African Americans have the highest rates of colon cancer among all ethnic groups in the United States. There are many factors which contribute to these statistics. Environmental factors, differences in tumor biology and access to screening have all been sited as possible causes. The American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy recommend that colorectal cancer screening begin at age 45 in African Americans. Ultimately, screening colonoscopy and early polyp detection are our best tools in trying to change this trend.