5 Takeaways From The New Colorectal Cancer Screening Guidelines

Reported by MindBodyGreen.

Colorectal cancer screening just got a significant overhaul. The American Cancer Society released its first major guideline update since 2018, prompted by two converging forces: FDA approval of new molecular screening tests and a genuinely alarming rise in colorectal cancer (CRC) among younger adults. According to MindBodyGreen, CRC incidence in adults under 50 climbed 3% per year between 2013 and 2022 — and among that age group, it's now the second-leading cause of cancer death in women. Diet and environmental exposures have been flagged as key drivers, particularly in younger women.

The headline news for anyone who was hoping to swap their colonoscopy prep for a simple blood draw: not yet. Blood-based liquid biopsy tests received a pointed thumbs-down as a primary screening method. The problem is sensitivity — these tests detected advanced precancerous lesions at a rate of only around 13% in two large prospective studies. That number matters enormously because roughly 80% of CRC's long-term mortality benefit from screening comes from catching and removing precancerous growths before they turn cancerous. Blood tests also become less accurate with age, with specificity dropping from above 90% in adults under 55 to about 80% in those 70 and older — meaning more false positives for the people least able to tolerate unnecessary follow-up procedures. The ACS stops short of calling them useless: for someone who would otherwise skip screening entirely, a blood test beats nothing.

Two New Tests Just Made the Preferred List

The most actionable update is the addition of two FDA-approved stool-based tests to the ACS's preferred options. ColoSense (mt-sRNA) combines eight RNA biomarkers, a fecal immunochemical test, and self-reported smoking status into an algorithm — it showed 94.4% sensitivity for CRC overall and 100% sensitivity for stage I disease in its validation study. Cologuard Plus (ng-mt-sDNA), a next-generation upgrade to the original Cologuard, demonstrated 93.9% CRC sensitivity with improved specificity. Both are done every three years. Worth flagging: Medicare and Medicaid coverage for ColoSense was still pending at time of publication, which could be a real access issue depending on your insurance situation.

Two points the guidelines hammer with unusual firmness. First: if any non-colonoscopy test — stool or blood — comes back positive, a follow-up colonoscopy within six months is non-negotiable. Not a repeat stool test. Not a wait-and-see. A colonoscopy. Real-world compliance on this is poor; only 50% of people with a positive blood test completed follow-up colonoscopy within six months in one cited trial. Second: the screening start age of 45 stands. Only 37% of adults aged 45–49 were up to date on screening as of 2023 — a number that needs to move.

The guidelines also make the racial and economic disparities impossible to ignore. Black individuals face CRC incidence rates 11% higher and mortality rates 40% higher than White individuals. For American Indian and Alaska Native populations, incidence is 48% higher and mortality 44% higher — and Alaska Native people specifically have more than double the CRC incidence and mortality rates of White Americans. Lower insurance coverage, higher costs of newer tests, and systemic access gaps are all cited as contributing factors. More screening options only helps if those options are actually reachable.

The bottom line: if you're 45 or older and haven't been screened, the best test is the one you'll actually complete — so talk to your doctor and pick one.

Read the original at MindBodyGreen.