Objective: To investigate the prevalence of colorectal cancer in Yongjia County, Zhejiang Province from 2020 to 2021, so as to provide insights into colorectal cancer control. Methods: Residents registered in Yongjia County at ages of 50 to 74 years were sampled, and positive populations were screened using Zhejiang Provincial Questionnaires for Assessment of Risk of Colorectal Cancer Screening among High-risk Populations and fecal occult blood test, and those positive for questionnaires or fecal occult blood test served as a positive screening. Residents with a positive screening underwent colonoscopy, and the detection of high-risk lesions (colorectal cancer and pericancer lesions) was analyzed among those positive for questionnaires, fecal occult blood test and screening. Results: Totally 102 504 residents were tested, and 46 138 (45.01%) residents completed questionnaire surveys and fecal occult blood tests. The rate of positive screening was 21.10%, and the rate of positive questionnaire surveys was 7.13%, while the positive rate of fecal occult blood test was 15.16%. The rate of positive screening was significantly higher in men than in women (27.06% vs. 17.14%; (χ2=654.747, P<0.001), and there was an age-specific proportion of positive screening (χ2=418.264, P<0.001), with high prevalence seen in residents at ages of 65 to 69 years (26.43%) and 70 to 74 years (24.98%). Colonoscopy was performed among 2 966 residents, with a compliance rate of 30.47%, and colonoscopy detected 348 residents with high-risk lesions, including 317 cases with pericancer lesions and 31 cases with colorectal cancer, with 11.73% detection of high-risk lesions and 1.05% detection of colorectal cancer. The prevalence of high-risk lesions was significantly higher in men with positive screening than in women with positive screening (15.77% vs. 7.59%; χ2=47.915, P<0.001), and there was a significant difference in the detection of high-risk lesions among residents with positive screening at different age groups (χ2=25.909, P<0.001), with a high detection in residents at ages of 65 to 69 years (14.32%) and 70 to 74 years (15.49%). Conclusions The prevalence of high-risk lesions of colorectal cancer is 11.73% among residents living in Yongjia County at ages of 50 to 74 years, and men and the elderly at ages of 65 years and older are high-risk populations for colorectal cancer. Improving the awareness of colorectal cancer prevention knowledge and the compliance of colorectal cancer screening is recommended.