2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.

To the Editor: I have a question about the article by Massad et al in the April 2013 issue of the journal. On page 840, the authors state, "For women aged 21–24 years with CIN 1 after ASC-H or HSIL cytology, observation for up to 24 months using both colposcopy and cytology at 6-month intervals is recommended, provided the colposcopic examination is adequate and endocervical assessment is negative (BIII).” Yet, on the same page, under the heading "Management of Women With CIN 1 or No Lesion Preceded by ASCH or HSIL," the recommendation is, "When CIN 2+ is not identified histologically, either a diagnostic excisional procedure or observation with co-testing at 12 months and 24 months is recommended, provided in the latter case that the colposcopic examination is adequate and the endocervical sampling is negative." Why is the recommended management for women aged 21–24 years more aggressive than for older women?