It is increasingly common to see headlines and discussions on social media about the rise in colorectal cancer cases among younger adults. In fact, the rising incidence of colorectal cancer in people under the age of 50 contributed to the American Cancer Society's decision in 2018 to recommend lowering the recommended age for average risk screening from 50 to 45 years. Building on the momentum of growing public awareness about colorectal cancer, the American Cancer Society in May 2026 released updated screening guidelines to include new tests that reflect the latest scientific advances and can improve access to health care. I'm a public health researcher who has spent nearly 20 years developing colorectal cancer prevention programs and studying ways to improve screening guidelines. Offering more screening options can help detect cancer earlier or prevent it altogether. What's new in the guidelines? The updated guidelines added two additional screening options. The first is a home screening test that analyzes stool samples for occult blood and other molecular markers that may indicate the presence of colorectal cancer. Guidelines recommend carrying out these tests every three years. The other option is a blood test that can be done in the doctor's office. Patients who refuse to have a colonoscopy or a stool-based screening test may opt for this test. Notably, the updated guidelines still recommend patients choose between a stool test and a direct visual exam — such as a colonoscopy — as primary screening methods. It also continues to be recommended that adults at average risk for colorectal cancer begin screening at age 45 and continue screening until age 75 or, if recommended by a doctor, beyond that age. Which exam is better? For people with a family history of colorectal cancer or genetic or hereditary syndromes – or signs and symptoms of colorectal cancer, such as blood in the stool – colonoscopy is the only recommended test. If you are 45 years old and at average risk, your doctor may recommend stool and blood tests. But because these are new options, many doctors' offices may not be offering the tests right away. In the end, the best exam is the one that is done. Can I have blood or stool tests instead of a colonoscopy? Colonoscopy remains the preferred screening test for colorectal cancer. It is the only option for those who have signs and symptoms of colorectal cancer and is the recommended test for those at increased risk. For those at average risk, a colonoscopy may still be recommended. Stool tests do not require the same preparation as a colonoscopy and are widely used. New stool tests have evolved in their ability to detect polyps and abnormal cells in samples. New blood tests are recommended only if the patient refuses to have a colonoscopy or stool test. It's important to note that the new blood tests are not as sensitive as other tests for cancer prevention, although science is advancing to offer more options. Bottom line: A colonoscopy will also be necessary if a stool or blood test shows a positive or abnormal result. Colon cancer warning symptoms There are often no warning signs or symptoms of colorectal cancer, so it is essential to start screening at age 45, especially if you have a family history or genetic risk of developing colorectal cancer. Common symptoms of colorectal cancer include blood in the stool, change in bowel habits or stool, pain, or unexplained weight loss of 10 pounds or more. If you notice these symptoms, regardless of your age, talk to your doctor and consider requesting a colonoscopy. How can I reduce my risk? To reduce your risk of colorectal cancer, people at average risk for the disease should start screening at age 45. Pay attention to your body. Note any concerning changes or symptoms and talk openly with your doctor. Healthy lifestyle choices can also help reduce your risk of colorectal cancer. This includes at least 30 minutes of physical activity per day, a balanced diet rich in fruits and vegetables and reducing the consumption of processed foods. Reducing alcohol consumption and avoiding smoking and e-cigarette use may also lower your risk of colorectal cancer and other types of cancer. Andrea Dwyer receives funding from the US National Cancer Institute, the US Centers for Disease Control and Prevention, and the Colorado Department of Public Health and Environment. Andrea Dwyer is affiliated with the National Roundtable on Colorectal Cancer and the National Guidance Roundtable of the American Cancer Society and the organization Fight Colorectal Cancer.