Background: There has been a rapid rise in colorectal cancer (CRC) incidence in recent decades in many Asian countries. Age, gender, smoking, and family history are the significant risk factors of CRC. This study would like to develop an Asia-Pacific Colorectal Screening (APCS) score to identify subjects with high-risk for colorectal advanced neoplasia (AN) in Asia. Methods: A multicentre study was in 11 Asian cities. A total of 7,463 asymptomatic subjects underwent screening colonoscopy. The first 2,000 subjects were used as a derivation cohort. AN was defined as advanced adenoma and CRC. A multiple logistic regression was applied to the derivation cohort identifying significant risk factors for AN; odds ratios of significant risk factors were then utilized to develop APCS score ranging from 0-6, including age (0=40-49, 1=50-59, 2=60+), gender (0=female, 1=male), family history (0=absent, 1=present), smoking (0=no, 1=current or past), and Body Mass Index (BMI) (0= <23kg/m², 1= >23kg/m²). Three tiers of risk were defined: 0 ‘average risk’ (AR); 1-3 ‘moderate risk’ (MR); and 4–6 ‘high risk’ (HR). The APCS score was applied to the validation cohort as performance assessment. Results: The baseline prevalence of AN were 4.9% and 5.4% in the derivation and validation cohorts. In the validation cohort, 110 subjects (2.0%) were in AR, 4,148 subjects (75.9%) in MR, and 1,205 (22.1%) subjects in HR. Prevalence of AN in AR, MR and HR were 0.9%, 4.1% and 10.5% respectively. Compared with AR, subjects in MR and HR had 4.5-fold and 11.5-fold increased prevalence of AN. Conclusions: The APCS score based on age, gender, family history, smoking and BMI is a useful tool in stratifying asymptomatic Asians for priority of CRC screening.