This study will investigate whether patient navigation can increase rates of colorectal cancer screening among linguistically and culturally diverse disadvantaged patients served by urban community health centers.

Inclusion Criteria:

• Patients aged 52-75 who had one visit to a primary care physician in a community health center in each of the 2 previous years and who have not received colorectal cancer screening based on HEDIS criteria.

Exclusion Criteria:

• Current cancer diagnosis, undergoing treatment (or treatment completed within the past year)
• Severe cardiac disease (high-risk CAD,9 valvular disease, NYHA Class III or IV CHF, EF < 35%)
• Severe COPD (FEV1< 1liter or on home oxygen)
• CVA with severe functional impairment (aphasia or hemiparesis)
• MS with severe functional impairment
• Renal failure with CrCl< 30 or on dialysis
• Gastrointestinal symptoms (pain, bleeding, etc) within the past 6 months
• Chronic active liver disease or cirrhosis, with albumin < 3 or elevated INR
• Advanced HIV disease (CD4 count <200)
• Severe lupus (with cerebritis or renal failure as defined above)
• Severe complications of diabetes (blindness, amputations other than toes)
• Advanced Dementia
• Psychosis
• Paranoia
• Active substance abuse
• Schizophrenia
• Psychiatric hospitalization within the past year