Convincing data demonstrate that screening reduces mortality in colorectal cancer. International organizations and national authorities recommend implementation of colorectal cancer screening programs. There are several different primary methods for screening, including tests of blood in feces, sigmoidoscopy and colonoscopy, all with their inherent advantages and disadvantages. The majority of programs utilizes fecal occult blood test as primary screening method followed by colonoscopy. Colonoscopy as a primary screening method has the advantage of directly removing precancerous lesions and ongoing studies evaluates the role of colonoscopy as a primary screening method for colorectal cancer. Challenges for implementation of screening in Sweden include limited access to colonoscopy resources and problems to reassure quality control. This article summarizes current evidence for colorectal cancer screening, as well as methods and requirements for implementation.