What You Need to Know About the Latest Colorectal Cancer Screening Recommendations
The American Cancer Society recently updated its colorectal cancer screening guideline for the first time since 2018 by adding two new recommended tests. Following the publication of the updated guideline, we received questions and comments from patients, healthcare professionals, and industry partners seeking further clarity about colorectal cancer and the new recommendations.
The Cancer Connections team spoke with Dr. William Dahut, the American Cancer Society’s Chief Scientific Officer, to address the most asked questions. Here, he explains what’s changed, why screening matters, and how to make sense of the different screening options available today.
1. Cancer Connections: What is colorectal cancer and what causes it?
Dr. Dahut: Colorectal cancer starts in the colon or the rectum. These cancers can also be called colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common. Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps. Researchers have found several factors that can increase a person’s risk of colorectal cancer, but it’s not yet clear exactly how all these factors might cause this cancer.
2. Cancer Connections: Why is colorectal cancer screening important?
Dr. Dahut: The American Cancer Society recommends that people at average risk of colorectal cancer start regular screening at age 45. Screening is the process of looking for cancer or precancer in people who have no symptoms. Several tests can be used to screen for colorectal cancer. The most important thing is to get screened regularly, no matter which test you choose. Colorectal cancer can often be found early with regular screening. Screening can also prevent colorectal cancer by finding polyps and removing them before they turn into cancer.
3. Cancer Connections: What are the warning signs of colorectal cancer? Should I get checked if I have symptoms, even if I’m under 45?
Dr. Dahut: Colorectal cancer might not cause symptoms right away, but if it does, the warning signs include one or more changes that are new, unusual, or don’t go away. Everyone should be aware of these signs and symptoms, such as changes in bowel habits, rectal bleeding, or pain in the abdomen.
Many of these symptoms can be caused by conditions other than colorectal cancer, such as infection, hemorrhoids, or irritable bowel syndrome. But, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.
4. Cancer Connections: What is meant by a “gold-standard” test? Does that mean it is better than others with a similar recommendation?
Dr. Dahut: The word “gold standard” has commonly been used by many to describe colonoscopy since it was first recommended for screening in the 1990s. Although the term “gold standard” is often used, a better term going forward is “reference test,” since colonoscopy is used as a benchmark test when evaluating the performance of new tests. This was the case for the two new tests that ACS added to the recommended screening options in the 2026 guideline update. In our living guidelines model, we only evaluate new tests or tests with updated data. Therefore, tests such as FIT (fecal immunochemical tests) and colonoscopy were not assessed in this guideline update. Each of the recommended individual colorectal screening tests has strengths and limitations. Although the ACS groups stool tests and visual exams, including colonoscopy, into a preferred group of screening options, we do not prioritize any one over the other. We recognize that individuals differ in the screening tests they are willing to undergo, or able to use, and it is important to support individual choice.
5. Cancer Connections: What is meant by “the best test is the one you get”? How should people know which test is best for them?
Dr. Dahut: Being offered the choice of a screening test is important because individuals have shown preferences for some screening tests over others. Other factors, including access and cost, can limit choices among the recommended tests. Our point here is that each of the screening tests endorsed in the guideline is a proven and effective option, and thus regular screening with any of these tests is better than no test at all. However, we purposely emphasized that of our recommended tests, stool and visual options are preferred. Blood-based tests are recommended only for individuals who are unable or have chosen not to undergo preferred tests. Individuals should consult with their healthcare provider and learn the benefits and limitations of each test. If an individual is only able or willing to take one of the recommended tests, then that test becomes the best for them. It does not mean that all tests are equally effective.
6. Cancer Connections: Why did the American Cancer Society update the colorectal cancer screening guideline now?
Dr. Dahut: This is the first update to the colorectal cancer screening guideline since May 2018. The update reflects advances in disease detection and the need to evaluate new screening test options, one of which may reduce barriers to access. Specifically, there is a new version of the multi-target stool DNA test (Cologuard Plus®), a new multi-target stool test that measures RNA biomarkers (ColoSense®), and a new blood-based test (Shield®) that measures DNA fragment patterns associated with colorectal neoplasia.
7. Cancer Connections: Did the American Cancer Society consider lowering the screening recommendation starting age to below 45?
Dr. Dahut: The American Cancer Society updated its colorectal cancer screening guideline in May 2018, lowering the age to start testing from 50 to 45. This change was based on historically rising rates in younger adults. Pushing the age below 45 for the general population was determined not to be warranted at this time because rates in adults ages 40-44 are very low, less than half those of adults ages 45-49. We continue to track incidence trends to ensure that the target ages for screening include age groups at high enough risk to benefit from screening. Still, with the rising number of colorectal cancer cases in younger adults, we continue to emphasize how important it is not to dismiss symptoms of colorectal cancer at any age. The ACS reinforces the point that if a person identifies any symptoms, regardless of age, they should speak with their doctor immediately.
8. Cancer Connections: What is the difference between Cologuard Plus® and ColoSense®? Which one is used more frequently?
Dr. Dahut: Cologuard Plus® is the new version of Cologuard® and is a stool test that measures the level of human hemoglobin in stool along with DNA markers associated with colorectal cancer. ColoSense® is also a multi-target stool test that measures the presence of human hemoglobin in the stool and RNA markers associated with colorectal cancer. The previous version of Cologuard®, and its replacement Cologuard Plus® are the most commonly used stool tests in the U.S. The multi-target stool RNA test was recently developed and FDA approved. We anticipate more public information about these tests in the years ahead. However, since ColoSense® is a new test, we do not have any data on how many individuals are being screened with this test compared with other stool tests.
By referencing specific brands in our guideline, the American Cancer Society is not attempting to endorse specific tests. Rather, we note the brand names of the multi-target stool DNA and RNA tests, and the blood-based test, because they are the only tests of their type available for colorectal cancer screening at this time.
9. Cancer Connections: What increases the risk of colorectal cancer, and how can people reduce their risk?
Dr. Dahut: To learn more about risk factors that can and cannot be changed, see Colorectal Cancer Risk Factors
Additional Resources:
Reviewed by the American Cancer Society communications team.
