorectal cancer, such as:

• constipation
• diarrhea
• narrow stools
• blood in the stools
• black stools
• abdominal pain or bloating
• anemia
• fatigue

Firoozi noted that many of these symptoms occur when the cancer is no longer in its early stages. “Don’t wait for the symptoms,” he advised. “Get screened before you have them.”

Reducing your risk of colorectal cancer

Adopting healthy lifestyle habits may help lower the risk of colorectal cancer.

While obesity and diabetes are both associated with a higher risk of colorectal cancer, Firoozi noted that weight management is key for lowering risk.

Firoozi said he advises patients to adopt a diet low in red and processed meats, eating “fish and fowl” instead. He recommended filling your plate with high fiber and low fat foods, such as fruits, vegetables, and whole grains.

Bilchik said that exercise is also important. He said a healthy routine of diet and fitness should start well before people reach 45. “The clock starts ticking at a younger age,” he said.