Carmen E. Guerra, MD, MSCE, FACP, Ruth C. and Raymond G. Perelman Professor and Vice Chair for the Department of Medicine, is one of the authors of the latest American Cancer Society colorectal cancer screening guideline published in CA: A Cancer Journal for Clinicians in May, 2027.
For the first time, the guidelines include of a blood test for CRC (Guardant’s Shield test). However, the guideline recommends offering this option only to patients who decline all other screening methods, as the blood test demonstrated lower sensitivity for both advanced precancerous lesions and stage I cancers.
In addition, newer more advanced stool-based tests were added to the menu of screening options available for CRCS to join the list of preferred options:
- Next‑generation multitarget stool DNA (ng‑mt‑sDNA) replaces/updates prior DNA tests (Exact Sciences’ Cologuard Plus)
- New multitarget stool RNA (mt‑sRNA) test (Geneoscopy’s ColoSense)
Table 1 from the publication, reproduced below, summarizes the expanded screening options.
As the colorectal cancer screening guidelines continue to emphasize, the best screening test is the one that patients are willing and able to complete.
| TABLE 1. American Cancer Society guideline for colorectal cancer screening, 2026 update. |
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| Recommendations |
| The American Cancer Society (ACS) recommends that adults aged 45 years and older with an average riskb 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. Patients should be informed that a positive result on a noncolonoscopy 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 (qualified recommendation). – 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 (qualified recommendation). – The ACS recommends that clinicians discourage individuals older than 85 years from continuing colorectal cancer screening (qualified recommendation). |
| 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 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 |
| Recommendation for 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 (see Table 2). – 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. |
| View Table 1 in the original publication |