Background: Limited data exists for colorectal polyps in Asian population in U.S. Advanced polyps are considered as a high risk for CRC and require close surveillance. The aim of the study was to evaluate and compare the characteristics of polyps based on patient demographics, anatomic distribution, size, and histopathology in the Asian population living in one of the most heavily populated and diverse communities in U.S. Methods: We conducted a retrospective, single center chart review study of all asymptomatic Asian patients who underwent screening colonoscopy at a New York City hospital from Jan 2006 to Dec 2010. The patients without polyps were excluded from the study. Based on histopathology and size, polyps were divided into 2 groups: advanced and non-advanced. Results: Of the total 1,300 patients, 311 were found to have colon polyps. Mean age of the study population was 60.8 years (range 50-82). There were 173 males and 138 females, with male to female ratio 1.3:1. In gender analysis, 61% of the advanced polyps were found in males, however, the difference was not statistically significant (p = 0.255). 41% of patients had right sided polyps, 49% had left sided polyps, and 10% had bilateral polyps. Analysis showed significant increase in the proportion of patients with advanced polyps on left side (65%, p < 0.05). Large size (≥ 1 cm) of the polyp correlated with advanced nature of the polyp (p < 0.0001). On pathology review of the patients with polyps, 191 had non-advanced tubular adenoma, 38 had advanced tubular adenoma, 33 had hyperplastic polyp, 35 had villous/tubulovillous, and 13 had high grade dysplasia/colorectal cancer. Only 43 out of 86 patients (49%) with advanced polyps had follow-up colonoscopy. Conclusions: Polyps located on the left side were independently associated with advanced nature of polyp. Our results also revealed that large size polyps (≥ 1 cm) were strongly associated with being advanced in nature.Vigilant approach of the left side and large lesions should be exercised during screening colonoscopy in Asian Americans. Failure of the patients to follow up could be secondary to poor access to health care, language barrier, or health care beliefs. Efforts should be made to ensure adequate follow-up for surveillance colonoscopy.