{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T05:18:27Z","timestamp":1791695907367,"version":"4.3.4"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CA A Cancer J Clinicians"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality in the United States, with rates recently increasing among adults younger than 65 years. In 2018, the American Cancer Society (ACS) lowered the recommended age to initiate screening for average\u2010risk adults to age 45 years. Since then, new molecular\u2010based screening tests\u2014a multitarget stool RNA test (mt\u2010sRNA), a next\u2010generation mt\u2010sDNA test, and a blood\u2010based cell\u2010free DNA assay\u2014have received regulatory approval for CRC screening. For this update, the ACS Guideline Development Group commissioned a targeted, systematic evidence review evaluating diagnostic performance and published modeling studies to judge the potential impact of these tests on CRC incidence and mortality. The ACS reaffirms the recommendation that average\u2010risk adults should initiate CRC screening at age 45 years and continue through age 75 years for those with a life expectancy greater than 10 years. Consistent with prior guidelines, the ACS emphasizes that offering multiple, recommended\u00a0screening options supports informed patient choice and may improve participation, because the most effective screening test is the one that the patient completes. The next\u2010generation mt\u2010sDNA test, which is an updated version of an already recommended mt\u2010sDNA test, and the mt\u2010sRNA test demonstrated high sensitivity for CRC and moderate sensitivity for advanced precancerous lesions and are recommended, along with annual high\u2010sensitivity fecal immunochemical and high\u2010sensitivity guaiac\u2010based fecal occult blood tests, as preferred stool\u2010based screening options at 3\u2010year intervals. Compared with established stool\u2010based tests, blood\u2010based tests demonstrated lower sensitivity for both advanced precancerous lesions and stage I cancers, with modeling studies predicting less effectiveness in reducing CRC incidence and mortality. At this time, blood\u2010based tests should be recommended only to individuals who decline or do not complete preferred screening tests. Ongoing evaluation of adherence, real\u2010world implementation, and clinical outcomes will inform future updates for these new tests. For screening to be effective, a positive result on any noncolonoscopy screening test requires timely follow\u2010up with colonoscopy, preferably within 6 months, to complete the screening process.<\/jats:p>","DOI":"10.3322\/caac.70083","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:52:33Z","timestamp":1779886353000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Colorectal cancer screening: An update to the American Cancer Society guideline, 2026"],"prefix":"10.3322","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5510-7224","authenticated-orcid":false,"given":"Andrew M. D.","family":"Wolf","sequence":"first","affiliation":[{"name":"University of Virginia School of Medicine  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4714-7726","authenticated-orcid":false,"given":"Richard M.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9642-6238","authenticated-orcid":false,"given":"Louise C.","family":"Walter","sequence":"additional","affiliation":[{"name":"University of California, San Francisco and the San Francisco Veterans Affairs Health Care System  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2641-7755","authenticated-orcid":false,"given":"Charnita","family":"Zeigler\u2010Johnson","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Fox Chase Cancer Center  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3292-5035","authenticated-orcid":false,"given":"Timothy R.","family":"Church","sequence":"additional","affiliation":[{"name":"University of Minnesota School of Public Health  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6349-9142","authenticated-orcid":false,"given":"Carmen E.","family":"Guerra","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8833-4213","authenticated-orcid":false,"given":"Elena B.","family":"Elkin","sequence":"additional","affiliation":[{"name":"Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9164-6370","authenticated-orcid":false,"given":"Ruth","family":"Etzioni","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7533-9090","authenticated-orcid":false,"given":"Abbe","family":"Herzig","sequence":"additional","affiliation":[{"name":"Sarah Lawrence College  Bronxville New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-7894","authenticated-orcid":false,"given":"Kevin C.","family":"Oeffinger","sequence":"additional","affiliation":[{"name":"DCI Center for Onco\u2010Primary Care Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7054-3014","authenticated-orcid":false,"given":"Rebecca B.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Tufts University and Tufts Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-8687","authenticated-orcid":false,"given":"Sana","family":"Raoof","sequence":"additional","affiliation":[{"name":"Brown University Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-3864","authenticated-orcid":false,"given":"Ya\u2010Chen","family":"Tina Shih","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology David Geffen Schoold of Medicine, and Director of Cancer Health Economics Research Program University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9249-4316","authenticated-orcid":false,"given":"Steven J.","family":"Skates","sequence":"additional","affiliation":[{"name":"Biostatistics Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5618-6380","authenticated-orcid":false,"given":"Tyler B.","family":"Kratzer","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research Department American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8338-2611","authenticated-orcid":false,"given":"Deana","family":"Manassaram\u2010Baptiste","sequence":"additional","affiliation":[{"name":"Center for Early Cancer Detection American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3344-2238","authenticated-orcid":false,"given":"Robert A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Center for Early Cancer Detection American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70043"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.30.4.208"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.42.5.296"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.47.3.154"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.49.1.4"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.51.1.38"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3322\/CA.2007.0018"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21457"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.332"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010014\u20103466\u2010y"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70067"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw322"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2200869"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.25467"},{"key":"e_1_2_8_16_1","volume-title":"Cancer Prevention & Early Detection Facts & Figures 2026","author":"American Cancer Society","year":"2026"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.epi\u201007\u20102629"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw322"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.22231"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2304714"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.70115"},{"key":"e_1_2_8_22_1","volume-title":"Overview of information related to ColoSense \u2013 P230001","author":"U.S. Food and Drug Administration","year":"2024"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.02.011"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2022.40.4_suppl.TPS208"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.7515"},{"key":"e_1_2_8_26_1","volume-title":"Guardant Health\u2019s Shield\u2122 Blood Test Approved by U.S. Food and Drug Administration as a Primary Screening Option, clearing Path for Medicare Reimbursement and a New Era of Colorectal Screening [press release]","author":"Guardant Health","year":"2024"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102023\u2010330980"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010025\u201023065\u20109"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.16531"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1800"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.70428"},{"key":"e_1_2_8_32_1","volume-title":"Colorectal Cancer Screening, Version 2.205","author":"National Comprehensive Cancer Network (NCCN)","year":"2025"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/92.23.1888"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102017\u2010314753"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2310336"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaf209"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaf277"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.4417"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1311194"},{"issue":"23","key":"e_1_2_8_40_1","first-page":"5489","article-title":"Aging and DNA methylation in colorectal mucosa and cancer","volume":"58","author":"Ahuja N","year":"1998","journal-title":"Cancer Res"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43587\u2010025\u201001021\u2010x"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1158\/0008\u20105472.Can\u201018\u20101682"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast\u20102019\u2010000353"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2024.03.011"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djae124"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2024.03.010"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.0435"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001531"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2026.02.009"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.017"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010025\u201004997\u20105"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2025.10.015"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/21501319251348099"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2004.049684"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.367"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1158\/1940\u20106207.CAPR\u201019\u20100089"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.7326\/annals\u201024\u201000910"},{"key":"e_1_2_8_58_1","volume-title":"Guardant Health Receives ADLT Status From CMS for Shield Blood Test [press release]","author":"Guardant Health","year":"2025"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.3389\/or.2025.1653617"},{"key":"e_1_2_8_60_1","volume-title":"Health Equity Principles","author":"American Cancer Society","year":"2023"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010016\u20103629\u2010y"}],"container-title":["CA: A Cancer Journal for Clinicians"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.3322\/caac.70083","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.3322\/caac.70083","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.3322\/caac.70083","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:36:38Z","timestamp":1782120998000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.3322\/caac.70083"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":60,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.3322\/caac.70083"],"URL":"https:\/\/doi.org\/10.3322\/caac.70083","archive":["Portico"],"relation":{},"ISSN":["0007-9235","1542-4863"],"issn-type":[{"value":"0007-9235","type":"print"},{"value":"1542-4863","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2026-03-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70083"}}