Cervical cancer is the first gynecological cancer among African women in terms of frequency and mortality. This cancer is easily accessible to prevention by human papillomavirus (HPV) vaccination and screening by pap smears combined or not with HPV test. In Fianarantsoa, Madagascar, screening methods have been available since 2010. Objectives of this study are to assess medical and paramedical knowledge about cervical cancer history, emphasize reality of this disease in the region, and update prevention and management of precancerous lesions. We found a lack of knowledge concerning cervical cancer history by doctors, nurses, and midwives. Twenty-two invasive cervical cancers have been observed in oncology and gynecology services. None of those women had undergone a planned screening. Screening rate by visual inspection after acetate application was 0.47% and by sporadic pap smears was 1.86%. Positive test was observed in 10% and 8.5%, respectively. Fifty-three women have undergone cryotherapy for precancerous lesions within four years. This study shows that real incidence of cervical cancer must be very high in the community, here in the region and probably in Madagascar, contrasting with misunderstanding of medical and paramedical staff. Screening policy should be put in place and efforts need to be done to increase the level of screening rate and improve prognosis and mortality by cancer.