Updates of the current screening guidelines for the early detection of cervical cancer

cancer in Korea has been released in this journal [1]. It was developed based on preexisting guidelines generated by the American Society for Colposcopy and Cervical Pathology (ASCCP) [2], the National Comprehensive Cancer Network [3], the United States Preventive Services Task Force [4], and the Institute for Clinical Systems Improvement [5]. Coincidentally, updated versions of ASCCP guideline [6] and American Cancer Society (ACS) guideline [7] have been issued around the same time. Therefore, the updated contents of the abovementioned guidelines are not reflected in ours. The essential changes of the 2012 ASCCP guidelines from prior 2006 version are as follows [6]: 1) cytology reported as negative but lacking endocervical cells can be managed without any repeat, 2) cytology reported as unsatisfactory requires repeat even if human papillomavirus (HPV) is negative, 3) For atypical squamous cells of undetermined significance (ASC-US) cytology, immediate colposcopy is not an option. The serial cytology option for ASC-US incorporates cytology at 12 months, and then if negative, cytology every 3 years, 4) ASC-US and HPVnegative results should be followed with co-testing at 3 years rather than 5 years, 5) ASC-US and HPV-negative results are insufficient to allow exit from screening at age 65 years, 6) women aged 21-24 years are managed conservatively. Recently reported rates of cytology results reported as negative but lacking endocervical cells have ranged from 10% to 20% [8]. Prior guidelines recommended early repeat cytology [9]. A recent meta-analysis found that negative cytology had favorable specificity and negative predictive value despite absent endocervical cell component [10]. Given that most cytology is performed using liquid-based media, unsatisfactory cytology results arise mainly from insufficient squamous cells [11]. The 2012 ASCCP guidelines recommended repeat cytology in 2 to 4 months for women with an unsatisfactory cytology result. Those two issues regarding specimen adequacy were not included in our guidelines. The management of women with ASC-US has also been Expert Opinion