<p>Early cancer screening is globally acknowledged as a key strategy for reducing cancer mortality and improving treatment efficacy, and has been integrated into core public health policies in many countries. To assess the effectiveness of early cancer screening programs in China and to inform targeted screening strategies for high-risk populations, we examined trends in screening adherence and detection rates for five cancers among individuals aged 40–74 in Nanchang, China. From 2018 to 2022, we used the Cancer Risk Assessment Questionnaire to evaluate cancer risk, referring high-risk individuals to designated hospitals for free clinical screenings by appointment. During this period, 75,554 participants were assessed. The results revealed an overall high-risk rate of 54.12%, with no significant gender difference (53.86% for men and 54.29% for women). The highest risk rate, 61.88%, was observed in the 65–69 age group. Among the cancers studied, lung cancer had the highest risk (29.54%), followed by colorectal (26.02%), upper gastrointestinal (21.40%), breast (20.22%), and liver cancer (11.58%). Notably, all cancer types except breast cancer had higher risk rates in men. The participation rate for breast cancer screening was the highest, followed by those for lung cancer, liver cancer, colorectal cancer, and upper gastrointestinal cancer. As the program progressed, we observed a decrease in the overall high-risk rate and an increase in screening adherence for lung and colorectal cancers. Future efforts should focus on improving screening and monitoring risk factors for the 65–69 age group. Additionally, enhancing awareness campaigns for lung cancer, refining screening methods for upper gastrointestinal cancers, and increasing participation in screening programs are crucial.</p>