Overview
- The society published the guideline update on May 27, 2026, formally adding FDA‑cleared multitarget stool tests (Cologuard Plus and ColoSense) and the Shield blood test to screening choices for average‑risk adults 45–75.
- Colonoscopy remains the gold standard and the guideline says Shield should be offered only to people who decline or cannot complete preferred tests so they will accept some screening.
- Clinical data show Shield detected about 83% of colorectal cancers in pivotal studies but missed most advanced precancerous lesions, while stool multitarget tests have high cancer sensitivity but only moderate detection of precursors.
- The guideline requires that any positive stool or blood test be followed by a diagnostic colonoscopy, preferably within six months, and calls for monitoring real‑world follow‑up and adherence to ensure screening completes the care pathway.
- Coverage and impact are uncertain: Medicare currently pays for one blood test brand, the USPSTF has not yet adopted these new modalities, and modeling suggests blood tests will likely reduce fewer cancers and deaths than stool tests or colonoscopy unless adherence and follow‑up improve.