Fecal blood is an inherently insensitive and nonspecific marker for asymptomatic colorectal neoplasia. As such, use of fecal occult blood tests (FOBTs) necessarily limits the effectiveness and efficiency of a screening application. FOBT screening may result in a modest reduction in colorectal cancer-specific mortality, but it alters neither colorectal cancer incidence nor overall mortality. Costs resulting from FOBT screening are substantial, and the extent to which screen-induced mortality offsets any benefits remains unknown. In the absence of a clearly demonstrated net benefit with FOBT screening, affordability of this expensive effort can be legitimately questioned.