The American Cancer Society (ACS) just released a guideline update to its guideline on colorectal cancer screening. This 2026 update reaffirms the ACS recommendation that average-risk, asymptomatic adults begin colorectal cancer screening at 45 years of age and, for patients with a life expectancy greater than 10 years, continue through age 75. The update also reflects advancements in molecular-based screening tests, which recently received regulatory approval for screening. Notably, the guideline added in a preferred test to the options for stool-based testing (multitarget stool RNA test; [mt-sRNA]) and added guidance on blood-based colorectal cancer screening tests.

Today, we spotlight some key recommendations from the 2026 ACS Colorectal Cancer Screening guideline. For a complete look at the ACS guideline, as well as more details on the following recommendations, view the full-text version.

Key Elements of the 2026 ACS Colorectal Cancer Screening Guideline Update:

The ACS recommends that adults aged 45 years and older with an average risk of developing colorectal cancer undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. Blood-based screening tests are recommended only for individuals who decline or have not completed a high-sensitivity stool-based test or a structural (visual) exam.

The ACS recommends that clinicians individualize colorectal cancer screening decisions for individuals aged 76 through 85 years, based on patient preferences, life expectancy, health status, and prior screening history.

Preferred Screening Options:

  • Stool-based tests: High-sensitivity fecal immunochemical test every year. High-sensitivity guaiac-based fecal occult blood test every year. Multitarget stool DNA test (original or next-generation) every three years. Multitarget stool RNA test every three years.
  • Direct visual examinations: Computer tomography colonography every five years. Flexible sigmoidoscopy every five years. Colonoscopy every 10 years.

Blood-based screening tests are not preferred screening options at this time; they should be recommended only to individuals who decline or have not completed one of the preferred colorectal cancer screening tests.

Blood-based tests should not be ordered without prior discussion with the patient. Patients who choose a blood-based test should be informed that: Blood-based tests have lower sensitivity than high-sensitivity stool-based tests and direct visual examinations in detecting advanced precancerous lesions and stage I colorectal cancers, limiting their effectiveness for reducing colorectal cancer incidence and mortality relative to the preferred options. If their blood-based test is positive, patients will need to undergo a follow-up colonoscopy to complete the screening process.

Manufacturers have not specified a recommended testing interval; however, the Centers for Medicare and Medicaid Services specifies a 3-year interval for Medicare beneficiaries.

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