More than 50 million Americans remain unscreened for colon cancer

For decades, we have faced a central challenge in colorectal cancer screening. One in three eligible Americans—over 50 million people—remain unscreened despite established methods like colonoscopy or stool-based tests existing for decades. This gap persists even though early detection saves lives, and even as colorectal cancer is now the number one cancer killer for Americans under 50.

Recently, the American Cancer Society took an important step to change that.

In updated screening guidelines, the American Cancer Society now recommends blood tests for patients who decline or have not completed stool-based or visual examination tests. The inclusion of blood tests marks a momentous step forward to address the persistent screening gap and rising colorectal cancer rates in adults under 65. It offers a new, proven choice for the more than 50 million Americans who are not up to date with their colorectal cancer screening.

For anyone who has spent years working to close the colorectal cancer screening gap, this is a meaningful moment. Clinical studies and real-world experience show that blood tests work and expand the screened population. In a pivotal New England Journal of Medicine study, the FDA-approved blood test for colorectal cancer screening called Shield detected 100% of colorectal cancer patients at Stage II or above. A recent study looking at two primary care clinics in Appalachia—a region with low colorectal cancer screening rates and correspondingly high rates of colorectal cancer—found that over 95 percent of patients completed their screening tests when the Shield blood test was offered. Overall screening rates in those clinics doubled. 

We also see widespread public support for blood tests to screen for colon cancer and boost participation in established screening methods like colonoscopies. A recent Harris Poll survey found that 85% of screening-eligible Americans would be more likely to get a colonoscopy if they first had a positive result from a blood test. Ninety-two percent of eligible Americans believe colorectal cancer blood tests should be accessible and covered with no co-pay. 

Every time I meet a patient screened for the first time because of an innovative and more accessible option, I’m reminded why this work matters. The updated American Cancer Society guidelines extend access to this innovation for millions more Americans, as several states have already adopted laws ensuring coverage consistent with these guidelines. While no single solution can erase the colorectal cancer screening gap, expanding the number of proven, evidence-based options is how we begin to screen every eligible person in this country. 

The question now is whether we can provide equitable and broad access to people in every state across the country. The government-funded U.S. Preventive Services Task Force (USPSTF) determines the cancer screening options available for free to every eligible American, providing a national standard. 

Unfortunately, the USPSTF has not updated its recommendations in years, even as science and technology continue to outpace government bureaucracy and leave patients behind. When the USPSTF next convenes, it has an opportunity to ensure millions of Americans gain equal, national access to life-saving choices like the blood-based screening tests just recommended by the American Cancer Society. 

With a national guideline update, we can better align federal policy and expand insurance coverage to this American innovation.

Cancer doesn’t wait. Neither should we. 

1. American Cancer Society National Colorectal Cancer Roundtable. Colorectal Cancer Is A Major Public Health Problem. https://nccrt.org/our-impact/data-and-progress/
2. Ebner DW, Kisiel JB, Fendrick AM, Estes C, Li K, Vahdat V, Limburg PJ. Estimated Average-Risk Colorectal Cancer Screening-Eligible Population in the US. JAMA Netw Open. 2024 Mar 4;7(3):e245537. doi: 10.1001/jamanetworkopen.2024.5537. PMID: 38551567; PMCID: PMC10980958. https://pmc.ncbi.nlm.nih.gov/articles/PMC10980958/
3. Scientific American. Colon cancer is killing more young people in the U.S. than any other cancer. January 22, 2026. https://www.scientificamerican.com/article/colon-cancer-is-killing-more-young-people-in-the-u-s-than-any-other-cancer/
4. Ebner DW, Kisiel JB, Fendrick AM, Estes C, Li K, Vahdat V, Limburg PJ. Estimated Average-Risk Colorectal Cancer Screening-Eligible Population in the US. JAMA Netw Open. 2024 Mar 4;7(3):e245537. doi: 10.1001/jamanetworkopen.2024.5537. PMID: 38551567; PMCID: PMC10980958. https://pmc.ncbi.nlm.nih.gov/articles/PMC10980958/
5. Chung, D. C., Gray, D. M., II, Singh, H., Issaka, R. B., Raymond, V. M., Eagle, C., Hu, S., et al. (2024). A cell-free DNA blood-based test for colorectal cancer screening. New England Journal of Medicine, 390(11), 973–983. https://doi.org/10.1056/NEJMoa2304714
6. Haynes WB Jr, Talari MP, Elmore KA, Jastan RM, Resil JJL. Blood-Based Colorectal Cancer Screening: Implementation Into 2 Appalachian Primary Care Clinics. Am J Prev Med. 2025 Jul;69(1):107636. doi: 10.1016/j.amepre.2025.04.006. Epub 2025 Apr 17. PMID: 40252860
7. American Cancer Society. Colorectal Cancer Facts & Figures 2023-2025. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf
8. Haynes WB Jr, Talari MP, Elmore KA, Jastan RM, Resil JJL. Blood-Based Colorectal Cancer Screening: Implementation Into 2 Appalachian Primary Care Clinics. Am J Prev Med. 2025 Jul;69(1):107636. doi: 10.1016/j.amepre.2025.04.006. Epub 2025 Apr 17. PMID: 40252860
9. Guardant Health. Press Release: New Guardant Health/Harris Poll Survey Shows 92% of All Eligible Americans Believe Colorectal Cancer Blood Tests Should be Accessible and Covered Similar to Medicare. March 13, 2026. https://investors.guardanthealth.com/press-releases/press-releases/2026/New-Guardant-HealthHarris-Poll-Survey-Shows-92-of-All-Eligible-Americans-Believe-Colorectal-Cancer-Blood-Tests-Should-be-Accessible-and-Covered-Similar-to-Medicare/default.aspx
10. New Guardant Health/Harris Poll Survey Shows 92% of All Eligible Americans Believe Colorectal Cancer Blood Tests Should be Accessible and Covered Similar to Medicare. Guardant Health Press Release. March 13, 2026. https://investors.guardanthealth.com/press-releases/press-releases/2026/New-Guardant-HealthHarris-Poll-Survey-Shows-92-of-All-Eligible-Americans-Believe-Colorectal-Cancer-Blood-Tests-Should-be-Accessible-and-Covered-Similar-to-Medicare/default.aspx