CONTEXT: Racial differences in receipt of cancer prevention services may be related to poorer outcomes for minorities. Understanding reasons for such differences could help target appropriate interventions. OBJECTIVES: To determine if racial differences exist in the use of cancer prevention services among older blacks and whites and to explore explanatory factors. DESIGN: Sixth follow-up survey of probability sample, four-stage stratified household design with 4,162 at baseline in 1986-1987 and 2,846 surveyed in 1992-1993. SETTING: The Piedmont area of North Carolina. PARTICIPANTS: At time of follow-up survey in 1992-1993 there were 1,486 women and 726 men age >70 years, of whom 1,246 were black and 966 were white. MEASUREMENTS: Self-reported use of Papanicolou (pap) testing, clinical breast examination, mammography, rectal examination, and fecal occult blood testing on a regular basis within the last two years. RESULTS: Compared with older whites, older black persons are less likely to receive pap test (48.1% black vs 56.6% white, P < .001), clinical breast examination (64.6% black vs 69.2% white, P < .007), mammography (30.2% black vs 40.5% white, P < .001), rectal examination (50.2% black vs 62.4% white, P < .001), and fecal occult blood testing (37.5% black vs 46.2% white, P < .001). Effect of race on receipt of cancer prevention services was not significant when levels of education, income, and insurance coverage were considered. CONCLUSION: Racial differences exist in the use of cancer prevention services among older Americans. However, these differences are related to educational, income, and insurance differences between blacks and whites.