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Purpose:There is no national policy for colorectal cancer (CRC) screening in Saudi Arabia (SA) despite the increasingly early onset of CRC in high-income countries. This study aims to assess the participation and impact of a CRC screening program in central area of Saudi Arabia. Methods:The guaiac fecal occult blood test (g-FOBT) was used as a first-line, non-invasive screening test to select patients for colonoscopy. The g-FOBT (+) Saudis, aged 45–76 years old (yo), were provided colonoscopies regardless of their risk of developing CRC or the presence of symptoms. Results: The first-round participation rate was 73% (35640/48897). The average age was 53 yo (range 45-75), 49% were female (17464/35640), 76% were asymptomatic, 13% underwent sigmoidoscopy, and 77% were well-prepared. The g-FOBT (+) rate was 6.3% (n = 2245), and 76% (n = 1701) of these underwent lower GI endoscopy. The prevalence of CRC was 4.8% (81/1701), advanced adenoma 9.5% (162/1701), adenoma 15.9% (270/1701), non-adenoma polyps 7.9% (135/1701), and no polyps or tumors 25.4% (432/1701). Other findings were internal hemorrhoids 32% (60/1701), colitis 24% (45/189), diverticulosis 7.9% (135/1701), and diverticulitis 2.6% (27/1053). Among young people volunteers CRC incidence was high, 1/3 of those with CRC with female predominance, above age 50 volunteers with CRC were more likely male, had older age, and among all CRC was at the left site colon (p < 0.005) during endoscopy. Conclusions: Low numbers of advanced adenomas and cancers were detected in the first round of CRC screening, however early onset CRC is rising. Screening participation was low, and public education is necessary along with expanded colonoscopy resources.