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Purpose Cancer of the cervix is the second most common cancer among women worldwide. Despite it is a serious public health problem in Sub-Saharan African countries including Ethiopia, formation on predictor of the precancerous cervical lesion is not well documented, particularly in the study area. This study aimed to identify the predictors of precancerous cervical lesions among women screened for cervical cancer in Bahir Dar town, North West Ethiopia, 2018/19. Patient and Methods Institution-based unmatched case–control study was conducted in selected health facilities in Bahir Dar town from November 15, 2018, to January 16, 2019. Data were collected from 102 cases and 305 controls using an interviewer-administered structured questionnaire and entered into Epi Data version 3.1, then export to SPSS version 23 for analysis. Variables with P-value ≤0.2 in the bivariate analysis were included in the multivariate logistic regression model. Odds ratio with 95% confidence interval was used to identify the predictors of precancerous cervical lesions. Results Women who initiated sexual intercourse before the age of 18 years (AOR = 1.68, 95% CI: 1.015–2.804), history of sexually transmitted infection (AOR =1.74, 95% CI: 1.087–2.790) and two or more lifetime sexual partners (AOR=1.733, 95% CI: 1.069–2.810) were predictors for a precancerous cervical lesions. Conclusion This study confirms that the initiation of sexual intercourse before the age of 18 years, having history of sexually transmitted infection, and two or more lifetime sexual partners were determinants for precancerous cervical lesions. So that it should be focused on prevention through early detection and treatment of sexually transmitted infection with condom promotion. Women with a higher risk of precancerous lesions should also be encouraged to be screened more frequently for cervical cancer.