ACS Colorectal Cancer Screening Update: Implications for Primary Care

In updated colorectal cancer screening guidance, the American Cancer Society reaffirmed that adults at average risk should begin screening at age 45 and continue through age 75 if they have a life expectancy greater than 10 years. The update also broadens recommended screening options, adding blood-based testing for the first time while continuing to emphasize stool-based testing and colonoscopy as preferred strategies for average-risk adults.

In this video, Xavier Llor, MD, professor of medicine and director of the GI and Pancreatic Cancer Prevention Program at Yale School of Medicine, discusses what the updated guidance means for primary care. Llor explains that the recommendation to begin screening at age 45 reflects the continued rise in young-onset colorectal cancer and reiterates a central implementation message for clinicians: the most effective screening test is the one a patient completes.

He also discusses how stool-based tests and colonoscopy fit into the preferred screening framework, as well as the role of blood-based tests for patients who decline or do not complete those options. Llor emphasizes that stool-based screening should be treated as part of a screening continuum, with positive results requiring timely follow-up colonoscopy to complete the process.