The goal of increasing participation in fecal occult blood testing (FOBT) for elderly African Americans is a national priority. Fatalism is believed to be a barrier to screening among this population. Fatalism is the belief that death is inevitable when cancer is present. The Powe Fatalism Model guided this descriptive, correlational study that reports on the relationship between race and fatalism, as well as the relationship between fatalism and participation in FOBT. Participants (N = 192) were recruited from randomly selected congregate meal sites. The majority of participants were African American, female, had minimal education, and minimal incomes. Elderly African Americans were significantly more fatalistic than elderly white participants and less likely to participate in FOBT. Not only was fatalism a significant predictor of FOBT, but it remained the only significant predictor of FOBT, but it remained the only significant predictor even when factors such as age, poverty, and education were controlled. Nursing science must accept the challenges of promptly identifying fatalistic individuals and the development of interventions to counteract its influence.