New colorectal cancer screening guidelines add blood and at-home stool tests

• The American Cancer Society (ACS) updated its colorectal cancer screening guidelines to include new blood-based and at-home stool tests, while continuing to recommend screening for average-risk adults beginning at age 45.
• New screening options include the at-home stool tests Cologuard and ColoSense, both recommended every 3 years, as well as the blood-based test Shield for people who decline other preferred screening methods.
• The ACS states that colonoscopy remains the gold standard for colorectal cancer screening, and a colonoscopy should follow any positive result from a stool or blood-based test within 6 months.
• The guideline changes aim to improve screening participation and reduce colorectal cancer deaths, as colorectal cancer rates continue to rise among adults younger than age 50.

Colorectal cancer is the third most common cancer worldwide, and the second leading cause of cancer-related deaths worldwide.

Early-onset colorectal cancer, which occurs in adults under 50, is rising globally at an alarming rate in younger adults, with research highlighting that it is the leading cause of cancer-related death among males and females under age 50.

Previous colorectal cancer screening guidelines from the ACS advised that average-risk adults aged 45 years and older undergo regular screening with either a stool-based test or a visual exam, based on personal preferences and test availability. It also recommends a timely colonoscopy after all positive results on non-colonoscopy screening tests.

Now, the ACS has updated its screening guidelines to expand the range of recommended screening tools, including new blood-based and at-home stool tests designed to improve participation and detect cancer earlier.

Published in CA: A Cancer Journal for Clinicians, the updated recommendations continue to advise that adults at average risk begin screening for colorectal cancer at age 45 and continue through age 75 and up to 85, depending on their preference and overall health. They also advise that individuals at higher risk may need to begin screening before age 45 and undergo testing more frequently.

The revised guidance reflects growing concern over rising colorectal cancer rates among younger adults, as well as persistent screening gaps across the United States.