Medical News Today (MNT)New Colorectal Cancer Screening Guidelines Add Blood and At-Home Stool Tests

✅ Guideline Update

The American Cancer Society revised its colorectal cancer screening recommendations, published in CA: A Cancer Journal for Clinicians, to expand available screening modalities for average-risk adults beginning at age 45. The update responds to persistent screening gaps and rising early-onset colorectal cancer incidence in adults under 50.

Clinical Considerations

• Two new multitarget stool tests are now recommended every 3 years: Cologuard (mt-sDNA, updated) and ColoSense (mt-sRNA, new), both FDA-approved with high sensitivity for colorectal cancer detection
• Shield, a blood-based circulating tumor DNA test, is recommended only for patients who decline or do not complete preferred stool-based or visual screening; it demonstrates lower sensitivity for early-stage disease than stool-based methods
• Any positive non-colonoscopy result requires follow-up colonoscopy within 6 months. Guidelines emphasize this step is frequently incomplete in practice, representing a critical care gap.
• Rising colorectal cancer rates in adults under age 50, which is now the leading cancer-related cause of death in this cohort, reinforce the clinical urgency of the age-45 initiation recommendation

Practice Applications

• Recognize that ACS guidance explicitly instructs clinicians not to direct patients to a specific test. Lead with visual vs. stool preference, then navigate options within the chosen category.
• Integrate patient-preference counseling into screening conversations; the best test remains the one the patient will complete
• Reinforce the mandatory follow-up colonoscopy for all positive non-colonoscopy results; cost, access, and logistical barriers are documented drivers of incomplete workup
• Consider earlier screening initiation and increased frequency for higher-risk patients per existing risk-stratification criteria, independent of this update