Does the HPV Vaccine Come With a Moral Hazard? Interview with:
“Syringe and Vaccine” by NIAID is licensed under CC BY 2.0
Ali Moghtaderi PhD MBA
Assistant Research Professor and
Avi Dor PhD
Professor of Health Policy and Economics
Milken Institute School of Public Health
George Washington University What is the background for this study?

Response: In this study, we investigate the effect of Human Papillomavirus (HPV) vaccination on participation in Pap test, which is one of the most effective cancer screening interventions. Cervical cancers are causally linked to HPV infections. The Pap test is a diagnostic procedure for early detection of cervical cancer. HPV vaccination provides partial protection against cervical cancer, and the Pap test is strongly recommended for women 21 to 65 years of age even after vaccination. If vaccination leads to a reduction in testing participation, it could contribute to greater incidence and severity of cervical cancer. Note that we focus on relatively older women (age 22 or older) who were not vaccinated at younger ages.  Continue reading

HPV Testing or PAP Smear To Screen for Cervical Cancer? Interview with:

Joy Melnikow, MD, MPH Professor, Department of Family and Community Medicine Director, Center for Healthcare Policy and Research University of California, Davis Sacramento, CA 95817

Dr. Melnikow

Joy Melnikow, MD, MPH
Professor, Department of Family and Community Medicine
Director, Center for Healthcare Policy and Research
University of California, Davis
Sacramento, CA 95817 What is the background for this study? What are the main findings?

Response: This systematic review of the medical literature was conducted to support the update of the US Preventive Services Task Force Recommendation.  Because the effectiveness of cytology (Pap smear) screening is so well established, the review focused on the evidence on use of high risk Human Papillomavirus (hrHPV) screening, alone (primary screening) or combined with cytology (co-testing) What should readers take away from your report?

Response: Current evidence supports the use of cytology, hrHPV testing alone, or co-testing as effective approaches to screening for cervical cancer.  hrHPV testing, alone or as co-testing, can be done at five year intervals, longer than the recommended 3 year interval for cytology. What recommendations do you have for future research as a result of this work? 

Response: Additional research is needed to identify effective strategies for outreach and screening women who are not regularly screened.  Because most women in the US are not part of an organized screening program, effective outreach is especially important in the US. Is there anything else you would like to add?

Response: Since the prior review, more evidence has emerged to support the use of hrHPV testing as primary screening.

I have no financial conflicts of interest. 


US Preventive Services Task Force. Screening for Cervical CancerUS Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674–686. doi:10.1001/jama.2018.10897


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Pap Tests: Why are Older Women Without a Cervix Still Getting Them? Interview with
Deanna Kepka, PhD, MPH  
Assistant Professor
College of Nursing & Huntsman Cancer Institute
University of Utah What are the main findings of the study?

Dr. Kepka: Nearly two-thirds, 64.8% (95% CI: 62.2% – 67.3%) of women reporting a hysterectomy also reported a recent Pap test since their hysterectomy and more than half,  58.4% (95% CI: 55.3% – 61.4%)  of women age 65 years and older without a hysterectomy reported a Pap test in the past three years.  Together, this represents approximately 14 million in the United States.
Continue reading