American Cancer Society Updates Colorectal Cancer Screening Guidance for Adults

The American Cancer Society (ACS) has issued an updated guideline on colorectal cancer screening that reaffirms the importance of initiating CRC screening at age 45 for average-risk adults.

The new guideline also highlighted emerging screening technologies, including blood-based tests, as part of an evolving screening landscape.

Findings and Recommendations

The updated ACS guidance comes as CRC incidence continues to rise among adults younger than 65 years, particularly in those under age 50. According to the guideline, CRC is projected to account for approximately 158,850 new diagnoses and 55,000 deaths in the United States in 2026. Epidemiologic data show that CRC incidence has increased by about 3% annually among adults younger than 50 years and by 0.4% annually among those aged 50–64 years. Rectal cancer incidence has also risen, increasing by roughly 1% annually from 2018 to 2022.

The ACS first lowered the recommended screening age from 50 to 45 in 2018. The updated review emphasizes maintaining access to multiple screening options, including stool-based tests, colonoscopy, computed tomography colonography, and newer technologies such as multitarget stool RNA testing and blood-based screening approaches.

Screening uptake has improved substantially over the past two decades, with self-reported up-to-date screening among adults aged 50 years and older increasing from approximately 38% in 2000 to 72% in 2023. However, participation remains lower in newly eligible age groups. Only 37% of adults aged 45–49 years and 55% of those aged 50–54 years reported being up to date with recommended screening in 2023.

The guideline also highlights persistent disparities. CRC incidence is estimated to be 11% higher among Black individuals than among White individuals, while mortality rates are approximately 40% higher. American Indian and Alaska Native populations experience the highest incidence and mortality rates nationwide.

Clinical Implications

The updated guidance reinforces the urgency of early CRC screening and outreach to younger adults. The continued rise in early-onset CRC suggests that delaying screening may result in more patients presenting with advanced-stage disease.

The ACS emphasizes patient-centered decision-making, encouraging clinicians to discuss available screening modalities and select options aligned with patient preferences, access, and likelihood of completion. Expanding screening choices may help improve adherence, particularly among underserved populations and younger adults entering the screening-eligible age range.

The guideline also underscores the need to address racial, ethnic, and socioeconomic disparities in CRC screening and outcomes. Improving access to screening, follow-up colonoscopy after positive noninvasive tests, and high-quality preventive care remains essential for reducing CRC mortality across the United States.

By reinforcing screening beginning at age 45 and expanding awareness of emerging testing options, the guidance aims to improve early detection, reduce mortality, and increase participation in CRC prevention efforts.

Reference:

Wolf AMD, Hoffman RM, Walter LC, et al. Colorectal cancer screening: An update to the American Cancer Society guideline, 2026. CA Cancer J Clin. 2026;76(3):e70083. doi:10.3322/caac.70083