Colorectal cancer is increasingly affecting younger adults in Colorado and nationwide, prompting major changes in how providers and public health leaders approach prevention. The updated American Cancer Society (ACS) screening guidance, released on May 27, 2026, reflects this shift, emphasizing earlier screening, more flexible testing options, and stronger follow-up care to catch cancer sooner and save lives.
One of the most impactful developments in the updated guidelines is the expansion of screening tools. While colonoscopy remains essential, patients now have more options than ever:
These tools are especially important for rural communities where access to specialists may be limited. Stool-based tests, in particular, help increase participation because they are convenient and non-invasive. Swati Patel, MD, says, “At-home stool tests are an excellent option to improve screening, especially where colonoscopy access is limited.” She also notes that though blood-based screening tests are an exciting development, they do not detect precancer and have limited sensitivity for early-stage cancer. Blood-based tests should not replace tests such as stool-based tests or colonoscopy, which are proven to prevent cancer or catch it at curable stages.
Health care providers are seeing a clear rise in colorectal cancer diagnoses among younger adults. This trend often leads to later-stage diagnoses because this age group has not historically been screened. Andrea (Andi) Dwyer, MPH, Director of the Colorado Cancer Screening Program (CCSP) at the University of Colorado Anschutz Cancer Center, confirms, “We’re seeing increasing rates of colorectal cancer in people under 50, even under 45.” Patel highlights an important nuance: “Many younger patients are diagnosed at later stages because symptoms such as rectal bleeding or abdominal pain are often dismissed, delaying diagnosis.” She adds, providers are also “seeing a higher proportion of rectal cancers in younger patients.”
Encouragingly, there are signs of progress. In 2021, guidelines shifted, with screening starting at age 45 for those at average risk. Thanks to this update, more people are getting screened earlier. Experts expect this to reduce late-stage diagnoses over time, just as screening has done for adults over 50.
Access to screening in Colorado varies widely. According to Dwyer, along the Front Range, screening rates are high—between 70% and 90% among insured people because of greater availability of health facilities. In rural and mountain areas, however, persistent barriers make screening more difficult to access, leading to lower screening rates. These barriers include:
Despite expanded options, screening disparities continue. Populations most at risk of being unscreened include uninsured individuals, rural residents, certain racial and ethnic groups, and adults under 50 who are unaware that screening now starts at age 45.
To close these gaps, Colorado providers are focusing on:
Colonoscopy is highly effective for detecting and preventing colorectal cancer by removing precancerous polyps. However, it is not always the best fit for every patient.
Test characteristics, such as sensitivity for cancer detection and ability to identify precancerous lesions, differ between options. “Colonoscopy is the gold standard,” Patel explains. “It’s necessary, since other tests require a colonoscopy if abnormal.” Stool-based tests present a strong alternative: They are non-invasive, can be performed at home, and are highly sensitive for detecting cancer. However, they must be repeated more often and are less effective at identifying precancerous polyps.
→ Colonoscopy vs. Stool-Based Tests: What is the Best Way to Detect Colorectal Cancer?
Colonoscopy, on the other hand, is typically needed only once every 10 years for average-risk individuals if results are normal. Dwyer highlights this as a key reassurance for patients weighing their options. Ultimately, she says, offering choices is essential. Patients are more likely to complete screening when they can select an option that fits their preferences and lifestyle.
→ Everything You Wanted to Know About Colonoscopy Prep (But Were Afraid to Ask)
The 2026 ACS guidelines place a strong emphasis on what happens after an abnormal screening result. A positive stool or blood test must be followed by a colonoscopy—preferably within a few months.
Patel warns, “Screening is only effective if those with abnormal, non-invasive tests complete a follow-up colonoscopy. Delays increase the risk of dying from cancer.”
Barriers to colonoscopy include logistical obstacles, confusion about next steps, and sometimes unexpected costs. To address this, health systems are implementing solutions such as care coordination between primary care and specialists.
These system-level changes are essential to ensuring screening works as intended.
The main message from the 2026 ACS guidelines is simple: If you are at average risk, start screening at age 45, and earlier if you have a family history or other risk factors.
Just as important, do not ignore symptoms. Rectal bleeding, unexplained abdominal pain, changes in bowel habits, iron deficiency, or unexplained weight loss should always prompt a conversation with a health care provider.
Patel says, “Colorectal cancer is preventable with timely screening. It’s never too early or too late to talk to your doctor.”
With rising rates among younger adults, increased access to screening options, and growing awareness, Coloradans have more tools than ever to protect their health. Taking action now could make all the difference.