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Background Lung cancer has been the leading cause of cancer death in China since the 1990s, and the disease burden is predicted to increase. The US National Lung Screening Trial (NLST) showed that annual low-dose CT resulted in a 15–20% mortality reduction in high-risk populations compared with chest x-ray, and the China National Cancer Center would like to confirm this finding in the Chinese population. Additionally, China has not yet developed national guidelines for lung and colorectal cancer screening, and scientific evidence from the Chinese population is needed to inform policy making. The China Cancer Screening Trial Feasibility Study seeks to obtain information necessary to design a long-term randomised lung and colorectal cancer screening trial. The primary objectives are to develop and test all data forms and data collection procedures; to assess the feasibility of recruitment and randomisation of participants into study arms, and the success of randomisation by comparing the distribution of baseline variables across arms, contamination in each arm, and compliance with screening exams and diagnostic follow-up after positive screening in each arm; to determine the positivity rates at each screening round in each arm; to identify and collect data for cancers in each arm over the study period; to develop and test procedures that collect and store biological samples; and to assess the performance of the organisations involved in designing, conducting, monitoring, and managing the study. Methods The study has been set up in three cites (Changsha, Hunan province; Lanzhou, Gansu province; and Haining, Zhejiang province) since August, 2014. Individuals at elevated risk of lung cancer were randomised into three arms: annual low-dose helical CT exams for 3 years (T0, T1, T2) and baseline colonoscopy (T0); two low-dose helical CT exams (T0, T2) plus annual faecal immunochemical test (OC-faecal immunochemical tests at T0, T1, T2); and annual InSure-faecal immunochemical tests combined with Septin 9 test (T0, T1, T2). A randomly selected 6 or 9 block size was used for randomisation. Staff at screening centres and all the participants were blinded to the order of randomisation, and enrolment was done by each screening centre. All participants will be followed for at least 3 years from randomisation to yield data stated in the study objectives. This study was approved by the ethics committee of Cancer Hospital, Chinese Academy of Medical Science, in June, 2014 (14-058/848). All participants signed informed consent forms before recruitment. Findings As of March 31, 2015, 2700 eligible participants, 900 in each study centre, were randomised into the three arms. Participants were stratified on the basis of sex and age (50–54 years, 55–59 years, 60–64 years, 65–69 years, and 70–74 years) in each centre. Low-dose spiral CT abnormality and non-calcified nodule/mass distribution were assessed. In each arm, compliance with the screening exams, positivity rates at the baseline screening, and compliance with diagnostic follow-up after positive screening exams were also studied. Interpretation This is the first randomised trial of lung and colorectal cancer screening in China. Results from the Feasibility Study will help to develop a practical design for the Randomised Cancer Screening Trial in China. Funding Cancer Institute and Hospital, Chinese Academy of Medical Sciences, and The National Health and Family Plan Committee of China.