The variability in the published results for colonoscopy and barium enema examinations is confusing. With both, optimum results are dependent on meticulous preparation, technical excellence, and operator proficiency. It is a mistake to place colonoscopy and the barium enema in competitive positions; the two methods ideally complement one another in the evaluation of high risk individuals, including those with positive Hemoccult tests. The exclusion of significant pathology by the double-contrast enema can be relied on and is less costly to the patient. Detection of abnormalities by a barium enema should, when necessary, be followed by colonoscopic verification and/or biopsy. When used in this sequence, the procedures provide a cost-effective approach to the early detection and control of cancer; it is estimated that observance of the ACS guidelines can reduce mortality rates by 30%.