Objective: Establishing the prevalence of premalignant and malignant cervical lesions amongst women living in the CARMEN initiative demonstration area, Bucaramanga, Colombia. Methodology: A cross-sectional study of 8,015 randomly selected women. Patients having abnormal cytology results received individualised diagnosis/treatment (colposcopy, biopsy, or conisation). Histopathological findings were correlated with demographical data and their sexual and reproductive history. Results: 8,071 women answered the survey but only 2,698 had up-to-date Pap smears (34.9%; 95%CI 17.2%-29.8%); 1,660 accepted updating their smears. 2.2% (95%CI 1.8%-2.6%) had Pap smears positive for cervical lesions, this being higher in those living with more mature women. Pre-malignant and malignant cervical lesion prevalence was 1.1% (95%CI 0.8%-1.4%). Women with pre-malignant or malignant cervical lesions were younger, had begun their sexual intercourse earlier and had had more sexual partners than healthy women. Conclusions: Pre-malignant and malignant cervical lesion prevalence is higher than in other parts of the world. Pap smear coverage is very low. Early detection of cervical cancer must be intensified.