Use this as your introduction Adapt the presentation to your group. Some slides will not be necessary for all groups.

Cancer a growth that makes you sick having Pap tests and looking after problems can prevent most cancer of the cervix

Facts about cancer of the cervix it grows slowly it can be cured if found and treated early most can be prevented by regular screening Explain: -On average, cervical cancer takes 10-15 years to grow to a point where it is invasive. -we never say “all” cancers can be prevented. We say “most”. This is because: -There are rare types of cancers that could potentially be undetected by a pap test. -About 1 in 5 Pap tests are read as “normal” when in fact there is dysplasia present. This is due to human error of the health provider, the laboratory cytotechnologist or the patient and this error rate is considered normal. That is why women should have 3 normal tests one year apart before extending the interval to 2 years. Emphasize: -Cervical dysplasia (early changes) and early cancer of the cervix often do not have symptoms. You can feel healthy and have early cancer of the cervix. -the majority of women who die from cervical cancer have either never been screened or haven’t been screened in more than 5 years.

Cervical Cancer in Manitoba about 52 women are diagnosed with cervical cancer every year in Manitoba 22 die from it having Pap tests and follow-up treatment for abnormalities can prevent most cancer of the cervix.

The Pap Test can find changes in the cells of the cervix treating these changes may prevent them from changing to cancer

The Pap Test is done at the your health care providers office, clinic, health centre or nursing station you will be asked to undress from the waist down, but you will be given a gown Emphasize: -the test is over within a couple of minutes.

What are they looking for? Explain: -the Pap test look for problems on the cervix. -it looks for changes before it is cancer -if you fix the changes you reduce the risk for cancer of the cervix

Explain: -that this is the female reproductive system. -outline where the ovaries, fallopian tubes, uterus and vagina are

Explain: -the cervix is located at the bottom of the uterus or at the top of the vagina -the uterus is where your babies grow when you’re pregnant -the cervix is what dilates or stretches to allow babies to come out

The Cervix Explain: -this is the view your health care provider will have of your cervix when providing your Pap test -the small opening in the centre of the cervix is called the “os”. This is what dilates, or stretches to allow babies through the birth canal.

Explain: -a speculum is inserted into the vagina in order to get a good view of the cervix -your health care provider will use a thin wooden stick called a spatula and a soft cervical brush called a cytobrush to remove cells from the cervix. -the Pap test should not be painful, however, some women do find this test uncomfortable. If you do experience some discomfort let your health care provider know.

Explain: -the cells taken from the cervix are placed on a slide. The slide is then sprayed with a fixative and transported to the lab for examination.

Who needs to have a Pap test? If you have ever had sex, even once, you need Pap tests If you are not sure, discuss with your doctor Encourage: - women to be absolutely honest with themselves. Explain: -even if they had one partner a very long time ago and have never been sexually active since - they have had sex.

Why do women who are sexually active have to have Pap tests? HPV (human papilloma virus) is a common virus spread through sexual contact this virus can cause cervical cancer you may not know you have this virus Explain: -HPV is called Human Papilloma Virus. -HPV is transmitted through sexual contact (includes intercourse and close intimate touching) -condoms may provide some protection but should not be relied upon to prevent HPV -if left untreated on the cervix, HPV can cause cervical cancer -most people who have HPV have no symptoms and feel healthy -you can pass it on to others without knowing it. - some types of this virus can cause changes in the cells of your cervix that can lead to cancer

How can I reduce my risk? not having sex is the surest protection delay sex until late teens or older avoid cigarette smoke limit the number of lifetime partners keep your body healthy and strong

What is the best thing you can do to reduce your risk? Have regular Pap tests!

How can I help the test? do not put anything into your vagina for 48 hours do not have sex for 24 hours try to make your appointment for mid-cycle Explain: -the use of lubricants, jellies or the presence of semen or blood in the sample of cells put on the slide may obscure the cervical cells on the slide, increasing the possibility that the Pap test could result in a “false negative” (interpreted as normal when it is not) or with be an unsatisfactory smear (meaning that no diagnosis is made and the test needs to be repeated). Note: Not every woman has control over when she has sex. Re-inforce that even if a woman has had sex within 24 hours she should not cancel her appointment. The test would be better if she had not had sex but it is still better to be screened.

How can I help the test? sex

How often do I need a Pap test? Every year Pick a day that is easy to remember If you have had 3 normal results 3 years in a row, then you can go every 2 years -Advise women to pick a season change or Birthday to remind them that it is time to have a Pap test.

First screen 2008 OK Next screen 2009 OK Next screen 2010 OK Next 2014 OK Next screen 2012 OK Explain: -screening should commence with sexual activity. -after 3 normal Pap tests at 1 year intervals, screening can be continued every 2 years. -women who have not been screened for more than 2 years, should be screened annually until there are three consecutive normal Pap tests, after 3 consecutive negatives, every 2 years.

Where do I go for a Pap test? your doctor or nurse call or visit our website to find a list of clinics offering Pap tests in your community the Pap test is free

Explain: -in Winnipeg there are a number of places you can go for a Pap test

If you are frightened or shy… take a friend ask for a woman to be there ask for a female to do the test (when you make appointment)

Does the Pap test check for infections? No Explain: -Pap test only looks for changes on cells of the cervix. -STI check needed if woman concerned about sexually transmitted infections etc. Tell women that the test for infections can be done at the same time as the Pap test. -explain that the Pap test does not check the ovaries or uterus. This is also a separate test, but that can also be done at the same time as your Pap test.

I had a hysterectomy… do I still need a Pap test? maybe…ask your doctor or nurse Explain: -a woman she speak with her doctor or nurse to determine if she still needs pap tests post hysterectomy. A woman who has had a hysterectomy may be able to stop having Pap tests if: She has had a total hysterectomy (this should be confirmed with her doctor) The hysterectomy was for benign conditions, ie. the hysterectomy was NOT because of cancer (this should be confirmed upon pathology with her doctor) All previous pap tests have been normal Note: -women do not always know or understand their medical history. The factors discussed above should be confirmed with her medical team to ensure she qualifies as somebody that may be able to stop having Pap tests.

I am past menopause… do I still need a Pap test? Yes

When can I stop having Pap tests? At 70 years of age you may be able to stop Talk to your health care provider

Where can I get my results? your doctor or nurse or, the Manitoba Cervical Cancer Screening Program

The Manitoba Cervical Cancer Screening Registry central confidential you can access your results and history your health care professional has access to your results you can opt out Explain: -women between 18 and 69 are automatically in the Manitoba Cervical Cancer Screening Registry. Action is required if a woman does not want to be part of the program. It is suggested that women who are thinking of opting out, first read the brochure – Registry – fact and Information and then talk to their health provider before making a final decision. Refer to: -the “blue” MCCSP brochure “Registry - Facts and Information” Reinforce: -women do not have to do anything to be part of the program. Action is required if they do not want to be part of the program.

* screening is still required * The HPV Vaccine Explain that: -there are over 100 types of HPV -over 70% of cervical cancers are caused by HPV 16 & 18 -Gardasil targets 16, 18, 6 & 11 (6 and 11 cause 90% of genital warts) -Cervarix targets 16 & 18 -vaccination should ideally occur prior to infection with HPV -screening is still required, because the vaccine does not cover other HPV’s that can still cause cervical cancer -the vaccine is non-therapeutic – it cannot be used to treat existing HPV infections -in the 2008/2009 school year, the HPV Vaccine will be implemented in Manitoba schools and provided on a voluntary basis for grade 6 girls. -the vaccine is covered for any grade 6 girl receiving the vaccine -at this time, the vaccine is not covered for other women wishing to obtain it. Gardasil = HPV 16, 18, 6 & 11 (Cervarix = 16 & 18) * screening is still required *

Resources Explain: -the MCCSP has a wide variety of resources available in many different languages -these resources are available to you for free -simply call the program or visit the website Available in the following languages: English, French, Cree, Ojibwe, Chinese, German, Hindi, Polish, Portuguese, Punjabi, Spanish, Tagalog, Vietnamese, Amharic, Somali, Swahili, Farsi, Russian, Serbo-Croation, Arabic, Korean, Ukranian, Urdu, Italian, Dinka, Cree Roman.

DVD’s and Video’s Explain that: -we have 2 videos -they can be found on our website and in libraries across the province -available in 12 languages Available in the following languages: English, French, Chinese, Cree, Hindi, Ojibwe, Portuguese, Punjabi, Spanish, Tagalog, Urdu, Vietnamese

When was your last Pap test? Are you due?

Remember… most cervical cancers can be prevented!

We are here to answer your questions! For more information: you can call the MCCSP at 788.8626 or 1.866.616.8805 or visit our website www.cancercare.mb.ca/mccsp/