Colorectal cancer screening: An update to the American Cancer Society guideline, 2026
Summary
Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality in the United States, with rates recently increasing among adults younger than 65 years. In 2018, the American Cancer Society (ACS) lowered the recommended age to initiate screening for average-risk adults to age 45 years. Since then, new molecular-based screening tests-a multitarget stool RNA test (mt-sRNA), a next-generation mt-sDNA test, and a blood-based cell-free DNA assay-have received regulatory approval fo
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# Colorectal cancer screening: An update to the American Cancer Society guideline, 2026
*Published: 2026 May-Jun*
Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality in
the United States, with rates recently increasing among adults younger than 65
years. In 2018, the American Cancer Society (ACS) lowered the recommended age to
initiate screening for average-risk adults to age 45 years. Since then, new
molecular-based screening tests-a multitarget stool RNA test (mt-sRNA), a
next-generation mt-sDNA test, and a blood-based cell-free DNA assay-have
received regulatory approval for CRC screening. For this update, the ACS
Guideline Development Group commissioned a targeted, systematic evidence review
evaluating diagnostic performance and published modeling studies to judge the
potential impact of these tests on CRC incidence and mortality. The ACS
reaffirms the recommendation that average-risk adults should initiate CRC
screening at age 45 years and continue through age 75 years for those with a
life expectancy greater than 10 years. Consistent with prior guidelines, the ACS
emphasizes that offering multiple, recommended screening options supports
informed patient choice and may improve participation, because the most
effective screening test is the one that the patient completes. The
next-generation mt-sDNA test, which is an updated version of an already
recommended mt-sDNA test, and the mt-sRNA test demonstrated high sensitivity for
CRC and moderate sensitivity for advanced precancerous lesions and are
recommended, along with annual high-sensitivity fecal immunochemical and
high-sensitivity guaiac-based fecal occult blood tests, as preferred stool-based
screening options at 3-year intervals. Compared with established stool-based
tests, blood-based tests demonstrated lower sensitivity for both advanced
precancerous lesions and stage I cancers, with modeling studies predicting less
effectiveness in reducing CRC incidence and mortality. At this time, blood-based
tests should be recommended only to individuals who decline or do not complete
preferred screening tests. Ongoing evaluation of adherence, real-world
implementation, and clinical outcomes will inform future updates for these new
tests. For screening to be effective, a positive result on any noncolonoscopy
screening test requires timely follow-up with colonoscopy, preferably within 6
months, to complete the screening process.
DOI: 10.3322/caac.70083