Current practice guidelines recommend annual fecal occult blood test screening for colorectal cancer in the average-risk population over the age of 50. Efficacy of fecal occult blood test screening is supported by several controlled prospective trials and case-control studies. Implementation of this recommendation, in combination with periodic flexible sigmoidoscopy every 5 years, is feasible, affordable, highly effective, and has the potential for reducing colorectal cancer mortality by at least 50%. With over 50,000 Americans dying of this malignancy each year, we cannot afford not to do this.