Colorectal cancer is the third most common cancer among U.S. men and women, and the second leading cause of cancer death for both sexes combined. Colorectal cancer screening is recommended in persons of average risk starting at 50 years of age. Due to advances in screening, the incidence and death rate from colorectal cancer has been decreasing in recent decades. Unfortunately, the successes observed on an aggregate scale do not hold true for all population groups, in part due to disparities in screening utilization. This study aims to explore differences in colorectal cancer testing rates and travel patterns between rural and urban residents of North and South Carolina between 2001 and 2010. Using population-based colonoscopy utilization data from outpatient discharge records, the research team has quantified travel patterns (particularly bypass behavior) for seeking care, and the availability of colonoscopy centers in rural counties.