Postal questionnaires on colorectal cancer screening practices were received from samples of primary-care physicians in Long Island, New York (LI-NY) (N = 190, 66.4% response rate), and in Connecticut (N = 215, 71.7% response rate). About 90% reported ever screening asymptomatic patients 50 years of age or older by fecal occult-blood test (FOBT), and 76-86% reported generally recommending such screening annually. Proportions who generally recommended screening by proctoscopy, 48% in LI-NY and 54% in CT, were higher than those reported in a 1984 survey by the American Cancer Society. About 40-43% of physicians, however, reported using proctoscopy (i.e., flexible sigmoidoscopy [FS]) only if the FOBT was positive. The major factors influencing screening by FS were the low probability of finding a lesion, cost to the patient, and patient fear or discomfort. Training in the use of FS, reported by 25-35% of physicians, was significantly more frequent in younger physicians (i.e., less than 50 vs. 50+ years of age). Differences in responses between physicians in LI-NY and CT were generally small. Over 90% of physicians reportedly obtained information on family history of cancer and 77-80% on family history of colorectal cancer for asymptomatic patients 40 years of age and older. A pragmatic approach to increasing screening for colorectal cancer is discussed, emphasizing higher-risk patients as defined by family history of cancer and personal medical history.