Guideline Video

Guideline Resources

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Just published May 27th, 2026, the American Cancer Society’s newest guideline on Colorectal Cancer Screening.

The purpose of this guideline update is to review current evidence for the newly available mt-sRNA test and two blood-based colorectal cancer (CRC) screening tests and to define their role in relationship to the stool-based and visual examinations previously recommended by the American Cancer Society CRC screening guideline.

In today’s rapid update, we’ll just be going over the key changes and recommendations that were added to this 2026 update. For the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

The American Cancer Society (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 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 exam. 

Patients should be informed that a positive result on a non-colonoscopy screening test requires timely follow-up with a colonoscopy to complete the screening process.

  • The recommendation to begin screening at age 45 years is a qualified recommendation.
  • The recommendation for regular screening in adults aged 50 years and older is a strong recommendation.
  • The ACS recommends that average-risk adults in good health with a life expectancy of greater than 10 years continue colorectal cancer screening through the age of 75 years.
  • 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.
  • The ACS recommends that clinicians discourage individuals older than 85 years from continuing colorectal cancer screening.

On to the section 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 every 3 years
    • Multitarget stool RNA test every 3 years
  • Direct visual examinations:
    • Colonoscopy every 10 years
    • Computed tomography colonography every 5 years
    • Flexible sigmoidoscopy every 5 years

Then for the section on Blood-based colorectal cancer screening

  • 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.

And there you have it. Make sure to check out the full guideline from the American Cancer Society and other related clinical decision support tools at guidelinecentral.com.

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