ACS adds blood-based testing to the 2026 colorectal cancer screening guideline
Industry Buzz
We need to increase our emphasis on colorectal cancer as a highly preventable disease as much as a treatable one.
—Robert Smith, PhD, via a press release
The American Cancer Society (ACS) has updated its colorectal cancer (CRC) screening guidelines, adding a blood-based screening test and new at-home stool tests in a move that could reshape how primary care clinicians approach screening conversations with reluctant patients.[]
A new option for patients who refuse traditional screening
The most notable change is the addition of a blood-based screening test that detects tumor DNA.
The recommendation is narrowly targeted: ACS advises its use only for average-risk adults who decline or have not completed recommended stool-based or structural examinations such as colonoscopy.[][]
For primary care physicians, this may represent a practical tool for addressing one of the most persistent barriers in CRC prevention: patient avoidance. More than 20 million eligible Americans have not been tested for CRC—about one-third of screening-eligible adults.[]
Importantly, the guideline does not place blood testing on equal footing with colonoscopy. Available evidence suggests that blood-based screening is less sensitive for advanced precancerous lesions and early stage cancers, meaning opportunities for cancer prevention may still be missed compared with visual examinations or high-sensitivity stool tests.[][]
Any positive blood-based result should be followed by a diagnostic colonoscopy.[]
Stool-based testing gains momentum
The ACS also added a multitarget stool RNA test and updated its recommendations for next-generation stool DNA testing, both of which are performed every 3 years.[]
These molecular tests demonstrated high sensitivity for CRC detection and moderate sensitivity for advanced precancerous lesions in clinical studies.[]
The guideline otherwise leaves key recommendations unchanged. Average-risk adults should begin CRC screening at age 45 and continue through age 75 if life expectancy exceeds 10 years. Screening decisions between ages 76 and 85 should be individualized, while routine screening is not recommended after age 85.[][]
The broader message for PCPs may be more significant than any single test. CRC incidence continues to rise among younger adults, and ACS leaders emphasize that the best screening test is ultimately the one patients complete.[]
By expanding the menu of evidence-based options, the organization hopes to close long-standing screening gaps, particularly in underserved and historically under-screened populations.[]
“We need to increase our emphasis on colorectal cancer as a highly preventable disease as much as a treatable one,” Robert Smith, PhD, senior vice president of early cancer detection science at the American Cancer Society, said in a press release.[]
What this means for the clinic: Primary care physicians may now have an additional pathway for patients who repeatedly decline colonoscopy or stool-based screening, potentially converting a missed screening opportunity into an actionable preventive intervention.