1. My name is _______________ and I am [your position] with
April 2003
We all have good reasons to stay healthy: busy lives, careers, friends, and family who depend on us.
Whatever your reasons are, when it comes to caring for your own health, you’re in charge.
Having regular Pap tests is one important thing you can do to take care of yourself.
Hello/Good evening.
My name is _______________ and I am [your position] with
[your organization] .
I’m here today to help you understand the importance of the Pap test.
Ask group members to identify why they want to stay healthy.

2. Today’s discussion … Cervical cancer in Ontario
April 2003
Today’s discussion …
Cervical cancer in Ontario
Cervical cancer and its risk factors
Preventing cervical cancer:
What is a Pap test?
How is a Pap test done?
How often should I have one?
What do my results mean?
Today, we’ll talk about cancer of the cervix, its prevalence in Ontario, and its risk factors.
Then we’ll discuss the Pap test, what it is, how often you should have one, how the test is done and what your results mean.
If you have any questions at any time during this presentation, please feel free to ask. I’ll do my best to answer them.
Or, if desired:
Because our time is limited, please hold your questions until the end of the presentation. Then, we can take more time to talk together.
Ask members of the group to introduce themselves and briefly describe their reasons for attending the session.
Ask the group if they have any specific concerns they would like you to address.

3. Cervical cancer: 2008 Ontario
April 2003
Cervical cancer: 2008 Ontario
In 2008, 500 Ontario women will be diagnosed with cervical cancer
150 Ontario women will die from it
Each week: - about 10 women in Ontario develop cervical cancer
- about 3 women die from cervical cancer in Ontario
Some statistics about cancer of the cervix for Ontario women:
In 2008, it was estimated that cancer of the cervix would be diagnosed in 500 Ontario women, and that 150 women would die from it.
In Ontario each week about 10 women develop and about 3 women die from cervical cancer.
Although we’ve seen a drop in cervical cancer over the past few years, it is still the 8th most common cancer in Ontario women (5-year average ).
Cervical cancer is the second most common cancer in women aged 35 to 49, and the third most common cancer for women aged 20 to 34 ( ).
The death rate from cervical cancer increases with age, and is highest for women aged 65 and older.
Ask participants: “These statistics show that new cases of cervical cancer significantly outnumber deaths from cervical cancer. Do you understand why?”
The answer is because early detection and treatment help prevent deaths from cervical cancer. If more women received regular Pap tests, there would be fewer new cases.
Ask if anyone has questions about cervical cancer.
Source: National Cancer Institute of Canada and Canadian Cancer Society
“Canadian Cancer Statistics 2007”

4. April 2003
What is the cervix?
The cervix is the opening of the uterus, or womb. It is at the top of the vagina.

5. What is cervical cancer?
April 2003
What is cervical cancer?
An abnormality of the cells lining the surface of the cervix
Cervical cells can change
Changes usually occur slowly, often over several years
Early changes may resolve or they can develop into cancer
Sometimes cells of the cervix change. Cervical cancer is an abnormality of the cells lining the surface of the cervix.
Cervical cancer usually develops slowly, over many years, often without symptoms or warning signs.
Early changes in cervical cells are called abnormal cells, not cancer. These abnormal cells sometimes change back to normal on their own.
If left untreated, unhealthy cells are the first step leading to cancer of the cervix.
Pap tests can show unhealthy changes that can be treated before they become cancer.

6. Cervical cancer risk factors
April 2003
Cervical cancer risk factors
• Sexual activity now or in the past
• Sexual activity before age 18
Smoking
• Multiple sexual partners
• Human Papillomavirus (HPV)
Any woman who has ever been sexually active, even once, is at risk for cervical cancer.
Even if you don’t have sex any more, or have gone through menopause (when your periods or monthly bleeding stops), you are still at risk and should keep having Pap tests.
If you had sex when you were a teenager, it is even more important that you have regular Pap tests. Why? In puberty, cervical cells are not yet mature, and are therefore more susceptible to infection.
Smoking and second-hand tobacco smoke can cause mild cell changes on your cervix to progress to cancer.
Your risk of cancer of the cervix can also relate to the number of sexual partners you have had. Risk is also related to the number of sexual partners your partner has had.
Remember, though: you are at risk even if you have had only one sexual partner.
This is because more partners can result in increased exposure to Human Papilloma Virus, or HPV.
HPV is very common – in fact, it is likely that most women have been exposed to it at some time.
HPV is a virus that can cause genital warts. There are many different types of HPV. A few types of HPV have been definitely linked to cervical cancer.
The kind of HPV that causes warts does not cause cervical cancer.
Most HPV infections go away on their own without causing any kind of abnormality. Some, however, can develop into cervical cancer if left undetected and untreated.
Other “cofactors” may influence the development of pre-cancerous cell changes following HPV infections. These include smoking, poor eating habits and your own body’s defenses (immune system).
Women are at greater risk of developing cervical cancer if they have never had a Pap test or have them infrequently. Regular Pap tests can detect abnormal cells before they become cancerous.
Although the above are risk factors, the main message is that all women who have ever been sexually active are at risk and need regular Pap tests.
Some women may be uncomfortable with the link between sexual activity and cervical cancer and may not want to ask specific questions as part of a group. Others may have been victims of sexual assault or abuse. You should allow lots of time for women to express their concerns, and the opportunity for private discussion if necessary.

7. Cervical cancer can be prevented by having regular Pap tests
April 2003
Cervical cancer can be prevented by having regular Pap tests
Almost all cancers of the cervix can be stopped when early cell changes are found and treated
Unlike other cancers, cancer of the cervix is largely preventable.
Regular Pap tests can prevent up to 90% of cervical cancer cases.
Pap tests detect abnormal cervical cells. If abnormal cells are discovered in the pre-cancerous stage and treated properly, cervical cancer is almost 90% preventable.
If you have any unusual symptoms such as bleeding after sex or between periods, you should check with your health care provider or clinic even if your last Pap test was normal.

8. What is a Pap test? The Pap test looks at cervical cells
April 2003
What is a Pap test?
The Pap test looks at cervical cells
It can detect changes in these cells before changes become cancerous
Not a test for other cancers or STDs
A screening test not a diagnostic test
The Pap test is a simple procedure and it only takes a few minutes to do.
It is an easy way to find out if you have a healthy cervix, or if there are early cell changes that might develop into cervical cancer.
A Pap test does not check for other types of cancer in the reproductive system (such as ovarian, vaginal, or uterine cancer) or for sexually transmitted diseases like gonorrhea.
The Pap test is used as a screening test.
Screening tests are important because they identify a disease before symptoms occur. Then, if treatment is necessary, it can start early and is likely to be more effective.
(Note: Screening tests are different from diagnostic tests. Diagnostic tests are done to identify an existing illness that may already show some symptoms.)

9. How is a Pap test done? By a doctor or nurse practitioner
April 2003
How is a Pap test done?
By a doctor or nurse practitioner
Speculum: allows doctor or nurse to see the cervix
Small spatula and brush used to take samples of cervical cells
Internal exam after Pap test
It’s common to have mild spotting after the Pap test
Your Pap test should take a couple of minutes to do.
You will be asked to remove your clothing from the waist down, and to lie on your back on the examining table. You’ll have a sheet or gown to cover the lower half of your body. Your doctor or nurse will give you instructions on how to position your body.
She or he will place a metal or plastic instrument called a speculum into your vagina. The speculum opens the vagina slightly so your doctor or nurse can see your cervix. The handle of the speculum stays outside of your body. The speculum can be warmed with warm water.
After the speculum is inserted, your doctor or nurse may need to move it around a bit to find the cervix. Once she or he can see the cervix, the speculum will be fixed in place.
Your doctor or nurse will then use a small spatula and a tiny brush to gently remove a few cells from the surface of your cervix (or from in and around your cervix). A brush and a spatula are both used because there are two areas of the cervix that need to be screened.
You may feel a mild sensation when your doctor or nurse takes the cervical cell sample. It can feel like a mild period pain.
Your doctor or nurse will then release and remove the speculum.
The sample is sent to a laboratory to be read.
After your Pap test, your doctor or nurse should do an internal exam to check your vagina, uterus, and ovaries. He or she inserts their gloved fingers into your vagina to check your organs. This exam takes only a minute or so.
You may have some mild spotting of blood (not your period) after the Pap test. This is normal. You should check with your doctor or nurse if it seems a bit more than expected or if you are worried.
You may feel nervous or uncomfortable about having a Pap test. Choose a doctor or nurse you feel comfortable with. You can bring a friend or family member to stay with you while the test is being done.
Ask women in the group when they had their last Pap test and how they felt about the experience.

10. Pap tests are most effective when…
April 2003
Pap tests are most effective when…
you do not have your period
you have not had sex for 24 hours before the test
you have not used vaginal foams, medication or douches for 48 hours
you ask questions if you have any
You can do a few things to ensure your Pap test is as good as it can be:
You should not have your period on the day of your test. The ideal time for your Pap test is two weeks after the first day of your last period.
Don’t have sexual intercourse for 24 hours (or one day) before your test.
Do keep taking the birth control pill before your Pap test.

11. How often should I have a Pap test?
April 2003
How often should I have a Pap test?
Every year once you start having sex (intercourse)
If your tests are normal for three years in a row, then you will need a Pap test every two years - ask your doctor or nurse about how often you should have a Pap test
Have regular tests until at least age 70
Current Ontario Cervical Screening Guidelines recommend that women have Pap tests:
Every year once they start having sex (intercourse). Even if you haven’t been sexually active for a long time, you still need to have regular Pap tests.
Have the Pap test every year for the first three years. If the results of your tests are normal three years in a row, then you should have a Pap test at least every two to three years after that to ensure good health. Discuss with your doctor or nurse the best option for you.
It is very important for older women to have regular Pap tests at least until age 70. Changes in the cells of the cervix can happen in older women, even after menopause and even if there are no symptoms.
Ask the group if they understand these recommendations. Allow lots of time for questions.

12. How to relax during your Pap test
April 2003
How to relax during your Pap test
Remember it takes only a few minutes
Talk to your doctor or nurse about it
You may feel nervous, embarrassed, tense or uncomfortable about having a Pap test. Here are some suggestions for relaxing during the test:
Remember that the whole test takes only a few minutes.
If you feel nervous, or the thought of being examined brings up unpleasant memories, try talking about it. Ask your health care provider to explain what he or she is going to do.
...Cont’d.

13. How to relax during your Pap test
April 2003
How to relax during your Pap test
Take slow, deep breaths, wiggle your toes, think restful thoughts or focus on something else in the room
If your health care provider is male, a female assistant may remain in the room
Ask a friend or relative to come with you
Sometimes it helps to take some slow, deep breaths; wiggle your toes; think restful thoughts; or focus on something else in the room, like a picture or poster.
Remember, if your health care provider is male, a female assistant may remain during the test.
You can also ask a friend or family member to come with you.
Ask women to share their own techniques for relaxing during a Pap test.

14. Common reactions and feelings about the Pap test
April 2003
Common reactions and feelings about the Pap test
“I’m afraid the test will hurt.”
“I’ll be embarrassed.”
“I’ve never had a Pap test and never had a problem – I feel great.”
“I don’t need a Pap test because...
I’ve finished having children.
I’m in menopause.
I don’t have sex any more.”
The Pap test might be a bit uncomfortable, especially if you’re tense or nervous. It shouldn’t be painful, however, and it might help to remember that the test – and the discomfort – will last only a couple of minutes.
It’s normal to feel a bit nervous or embarrassed about your Pap test. You will become more comfortable with Pap tests as you make them a regular part of your medical check-ups.
Remember … changes in the cervix can occur without you knowing it, while you’re feeling great. Having regular Pap tests is the best way to help prevent cervical cancer.
Many women stop having Pap tests after they’ve finished having children. Women should continue having regular Pap test until at least age 70.
Even if you no longer have monthly periods, or are no longer sexually active, you’re still at risk for cervical cancer. It’s important to continue screening with Pap tests until at least age 70.
At this point, you may wish to discuss common reactions and feelings to and about the Pap test. Participants may want to know whom they can contact for information and support. Ask for suggestions about what kinds of questions to ask their health care providers.

15. April 2003
After your Pap test …
Your cervical cell sample is carefully checked for abnormal cells at a lab
The lab will report results to your health care provider’s office
Generally, your health care provider will call only if there’s a problem
If your test is normal, you can schedule your next Pap test in one or two years
After your Pap test, the glass slide with your name and information is sent to a laboratory. The slide is then stained with dye and examined under a microscope by a specially trained cytotechnologist*, who will look for abnormal cells.
If necessary, a pathologist** will further evaluate the sample.
The lab will report the results to your doctor’s office or health care clinic as soon as possible. Most health care providers will contact you only if your results are abnormal. You can also call in for your results.
Most times, your Pap test results will be normal.
If your test results are normal, you will need to have another test in one or two years. Ask your doctor or nurse when you should schedule your next Pap test.
*Cytotechnologists must have graduated from an accredited school of cytotechnology and successfully pass a special certification examination.
**Pathologists are physicians who complete a four- to five-year residency in pathology after medical school and are specially trained to make diagnoses by examining tissues or cells.

16. What if my test is abnormal?
April 2003
What if my test is abnormal?
The test may be inconclusive
You may have an infection
• The cells may be abnormal/ pre-cancerous
• The cells may be cancerous
If your Pap test is abnormal, you may be worried and wonder what it means. For most women, an abnormal Pap test result does not mean you have cancer.
Sometimes the test is simply inconclusive – in other words, the lab can’t tell what it means. Your health care provider may ask you to repeat the test.
Or, the test might show that you have an infection that can be treated with medicine like antibiotics.
An abnormal test may just mean that there are changes in the cells of your cervix. These cells can be treated before they turn into cancer. In most cases, the cells return to normal on their own. Your health care provider will probably ask you to have another Pap test in three to six months, to monitor the changes.
For some women, the abnormal cells do not change back and may become cancer cells if they are not found and treated. These are called pre-cancerous changes.
In rare cases, the Pap test may show cervical cancer. If this is the case, your doctor will refer you for treatment.
Like any medical test, the Pap test is not foolproof. In a small number of cases, it can miss an abnormality, which is known as a “false negative.”
It can also result in a “false positive” - cells are thought to be abnormal or cancerous, but are not.
Regular Pap tests will help reduce the chance that an abnormality will be missed.
Remember: Following up on an abnormal Pap result is your next most important step.
At this point in the presentation, you should pause and ask for questions about Pap test results.

17. Treatment for abnormal cell changes
April 2003
Treatment for abnormal cell changes
Repeat Pap test in 3 to 6 months
Colposcopy
Biopsy
Cryotherapy
Laser therapy
Cone biopsy/conization
LEEP
Surgery, radiation, chemotherapy
Your treatment plan will depend on the cell changes you have, your lifestyle and your needs.
Many specialists perform diagnostic and treatment procedures right in their own offices or you may be sent to a special clinic. Most treatments will take no more than 15 to 30 minutes.
Sometimes, your doctor or nurse will ask you to have another Pap test in 3-6 months to see if your cells will change back to normal on their own. You may worry about waiting that long, but remember that three out of four abnormal Pap test results return to normal by the next test.
For more serious cell changes, you will be referred to a specialist (a colposcopist) who will look more carefully at your cervix with a colposcope. It is a special set of binoculars that helps your doctor see your cervix more clearly. The procedure is similar to a Pap test.
Your doctor may also take a biopsy (small piece of tissue from your cervix) for a closer look under a microscope in a lab. It is the only way to know for sure if the abnormal cells are cancer. You may feel a little discomfort and you may have some cramping or light spotting for several days afterward.
Several treatment options are available to treat or remove the cells in the problem area:
In cryotherapy, freezing temperatures are used to destroy abnormal cells.
With laser therapy, abnormal cervical cells are “zapped” by a high-energy light beam.
In a cone biopsy or conization, a small cone-shaped piece of the cervix is removed where the abnormal cervical cells are found.
In a Loop electrosurgical excision procedure (LEEP), a loop of thin wire is used to remove tissue where abnormal cervical cells are found.
Cancer of the cervix can be treated with surgery, radiation, chemotherapy and other treatments.
After treatment, it’s more important than ever to continue having regular Pap tests. Your health care provider will let you know when to return for your next Pap test.

18. Things to remember 1. A Pap test can help prevent cervical cancer
April 2003
Things to remember
1. A Pap test can help prevent cervical cancer
2. Most results from Pap tests are normal
3. Most abnormal results are easily treated
1. A Pap test can help prevent cancer of the cervix by detecting early cell changes that can be easily treated.
2. Most Pap test results are normal and most cell changes aren’t cancer.
3. 1 in 10 tests are abnormal; most will return to normal.
...Cont’d.

19. April 2003
Things to remember
4. Cervical cancer can take up to 10 years to develop
5. All women who have ever been sexually active should have regular Pap tests
6. After three normal tests, Pap tests should be repeated at least every two years
3. Most unhealthy cell changes will either clear up naturally or are easily treated.
4. Cancer of the cervix may take up to 10 years to develop. Having regular Pap tests means that changes can be found and treated early.
5. All women who have ever been sexually active should have regular Pap tests.
6. If for three years in a row your Pap tests are normal, your Pap test should be repeated at least every two years.
...Cont’d.

20. Things to remember 7. Older women need Pap tests, too
April 2003
Things to remember
7. Older women need Pap tests, too
8. A Pap test checks for cervical cancer only not other cancers or STDs
9. When in doubt, check with your health care provider
10. If you have a male health care provider, you can ask to have a woman stay with you during your Pap test
7. It’s very important for older women to have regular Pap tests until at least age 70. Cell changes can happen in older women, even after menopause and even if there are no symptoms.
8. A Pap test does not check for other types of cancer in the reproductive system or for sexually transmitted diseases.
9. If you have any unusual symptoms, such as bleeding after sex or between periods, you should check with your health care provider or clinic – even if your last Pap test was normal.
10. If you prefer a female health care provider, it’s perfectly all right to request one. If one is not available, remember that a female nurse or office assistant can be present during your Pap test. You can also ask a friend or family member to be there.

21. Take the time to test… Good health is for life
April 2003
Take the time to test… Good health is for life
Protect yourself
Avoid tobacco
Take care …
… and get regular Pap tests
You can do other things to take care of your health and help prevent cervical cancer:
Protect yourself: Always use a condom and limit the number of sexual partners.
Avoid tobacco smoke: Smoking and second-hand smoke can cause mild cell changes on your cervix to progress to cancer.
Take care: It is really important to eat well, exercise regularly and get enough rest.
Remember - if all women were screened regularly, almost all deaths from cancer of the cervix could be eliminated.
It is our responsibility to take charge of our health – to talk with our health care providers about having regular Pap tests, and understand the results.
Take care of yourself and make sure you have regular Pap tests. Do it for the people who love you and need you. But most of all, do it for yourself!

22. April 2003

23. April 2003