Purpose: The purpose of this study was to enhance adherence among older (aged 55 years and older) African American men enrolled in a cancer screening trial for prostate, lung, and colorectal cancer. For this study, we defined "adherence" as completing the trial screenings. Design and Methods: We used a randomized trial design. Case managers contacted intervention group participants (n = 352) at least monthly by telephone and provided information and referral services. The control group included 351 participants. Results: Among participants with low income, those in the intervention group had higher screening adherence rates than did participants in the control group for (a) prostate-specific antigen test for prostate cancer (74.3% vs 53.0%, p = 0.001), (b) digital rectal exam for prostate cancer (66.2% vs 46.1%, p = 0.011), and (c) chest x-ray for lung cancer (70.9% vs 51.3%, p = 0.012). We found no statistically significant differences in adherence rates for flexible sigmoidoscopy screening for colorectal cancer. In contrast, among participants with moderate-to-high income, we found no statistically significant differences in adherence rates between intervention and control group participants for any of the screening tests. Implications: The case management intervention was effective in enhancing adherence among participants with the lowest income, who in many studies are the most difficult to retain. (Contains 2 tables and 1 figure.)