Background: Cervical cancer (CC) remains a significant public health concern affecting women globally, with an estimated 604,000 new cases and 342,000 deaths reported in 2020. It ranks as the fourth most prevalent cancer and the fourth leading cause of cancer-related mortality among women. 
Methods: A cross-sectional study was conducted at the Gynecology Clinic of Edward Francis Small Teaching Hospital (EFSTH). Participants were selected through a single-stage cluster sampling technique. The sample size was calculated using Epi Info version 7.2.5, and data were entered, cleaned, and analyzed using SPSS version 20. Statistical significance was set at p < 0.05.
Results: A total of 362 reproductive-age women participated. The majority 336 (92.8%) exhibited poor knowledge of cervical cancer. While 290 (80%) of the respondents had a positive attitude toward prevention, 292 (80.7%) demonstrated poor practice, as they had never undergone screening. Only 70 (19.3%) had been screened at least once. Educational status (p = 0.00, V = 0.4) and religion (p = 0.04, V = 0.1) were associated with good knowledge levels. Additional associations were observed between sociodemographic variables and attitudes or practices, although screening uptake remained generally low.
Conclusion: There is a clear disparity between the positive attitude toward cervical cancer prevention and the actual preventive practices among women in The Gambia. Strengthening education and improving access to screening are essential to reduce the burden of cervical cancer in The Gambia.