Q&A: What the American Cancer Society's Updated Colorectal Cancer Screening Guidelines Mean for Patients
The American Cancer Society (ACS) recently updated its colorectal cancer screening guidelines to include three additional recommended screening tests, expanding the options available for people at average risk of colorectal cancer. The changes reflect advances in screening technology and a broader effort to increase screening rates, particularly as colorectal cancer continues to rise among younger adults.
But while patients now have more choices than ever, experts emphasize that colonoscopy remains the most effective screening tool.
Joel Gabre, MD, a gastroenterologist and colorectal cancer specialist at the Herbert Irving Comprehensive Cancer Center (HICCC), explains what the new guidelines mean and how patients should think about their screening options.
What is different about the updated guidelines?
The biggest change is that the ACS has expanded its list of recommended screening options to include additional stool-based tests—Cologuard and ColoSense—as well as a blood-based test called Shield. These additions reflect advances in screening technology and an effort to lower barriers to colorectal cancer screening.
With these expanded options, the ACS is putting out an important message: the best screening test is the one that gets completed.
What are these new recommendations designed to accomplish?
Ultimately, the goal is to increase screening rates. If someone is unwilling to undergo a colonoscopy or complete a stool-based test, having another screening option may encourage them to take that first step.
That's especially important because we're seeing a concerning rise in early-onset colorectal cancer. Although average-risk screening now begins at age 45, screening rates among adults ages 45 to 49 remain lower than in older age groups. Expanding the available options may help close that gap and detect more cancers earlier. However, even with these new choices, colonoscopy remains the gold standard.
Why is colonoscopy still considered the gold standard?
Colonoscopy is unique because it's both a screening test and a preventive procedure. It allows us to examine the entire colon, identify cancers at their earliest and most treatable stages, and just as importantly, find and remove precancerous polyps before they ever become cancer. None of the other screening options can do that.
Blood- and stool-based tests are designed to detect signs that colorectal cancer may already be present, but they're less effective at identifying the precancerous polyps we want to find early and remove. And if one of those tests comes back positive, you'll still need a colonoscopy to determine what's causing the result and remove any abnormal tissue.
Another advantage is that, for people at average risk with a normal exam, colonoscopy only needs to be repeated every 10 years. That combination of long-lasting protection, early detection, and cancer prevention is what makes it the preferred screening test.
With more screening options available, how should patients decide which test is right for them?
The decision should start with a conversation with your health care provider. My concern is that people and busy primary care providers may see multiple approved options and not have enough time to fully discuss the strengths and limitations of each.
I want patients to understand why we recommend colonoscopy whenever possible. Colorectal cancer often develops with few or no symptoms in its earliest stages, and colonoscopy offers the greatest opportunity to prevent cancer before it starts by removing precancerous lesions during the same procedure.
That said, the most important thing is getting screened. If colonoscopy isn't the right option for someone, there are effective alternatives. The key is making an informed decision after understanding the risks, benefits, and limitations of each screening method. Every conversation should be centered on helping patients choose the screening approach they're most likely to complete.