Colon cancer is one of the few big cancers you can stop before it ever becomes cancer — if you get checked. The rules for getting checked recently changed.
The American Cancer Society rewrote its colorectal screening guidelines in spring 2026, its first update since 2018. It reaffirmed the starting line, added new tests, and again named an age when you’re allowed to stop.
Here’s where you land.
The starting line is 45
Screening used to start at 50, until 2018 when the ACS moved it up to 45. The latest guidelines reaffirm that everyone at average risk should start screening at 45, because colon cancer is showing up earlier. New cases in adults under 50 have been climbing about 3% a year, even as they’ve held steady or fallen in older groups.
It’s still a common, deadly disease. The ACS expects nearly 159,000 new colorectal cancer cases and about 55,000 deaths because of it in the U.S. in 2026. Caught early, it’s also one of the most beatable cancers there is.
Your menu of tests got longer
A colonoscopy every 10 years is still the standard everything else is measured against, because in the same visit, your doctor can find and remove precancerous growths. But it’s no longer the only option.
The guideline also endorses several at-home stool tests: a yearly FIT (fecal immunochemical test), and the stool-DNA test Cologuard or the newer stool-RNA ColoSense every three years. Research has found a stool test can rival a colonoscopy at cutting deaths — if you do it on schedule.
The new blood test: Easy, but not first choice
The newest option is a blood test called Shield. The FDA cleared it in 2024 as a screen for average-risk adults 45 and up, and Medicare covers it every three years for ages 45 to 85. A blood draw instead of the prep — it sounds like the easy button.
Read the fine print. In its main study, Shield caught roughly 8 in 10 colon cancers but only a small share of the advanced precancerous polyps a colonoscopy would spot and remove. That’s why the ACS lists it as a fallback for people who won’t do a preferred test — not as an equal.
And a positive blood test doesn’t end the process. You need to get a colonoscopy anyway.
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When you finally get to stop
The 2026 guidelines reaffirm this too.
Keep screening through age 75. Between 76 and 85, it becomes a judgment call you make with your doctor, weighing your overall health, how long you’re likely to live, and whether you’ve kept up with screening before. After 85, the guidance is to stop.
If you’re in that 76-to-85 window and healthy, the case for continuing can still be strong. It’s exactly the kind of test worth discussing rather than doing on autopilot.
What Medicare pays
Here’s a trap worth knowing before you schedule. Medicare covers a screening colonoscopy at no cost to you — but if the doctor removes a polyp during it, the visit is reclassified as a procedure, and you can owe 15% of the Medicare-approved amount. Same appointment, surprise bill.
The stool tests and the Shield blood test are covered as screenings too, at no cost when your provider accepts assignment. It’s worth asking, before the scope, how a polyp removal would be billed.
What to bring to your doctor
You don’t need to memorize the guideline. You need three answers:
- Am I due?
- Which test that I’ll actually do is right for me?
- And, if I’m past 75, is another round worth it for me?
The best screening test is the one you’ll finish. A colonoscopy you keep putting off protects no one — and a cancer you catch at 45 is a different conversation than one you find at 75.
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