American Cancer Society Updates Colon Cancer Screening Recommendations
Fast Facts
- Everyone who is at average risk of developing colorectal cancer should begin screening at age 45, but 1 in 3 adults are not getting screened on time. Screening should start earlier if you have risk factors.
- New screening guidelines updated in May 2026 include blood-based testing that can be performed in your doctor’s office, as well as home-based stool tests (Cologuard),
- Colonoscopy is still the gold standard, but the best screening test for colon cancer is the one that you will do on schedule. Detecting polyps early is the best way to prevent colon cancer from developing.
The US Preventative Services Task Force (USPSTF), the federal agency that determines screening guidelines for disease in the US, recommends that healthy adults aged 45-70 get a screening test for colorectal cancer if they have a life expectancy of at least 10 years. Despite the drop in screening age recommendation, the rate of colon cancer is still growing at about 2-3% per year in people under the age of 50.
Studies show that about 1 in 3 people who are eligible for screening, are not getting it done. This deficiency could be due to fear of the bowel prep for colonoscopy, lack of insurance coverage or simply not being educated about the recommendation.
In order to capture a bigger percentage of people at screening age, the American Cancer Society (ACS) updated its guidelines for colorectal cancer screening last month, May 2026. In addition to the previously approved tests for screening, the ACS has added new testing options to the arsenal doctors can use to improve colon cancer detection.
What are the standard tests for colorectal cancer?
The USPSTF recognizes both invasive, direct visualization tests and non-invasive tests for screening for colorectal cancer. These tests include:
Direct visualization test:
Direct visualization is the gold standard for finding colon cancer. Flexible sigmoidoscopy and colonoscopy are two tests that use cameras to look at the bowel.
- Flexible Sigmoidoscopy: This test looks at the last portion of the colon and rectum, it won’t find a tumor or polyp at the beginning of the colon. Flexible sigmoidoscopy requires a full bowel prep and anesthesia, but isn’t usually recommended for routine screening in the US. Flexible sigmoidoscopy needs to be done every 5 years, unless you enhance it by doing a FIT test every year, then you’ll need to do it every 10 years.
- Colonoscopy: Requires a bowel prep and anesthesia, but gives the most informed picture of the entire colon and rectum. Colonoscopy needs to be done every 10 years or more often if any abnormalities are found.
Non-invasive tests
- Fecal occult blood test (gFOBT): gFOBT, also called a hemoccult test, checks for blood in your stool that can’t be seen with the naked eye. It’s easy, inexpensive and your doctor can do it in the office.
- FIT test: “Fecal immunochemical test”(FIT) is done similar to the gFBOT. FIT test is a more specific test, because it uses antibodies to check for blood in the stool. You don’t have to worry about vitamins, medications or what you eat before the test. If it’s abnormal, you’ll need to follow-up with a colonoscopy right away. The FIT test should be done every year.
- FIT-DNA test: FIT-DNA (Cologuard) tests check for blood. It also detects abnormal DNA from cancer cells. You collect an entire bowel movement in a container at home and mail it back to the lab. If abnormal DNA or blood is detected, you’ll be referred for a colonoscopy. FIT-DNA should be done every 3 years.
- Radiology test: A CT colonography or “virtual colonoscopy” is done by a radiologist. It uses X-rays to create a 3-D picture of your colon and rectum. It can visualize physical abnormalities such as tumors or polyps. A normal virtual colonoscopy should be done every 5 years. If an abnormality is found, you’ll be referred for a colonoscopy.
What new tests are included in the updated colon cancer screening guidelines?
Many new developments are taking place in the world of colon cancer research. Among these are advances in genetic testing, biological cancer marker detection, molecular biology and computer algorithm developments. Based on these advances, the ACS now recognizes several new tests, but admits that they have shortcomings compared to the standard tests. The newly recommended tests include:
- Multi-target RNA stool test (mt-sRNA): mt-sRNA combines a traditional FIT test (occult blood) with a genomic test for segments of RNA (part of the genetic code). A computer algorithm then looks at these results in addition to self-reported smoking status to determine relative risk. People who are deemed to be at higher risk for colon cancer are referred for further work up. The FDA has approved mt-sRNA tests for use in average-risk people (ColoSense, Geneoscopy)
- Cell free DNA blood test: This is a non-invasive, no stool required, blood test that can be done as an outpatient. This test detects DNA from cancer cells that is floating free in the blood. Currently, this test should be reserved for people who cannot or will not do one of the other tests. The FDA has cleared one test for use in people over 45 with average risk (Shield, Guardant Health). Another test has been submitted to the FDA and is awaiting approval (Freenome SimpleScreen).
The goal of adding these new testing modalities is to increase the probability that people will get their screening tests completed. The major drawback to the new tests is that they are not as sensitive as the established ones. They need to be done annually and should never be used as the only screening tool in people who are at increased risk of developing colon cancer. All positive or inconclusive tests should be followed up with a colonoscopy.
The Bottom Line
Colon cancer is now the #1 cause of cancer death in people under 50. Despite screening recommendations, nearly 1 in 3 people aren’t getting screened for this curable but deadly disease. In order to improve screening rates, the American Cancer Society has added new screening tests for people at average risk of developing colon cancer. The new tests rely on biological markers, genetic material and computer analysis to assess risk. Positive tests should be followed up with a colonoscopy. If you’re intimidated by the idea of a bowel prep, check out the new tests available for screening. Check it for the ones you love.
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