New Guidelines Expand Colorectal Cancer Screening Options

The American Cancer Society has updated its colorectal cancer screening guidelines, expanding the options available to average-risk adults in hopes of getting more people tested for a disease that claims more than 55,000 lives in the U.S. each year.

The changes are significant because colonoscopy, while still considered the gold standard, isn't an option everyone is willing or able to pursue. "Colonoscopy still remains a test where there's no test that's better," said Dr. William Dahut, the Society's Chief Scientific Officer, "but there are folks that are unable or unwilling to undergo a colonoscopy." The new guidelines are designed to meet those people where they are.

For adults at average risk, the Society now recommends two at-home stool-based tests, each taken every three years. The first is Cologuard, a next-generation test that scans stool samples for DNA mutations, hidden blood, and certain genes or proteins that could signal cancer. The second, called Colosense, looks for RNA markers that can detect abnormal cell growth in the colon even when no blood is visible. For the first time, the guidelines also endorse a blood-based screening test that can be done in a doctor's office, though experts note it is less effective than the other options. As Dr. Dahut put it, "the test that one does is really the best test out there for them."

The guidelines also reaffirm that average-risk adults should begin screening at age 45 and continue through age 75, provided they have a life expectancy greater than 10 years. If any at-home or blood-based test comes back abnormal, a follow-up colonoscopy is needed within six months.