Background: Currently, a comprehensive program for screening and early detection of cervical cancer doesnot exist in Iran. This study aimed to determine the prevalence of abnormal Papanicolaou (Pap) smears andsome related factors among women living in Zanjan, Iran. Materials and Methods: This cross-sectional studywas conducted in 2012 in Zanjan on 4274 married women aged 20-65 years. The study participants were selectedthrough two-stage cluster sampling. After obtaining written consent, demographic and fertility questionnaireswere completed. Samples from cervix were obtained through a standard method using the Rover Cervex-Brush. Evaluation and interpretation of the samples were reported using the Bethesda 2001 method. Data werestatistically analyzed using chi-square and logistic regression models. Results: Most inflammatory changes in thesamples were mild (37.4%). Abnormal atypical changes in the epithelial cells were found in 4.04%. The highestpercentage of abnormal changes in the epithelial cells was atypical squamous cells of undetermined significance(ASCUS) (1.9%). Abnormal results of Pap smear was significantly and independently associated with age,papillomavirus infection, and lack of awareness about Pap smear tests. Conclusions: Given the high prevalenceof inflammatory and precancerous changes in this study, compared to other studies in Iran and other Muslimcountries, and the effect of demographic variables and individual factors on abnormal results, increasing theawareness of women and their families regarding the risk factors for cervical cancer, preventive measures suchas screening, and timely treatment seem necessary.