African Americans are more likely than any other racial or ethnic group to develop colorectal cancer (CRC) and to die as a result. Factors such as age, family history, income, knowledge, attitudes and beliefs regarding screening are important predictors of risk, and multiple factors may contribute to poor CRC outcomes for African Americans. Although screening is not the only factor associated with CRC outcomes, it may be one of the more important and modifiable risk factors for African Americans. Few programs have utilized narrative approaches to promote cancer screening among African Americans. None have focused on CRC screening. The purpose of this discussion is to review factors associated with CRC incidence, late detection and mortality among African Americans with emphasis on screening to improve CRC-related outcomes, and to discuss narrative health promotion as a culturally appropriate means for eliminating the disparities in CRC-related outcomes between African Americans and other racial/ethnic groups.