Colorectal cancer screening techniques should be effective, acceptable to patients, affordable, widely available, and safe. For average-risk adults aged more than 50 years who do not have significant colorectal symptoms, significant family history, or significant predisposing conditions, flexible sigmoidoscopy is an important option for reducing the risk for colorectal cancer, meeting all criteria for an effective and feasible screening modality. This article discusses evidence supporting flexible sigmoidoscopy, practical issues in implementation, and current controversies.