The American Cancer Society is updating its colon cancer screening recommendations with three new options: a blood test called Shield and two more sensitive at-home stool tests, Cologuard Plus and ColoSense. The update comes as younger adults are being diagnos
On a day that began like most others in American healthcare. the American Cancer Society moved quickly to change a choice many adults still put off. On Wednesday. the organization added three new colon cancer screening tests to its recommendations—pushing for more people to get checked more regularly. even as the number of young people being diagnosed with colorectal cancer continues to rise.
“People should be getting screening as soon as they are eligible. ” said epidemiologist Robert Smith. senior vice president of early cancer detection science at the American Cancer Society. shortly before the new recommendations were announced on Wednesday. He added: “We always say the best test is the one you get.”.
The target is clear: everybody aged 45 to 75 should be getting regular colon cancer screenings. according to both the American Cancer Society and federal guidelines. Yet survey data show that less than half of US adults aged 45 to 49 have completed their routine colon cancer screenings—even while young colorectal cancer cases are increasing.
For decades. colonoscopies have been the gold standard because a doctor can both examine and remove suspicious tissue in a single procedure. But the road to a colonoscopy is steep. People sometimes skip it because it requires prep, sedation, and recovery time. There’s also the practical problem of scheduling, with doctors’ offices sometimes booked weeks or months in advance.
That gap between what works and what people will actually do sits at the heart of the American Cancer Society’s new recommendations. Until today, the ACS endorsed colonoscopy and some more rudimentary stool tests. Now, it has added three higher-tech alternatives: a blood test and two more sensitive at-home stool tests.
The new stool tests—Cologuard Plus and ColoSense—are designed to do more than just look for blood.
Cologuard Plus uses some of the same techniques as previous stool tests. including testing for DNA shed from tumors like regular Cologuard. It then also checks for cell-free DNA. ColoSense, in turn, looks for cancer RNA in the stool. The American Cancer Society said these tests are more accurate and sensitive to cancer and pre-cancerous polyps because they go beyond checking for blood in stool and look for signs of cancer being shed.
Smith framed the upgrade in comparison to the inexpensive high-sensitivity fecal immunochemical test, or FIT, which has been available over the counter for years. “They’re much more sensitive than the standard high-sensitivity fecal immunochemical test,” he said.
FIT tests typically detect about 80% of colon cancers when performed annually. By contrast, Smith said Cologuard Plus and ColoSense both detect cancer more than 90% of the time, according to peer-reviewed studies, and they only need to be performed every three years.
“For someone’s 45 years old and they don’t have a family history,” Smith said, “a high-sensitivity stool test would be a simple thing to do.”
The third new option—Shield—takes a different route: it’s a blood test.
The American Cancer Society is recommending, for the first time, a blood test to screen for colon cancer. It is the Shield test from Guardant Health, which was FDA-approved in 2025. Studies suggest it can detect about 83% of the colorectal cancers that would be found during a colonoscopy.
Shield works by picking up cancerous DNA shed by tumors in the blood. As cancer grows and develops, the test gets better at finding it.
But Smith drew a limit around its use. Unlike stool tests and colonoscopies. the blood test isn’t great at screening for precancerous polyps. which is why he said he would only recommend this new blood test to people who aren’t willing or able to do a visual exam like a colonoscopy or an at-home stool test.
“We want people to get tested,” Smith said. “Given how many people have not been recently testing or may be averse to any of the tests that we recommend. we might save quite a few more lives from premature deaths due to colorectal cancer if more people got a blood test who hadn’t gotten the other tests.”.
Insurance coverage is part of the practical reality of screening access. All of the new tests the American Cancer Society is recommending for colon cancer are typically covered by most major insurance plans. but coverage isn’t universal. Shield and Cologuard Plus are already covered by Medicare, while ColoSense is still under review.
Even as the ACS expands options, colonoscopies remain central for a reason that goes beyond detection. Dr. Andrea Cercek. section head of colorectal cancers at Memorial Sloan Kettering Cancer Center in New York. said her biggest fear with these new recommendations is that people may skip more regular colonoscopies in favor of a “fancy” blood or stool test.
“Colonoscopy obviously is still the best test to get, because we can not only detect cancer, but hopefully we detect polyps before they have the chance of developing into cancer,” Cercek said.
She also warned that people could mistake strong cancer-detection performance for full protection. “There exists this possibility of having a polyp that then goes undetected and could potentially develop into a cancer by the time that you get your next screening test,” Cercek said.
There’s another operational catch: if any stool or blood test returns positive, it requires a colonoscopy as follow-up. Smith called it a bigger chore, but said the tradeoff has a better return on investment.
“Colonoscopy asks a lot of an individual: It’s generally a day away from work. they need to have a chaperone. they have to do a prep the night before. ” Smith said. “But it offers very high performance in detecting cancer and advanced precursor lesions. And if your test is normal, you don’t have to do another one for 10 years.”.
So the change underway is not simply an addition of tools—it’s an attempt to close a behavioral gap. The American Cancer Society’s new blood and stool options come with higher-tech detection rates. longer intervals for follow-up in some cases. and an effort to make screening feel more achievable for people who have been delaying it. At the same time. the message from clinicians remains firm: the new tests can’t replace the prevention built into colonoscopy when it comes to finding precancerous polyps.
American Cancer Society colon cancer screening colorectal cancer Shield blood test Guardant Health Cologuard Plus ColoSense stool tests FIT colonoscopy Medicare coverage