Colorectal cancer is quietly reshaping the landscape of cancer risk in America, claiming 55,000 lives in 2026 while simultaneously emerging as the leading cause of cancer death among men under 50 and the second-leading cause among women in that age group—a striking reversal that prompted the American Cancer Society to lower screening recommendations from age 50 to 45 in 2018. Now, responding to this alarming trend among younger people, the society has released updated guidelines that expand the toolkit for detecting this preventable disease, endorsing two new stool tests while deliberately limiting the role of blood tests that patients overwhelmingly prefer.
The updated recommendations, led by Andrew Wolf, MD, a cancer-prevention expert at UVA Health, represent a pragmatic approach to a persistent challenge: the most effective screening test, the panel concluded, is simply "the one that the patient completes." Wolf and a blue-ribbon panel of cancer experts conducted a systematic review of available colorectal cancer tests to determine which are most effective at catching disease early, when treatment is most successful. In addition to the existing options of colonoscopy and traditional stool tests that detect traces of blood, the new guidance endorses a next-generation DNA stool test and a novel RNA stool test as preferred screening methods for people at average risk.
The blood tests, however, tell a different story. Fifty-three percent of survey respondents said they would prefer a blood test every three years to annual stool tests or colonoscopies every decade, drawn to the simplicity and appeal of a quick finger prick. Yet Wolf's expert panel found that these blood tests showed lower sensitivity than stool-based tests for detecting advanced precancerous lesions and stage 1 cancers. "Although the idea of a blood test for colorectal cancer sounds very attractive, they aren't yet as good as the other tests at detecting precancerous growths and early-stage cancer," Wolf explained. As a result, the guidelines recommend blood tests only as a last resort for patients who refuse all other screening options—though Wolf stressed that a blood test is "certainly better than not screening."
What makes these recommendations particularly important is the silent crisis unfolding among Americans under 50. While colorectal cancer death rates have declined overall thanks to improved screening, detection, and treatment, that progress has been shadowed since 2013 by a troubling surge in the disease among younger people. The updated guidelines acknowledge this reality by making screening more accessible through expanded options, betting that offering patients several legitimate choices will increase participation rates and ultimately reduce suffering from a largely preventable cancer.
The experts emphasize one crucial safeguard: anyone who tests positive on either a stool or blood test must receive a prompt colonoscopy to confirm findings and remove any precancerous growths. Equally important, they stress that doctors must explain to patients the strengths and weaknesses of each available test, ensuring that people can make informed decisions about their own screening preferences rather than simply choosing the option that feels easiest. In a disease where early detection saves lives, the right choice is the one a patient will actually complete.