Objective: To analyze the status of colorectal cancer screening results in Shangcheng District, Hangzhou City from 2020 to 2022, so as to provide the evidence for developing prevention and control strategies for colorectal cancer. Methods: According to Colorectal Cancer Screening Program for Zhejiang Key Populations, residents registered in Shangcheng District and at ages of 50 to 74 years were recruited and screened using Zhejiang Provincial Questionnaires for Assessment of Risk of Colorectal Cancer Screening among High-risk Populations and fecal immunochemical test (FIT). Residents positive for questionnaires or FIT, or both positive for questionnaires and FIT were served as a positive screening and colonoscopy should be underwent. The rates of positive screening, compliance of colonoscopy and different pathological diagnosis results were analyzed. Results: Totally 118 227 residents were screened in Shangcheng District from 2020 to 2022, with a positive rate of 16.00%. The positive rates of questionnaires, FIT and both questionnaires and FIT were 8.14%, 6.46% and 1.40%, respectively. Colonoscopy was performed among 6 501 cases, with a compliance rate of 34.37%. Colonoscopy detected 3 689 cases with colorectal lesions, with a detection rate of 56.75%. The detection rates of colorectal cancer, pericancer lesions and other benign lesions were 1.12%, 9.15% and 46.47%, respectively. The detection rates of positive screening, colorectal lesions and pericancer lesions were higher in men (22.16%, 61.25% and 12.45%) than those in women (11.62%, 51.98% and 5.67%; all P<0.05). The detection rates of positive screening, colorectal lesions, colorectal cancer and pericancer lesions appeared a tendency towards a rise with age (all P<0.05). The detection rates of positive screening and colorectal lesions appeared a tendency towards a decline, and the compliance rate of colonoscopy appeared a tendency towards a rise from 2020 to 2022 (all P<0.05). The detection rate of pericancer lesions was higher among questionnaire and FIT positive residents (65.37%, P<0.05). Conclusions The detection rates of colorectal cancer and pericancer lesions in Shangcheng District from 2020 to 2022 were 1.12% and 9.15%, respectively. Men, the elderly, questionnaire and FIT positive residents are key populations, and the compliance of colonoscopy for the populations should be improved.