The American Cancer Society released updated colorectal cancer screening guidelines in May 2026 that give patients more choices than ever before. While colonoscopy remains the gold standard, adults can now opt for at-home stool tests or blood-based screening, making it easier to get screened and potentially catch cancer earlier when it's most treatable.

What Are the New Screening Options Available?

For decades, colonoscopy was essentially the only recommended screening method for colorectal cancer. The updated guidelines maintain colonoscopy as the most effective option, but they now formally recognize three additional screening pathways:

• Multitargeted stool DNA tests: Commonly known as Cologuard, these at-home tests detect DNA markers and hidden blood in stool samples, requiring screening every three years.
• Multitargeted stool RNA tests: A newer at-home option branded as ColoSense that detects RNA markers and traces of blood, also recommended every three years.
• Blood-based tests: A lab-drawn blood sample that can detect tumor DNA in the bloodstream, offering convenience for those who prefer not to handle stool samples.

The expansion reflects a critical reality: roughly one in three eligible Americans are not up-to-date on recommended screening, and many avoid colonoscopy due to discomfort, inconvenience, or access barriers. By offering alternatives, experts hope to close this screening gap and catch more cancers at earlier, more treatable stages.

Which Screening Method Should You Choose?

The answer depends on your preferences, access to care, and what your doctor recommends. Colonoscopy remains the most effective single test because it can both detect cancer and remove precancerous polyps in one procedure. If results are normal, you typically don't need another colonoscopy for 10 years.

Stool-based tests offer a strong alternative, especially for people in rural areas or those without easy access to specialists. These tests are non-invasive, can be done at home, and are highly sensitive for detecting cancer. However, they must be repeated every three years, and any positive result requires a follow-up colonoscopy.

"Blood tests are a very attractive option for many individuals, and could help increase the number of people screened, but these tests are less sensitive for early cancers and do not detect most pre-malignant polyps," said Xavier Llor, MD, PhD, professor of medicine and director of the GI and Pancreatic Cancer Prevention Program at Yale School of Medicine.

Xavier Llor, MD, PhD, Professor of Medicine and Director of the GI and Pancreatic Cancer Prevention Program at Yale School of Medicine

Blood-based tests, while convenient, are currently recommended only for people who refuse other screening options. They don't detect precancerous polyps and are less effective at catching early-stage cancers compared to stool-based tests or colonoscopy.

Why Is This Update Happening Now?

Colorectal cancer is increasingly affecting younger adults, a troubling trend that has prompted this shift in screening strategy. The disease is now the leading cause of cancer-related death for people under 50, yet many in this age group don't realize screening now begins at age 45 for those at average risk. In Colorado and other states, providers are seeing higher rates of colorectal cancer in people under 50, often diagnosed at later stages because symptoms like rectal bleeding or abdominal pain are dismissed or overlooked.

The 2021 guideline change that lowered the screening age from 50 to 45 has already begun showing promise. More people are getting screened earlier, and experts expect this to reduce late-stage diagnoses over time, just as screening has done for older adults.

How to Talk to Your Doctor About Screening Options

• Know your risk factors: If you have a family history of colorectal cancer, inflammatory bowel disease, or other risk factors, mention these to your doctor, as you may need earlier or more frequent screening.
• Discuss your preferences: Be honest about what appeals to you. If you're uncomfortable with colonoscopy, stool-based tests may be more likely to get you screened. If you prefer a single definitive test, colonoscopy may be the better choice.
• Ask about access and follow-up: If you choose a stool test or blood test, confirm that your healthcare system has a clear plan for follow-up colonoscopy if results are abnormal, and understand any potential costs.
• Don't delay if you have symptoms: Rectal bleeding, unexplained abdominal pain, changes in bowel habits, iron deficiency, or unexplained weight loss should prompt an immediate conversation with your doctor, regardless of your age or screening status.

What Experts Want You to Know

"There is an urgency to getting screened, as colorectal cancer is now the number one cancer killer for people under 50," explained Dr. Llor. "Screening at your doctor's office or your own home can potentially be life-saving."

Xavier Llor, MD, PhD, Professor of Medicine and Director of the GI and Pancreatic Cancer Prevention Program at Yale School of Medicine

The most important takeaway from the 2026 guidelines is straightforward: the best screening test is the one you'll actually complete. Whether that's a colonoscopy, a stool test you do at home, or a blood test at your doctor's office, getting screened is far more important than which method you choose.

For adults at average risk, screening should begin at age 45 and continue through age 75. If you have a family history of colorectal cancer or other risk factors, talk to your doctor about starting earlier. The expanded options mean there's now a screening method that fits nearly every lifestyle and preference, removing one of the biggest barriers to early detection and prevention.