This American Journal of Preventive Medicine article presents findings from a mixed-methods study conducted in 2005 to understand patient perspectives on colorectal cancer screening. Responses to a mailed survey identified fear and the bowel preparation as the most important barriers to screening, while remarks by focus group participants exposed the intricacies of complex barriers -- such as fear, lack of information, time, the role of physicians, and access to care -- as well as barriers that have little documentation in the literature, such as low self-worth, "para-sexual" sensitivities, fatalism, negative past experiences with testing, and skepticism about the financial motivation behind screening recommendations.