When is the next Pap smear due for a 55-year-old postmenopausal female with a recent Normal (NILM) Pap smear and negative High-Risk Human Papillomavirus (HPV) result?

Next Pap Smear Due Date for 55-Year-Old Postmenopausal Woman with Normal Results

For a 55-year-old postmenopausal woman with a normal Pap smear (NILM) and negative high-risk HPV test on 7/21/2025, the next Pap smear should be performed in 5 years (in 2030).

Rationale for 5-Year Screening Interval

The 2021 CDC Sexually Transmitted Infections Treatment Guidelines recommend the following screening approach for women in this age group:

• For women aged 30-65 years, the preferred approach is cotesting with HPV and cytology every 5 years 1
• When both the Pap test is normal (NILM) and the HPV test is negative, as in this case, the recommended interval is 5 years 1

This recommendation is consistent with the American Cancer Society guidelines which state that for women aged 30-65 years, cotesting with HPV and cytology every 5 years is the preferred approach 1.

Risk Assessment

The risk of developing high-grade cervical neoplasia (CIN3+) after a negative cotest (normal cytology and negative HPV) is extremely low. Research has shown that:

• Women with negative HPV tests have a very low risk of developing cervical precancer or cancer within 5 years 2
• The long-term risk of high-grade neoplasia after an initial negative HPV test and normal cytology is minimal 2

Special Considerations for This Patient

For this 55-year-old woman:

• Her age (55) places her in the 30-65 year screening category
• Both test components were negative (NILM cytology and negative high-risk HPV)
• Being postmenopausal does not alter the screening recommendation in this case

Exit Strategy from Screening

It's worth noting that if this pattern of normal results continues:

• Cervical cancer screening may be discontinued after age 65 if the woman has had:
  • At least 3 consecutive negative cytology tests, or
  • At least 2 consecutive negative cotests within the 10-year period before ceasing screening 1
  • The most recent test should have occurred within 5 years 1

Common Pitfalls to Avoid

1. Don't confuse management guidelines for abnormal results with routine screening intervals: Some clinicians mistakenly apply the 3-year interval (used for cytology-only screening) to women with normal cotests.

2. Don't stop screening prematurely: While this patient is approaching the age where screening might eventually be discontinued (65 years), she still requires regular screening at 5-year intervals until meeting exit criteria.

3. Don't over-screen: Annual Pap testing in HPV-negative women with normal cytology provides little clinical value and may lead to unnecessary procedures and psychological distress due to false-positive results 2.

In summary, this patient should return for her next cervical cancer screening in 5 years (2030) based on her current normal cotest results.