Introduction: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States and thethird most common malignant neoplasm worldwide. Chinese Americans are one of the ethnic minority groups whohave the lowest rates of CRC screening. The purpose of this study was to describe CRC screening among lessacculturated Chinese Americans and to identify factors associated with CRC screening. Methods: We performed areview of 383 patients’ medical records at a large community health clinic in Seattle’s metropolitan area betweenJuly 2003 and September 2004. Outcome measurements included receiving fecal occult blood testing (FOBT) in thelast 12 months, sigmoidoscopy in the previous 5 years and/or colonoscopy in the past 10 years. Compliance withCRC screening was assessed by documentation in patients’ medical records. Results: The overall use of CRC screeningper guidelines was 40%. Only 72(19%) patients had their FOBT test in the last 12 months. Eighty one patients (21%)had colonoscopy in the last 10 years and eleven (3%) of the patients had sigmoidoscopy in the last 5 years. Chisquareanalyses revealed no significant differences between users and non-users of FOBT, sigmoidoscopy, andcolonoscopy in terms of age, gender, insurance status or language. Discussion: Participation in CRC screeningamong less acculturated Chinese Americans was lower than rates derived from previous self-reported surveys.Research of effective preventive programs promoting annual FOBT is vital to increasing the use of CRC screeningamong this population.