Inclusion Criteria:

- Male and female adults aged 50-75 years of age:

- Able to provide informed consent

- Veteran eligible for VA care

Exclusion Criteria:

- Symptoms of lower gastrointestinal tract disease warranting colonoscopic evaluation,
including:

- More than one episode of rectal bleeding within the past 6 months

- Documented iron deficiency anemia

- Significant documented unintentional weight loss (>10% of baseline weight) over 6
months

- Family history of CRC in a first degree relative at any age

- Prior history of colonic disease including:

- Inflammatory bowel disease (e.g. ulcerative colitis or Crohn's disease)

- One or more colorectal neoplastic polyps (i.e. adenomas)

- Colorectal cancer

- Prior history of colonic resection

- Prior colonic examination, including:

- Colonoscopy within the past 10 years

- Sigmoidoscopy within the past 5 years

- Barium enema within the past 5 years

- CT colonography within the past 5 years

- gFOBT or FIT in the past 12 months

- Pregnancy

- Prisoner

- Significant comorbidity that would preclude benefit from screening or pose
significant risk for the performance of colonoscopy (e.g. severe lung disease,
end-stage renal disease, end-stage liver disease, severe heart failure, cancer)

- Participation in a concurrent interventional study

- Likely inability to track the individual over time (e.g. no permanent address at the
time of screening for study entry)