&NA;Community‐based screening for colorectal cancer can be effective when patient acceptance is high. Understanding the risks and benefits of screening, and the willingness of the physician to communicate this information to the patient, can be a positive influence on patient acceptance. In this nonrandomized retrospective observational study, we examined the results of offering screening to a group of patients attending the Palo Alto Medical Foundation in 1996.Average risk patients, (age 50 to 88 years, 53% female), were offered annual fecal occult blood testing (FOBT). A medical history was taken for all patients. Patients with positive FOBT findings were followed up with colonoscopy. Histological evaluation was done on all suspected neoplastic lesions (cancer and adenomas). Patients with negative FOBT results in 1996 remained under surveillance for 32 to 42 months.Of 11,501 patients who were offered screening, 75% participated in FOBT. There were 442 (5%) patients positive by FOBT. Advanced colonic neoplastic lesions were found in 78 patients. Of the 20 cancers detected during the surveillance period, 60% were early stage (Dukes A or B1). Other studies have shown that screening for colorectal cancer in community‐based settings can be effective in reducing mortality and incidence of the disease. This study extends these earlier reports, demonstrating that screening is most effective when patient acceptance is high.