The May issue of IJGC featured as lead article the updated ESGO/ESTRO/ESP guidelines for the management of patients with cervical cancer, with the aim to offer 'evidence-based' options for patients diagnosed with this challenging disease.1 Developing and implementing 'evidence-based' clinical practice guidelines is critical for enhancing the quality of patient care, reducing practice variation, and ensuring the effective and efficient use of healthcare resources.2 While we all hope for level I evidence to help guide our decisions, this is simply not possible as level I evidence is often lacking. Therefore, we usually need to take into account the collective information from retrospective data to make decisions. This is what we do in clinical practice. However, for guidelines that are meant to be practice setting, great caution must be taken to make strong - or even any - recommendations based solely on retrospective data, especially if limited in the number of published results or conflicting results. Also, guideline consensus groups should not ignore available level I evidence and be very cautious in introducing personal opinions into such guidelines.