ACS Updated Colorectal Cancer Screening Guidance

The American Cancer Society (ACS) reaffirmed that average-risk adults should begin colorectal cancer (CRC) screening at age 45 and continue through age 75 if life expectancy exceeds 10 years, while emphasizing that stool-based screening tests remain the preferred noncolonoscopy options over newer blood-based tests. CRC remains a leading cause of cancer incidence and death in the US, with rates rising among adults younger than 65 years. Since the ACS lowered the starting age for screening in 2018, several new molecular screening technologies have gained approval, including multitarget stool RNA (mt-sRNA), next-generation multitarget stool DNA (mt-sDNA), and blood-based cell-free DNA assays. After reviewing diagnostic and modeling evidence, the ACS concluded that the newer stool-based tests demonstrate high sensitivity for colorectal cancer and moderate sensitivity for advanced precancerous lesions, supporting their use every three years alongside annual fecal immunochemical and guaiac-based fecal occult blood tests. In contrast, blood-based tests showed lower sensitivity for early-stage cancers and precancerous lesions, with modeling studies suggesting less impact on reducing CRC incidence and mortality. Therefore, blood-based tests should currently be reserved for individuals who decline or do not complete preferred screening methods. The guideline also stresses that any positive noncolonoscopy screening result must be followed by timely colonoscopy—preferably within six months—to complete effective screening. Source: https://acsjournals.onlinelibrary.wiley.com/