American Cancer Society Updates Colorectal Screening Guidelines to Include Blood Tests

The American Cancer Society released updated colorectal cancer screening guidelines on May 27, 2026, adding blood-based testing and new at-home stool-based options to its list of recommended screening tools.

The guidelines maintain the recommendation that average-risk adults begin screening at age 45 and continue through age 75, provided they have a life expectancy of at least 10 years.

The ACS now includes a blood-based screening test called Shield, which detects tumor DNA in the blood. These tests are intended for use in a doctor's office but are strictly recommended only for patients who decline or fail to complete preferred screening options. The ACS notes that blood tests have lower sensitivity for advanced precancerous lesions and stage I cancers compared to stool-based tests or visual exams.

The update also adds a new at-home stool RNA test called ColoSense, which analyzes stool samples for hemoglobin and specific RNA markers. Both the updated stool DNA test (Cologuard) and ColoSense are recommended every three years.

Colonoscopy remains the gold standard and preferred screening method, recommended every 10 years. CT colonography and flexible sigmoidoscopy remain options as well.

Any positive result from a stool or blood-based test must be followed by a diagnostic colonoscopy, ideally within six months.

Colorectal cancer is now the leading cause of cancer death among adults under age 50 in the United States. The ACS said the expanded options aim to reach underserved, rural, and minority populations who face barriers to traditional colonoscopies.

The ACS Cancer Action Network noted that coverage and out-of-pocket costs remain significant hurdles, and it was unclear whether the US Preventive Services Task Force would adopt the new modalities in its own upcoming guidelines.