1. Cervical Cancer Screening
I am here today to talk to you about Cancer of the Cervix.
Presenter: Lesley Dyck
Web, General
Manitoba Cervical Cancer Screening Program

2. What do you already know about cervical cancer screening?
What do you already know about cervical cancer screening?

3. Female body www.TellEveryWoman.ca Explain:
-that this is the female reproductive system.
-outline where the ovaries, fallopian tubes, uterus and vagina are

4. Female body www.TellEveryWoman.ca 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

5. HPV causes cervical cancer.
True or False?
HPV causes cervical cancer.

6. HPV causes cervical cancer.
True
HPV causes cervical cancer.
Explain:
-HPV is called Human Papilloma Virus.
-most people who have HPV have no symptoms and feel healthy
-you can pass it on to others without knowing it.

7. HPV HPV- Human Papillomavirus You may not know you have this virus
You can pass this virus without knowing it to men or women
Explain:
-HPV is called Human Papilloma Virus.
-most people who have HPV have no symptoms and feel healthy
-you can pass it on to others without knowing it.

8. HPV HPV spreads through sexual contact Some types cause
genital warts, or
cervical changes which can lead to cancer
HPV can cause problems for some women
Explain:
-HPV is transmitted through sexual contact (includes intercourse and close intimate touching)
-3 out of 4 people will come into contact with genital HPV in their lifetime.
-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
- some types of this virus can cause changes in the cells of your cervix that can lead to cancer

9. Most cervical cancer can be prevented.
True or False?
Most cervical cancer can be prevented.
Explain:
-HPV is called Human Papilloma Virus.
-most people who have HPV have no symptoms and feel healthy
-you can pass it on to others without knowing it.

10. Most cervical cancer can be prevented.
True
Most cervical cancer can be prevented.
Explain:
-HPV is called Human Papilloma Virus.
-most people who have HPV have no symptoms and feel healthy
-you can pass it on to others without knowing it.

11. Facts about cancer of the cervix:
Facts about cancer of the cervix:
It grows slowly
It can be fixed if found and treated early
Most can be prevented by regular Pap tests
Explain:
-On average, cervical cancer takes 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.

12. The Pap Test Can find changes or problems in the cells of the cervix
The Pap Test
Can find changes or problems in the cells of the cervix
Treating these problems can prevent them from changing into cancer
Early changes are called “cervical dysplasia”

13. The Pap Test Is done at a health clinic by a nurse or doctor
The Pap Test
Is done at a health clinic by a nurse or doctor
You will be asked to undress from the waist down, and you will be given a gown to put on
Emphasize:
-the test is over within a couple of minutes.

14. Pap Test www.TellEveryWoman.ca
GET A VOLUNTEER TO DEMONSTRATE!!
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.

15. Slide www.TellEveryWoman.ca 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.

16. Cervix www.TellEveryWoman.ca 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.

17. What are they looking for?
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

18. Only women who have had sexual intercourse need to have a Pap test.
True or False?
Only women who have had sexual intercourse need to have a Pap test.

19. False, partly…

20. Who needs to have a Pap test?
Who needs to have a Pap test?
If you have ever had sex, even once, you need a Pap test
If you have ever had close intimate touching, even once, you need a Pap test
If you are not sure, discuss with your health care provider.
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.

21. Why do women who have been sexually active have to have Pap tests?
HPV (human papillomavirus) 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

22. sex How can I help the test? www.TellEveryWoman.ca 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.
-No Tampons, douches, creams and/or foams for 48 hours before Pap test
-No intercourse 24 hours before the test

23. Women should have a Pap test every year.
True or False?
Women should have a Pap test every year.

24. Women should have a Pap test every TWO years.
False
Women should have a Pap test every TWO years.

25. Every year – pick a day that is easy to remember
Every year – pick a day that is easy to remember
Begin screening three years after onset of sexual activity
Continue screening every two years
-Advise women to pick a season change or Birthday to remind them that it is time to have a Pap test.

26. Pap Test 2012 OK Pap Test 2008 OK Pap Test 2010 OK
Pap Test
2012 OK
Explain:
-screening should commence within three years of first sexual activity.
-women should be screened every 2 years.
Pap Test
2008 OK
Pap Test
2010 OK

27. Where do I go for a Pap test?
Where do I go for a Pap test?
Your doctor or nurse
Call MCCSP at or toll free at
Visit our website to find a location near you:
TellEveryWoman.ca
The pap test is FREE

28. Go to TellEveryWoman.ca to find a location near you during Pap week.
You don’t need an appointment for a Pap test during Pap week.

29. If you are frightened or shy…
If you are frightened or shy…
Ask for a female nurse to be there
Ask for a female to do the test when you make the appointment

30. The Pap test checks for infections.
True or False?
The Pap test checks for infections.

31. The Pap test does NOT check for infections.
False
The Pap test does NOT check for infections.
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.

32. I had a hysterectomy… do I still need a 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.

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

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

35. Where can I get my results?
Where can I get my results?
Call the clinic where you had the Pap test performed, or
Call…
Manitoba
Cervical
Cancer
Screening
Program

36. The Registry Keeps a record of all Pap tests done after April 2001
The Registry
Keeps a record of all Pap tests done after April 2001
Screening histories
More understanding of cancer of the cervix
Follow-up
Reminder letters
Invitation letters
Keeps record of all Pap test after April 2001
Allows you to request your own test results
Allows you and or your healthcare provider to access past pap test results to follow management screening guidelines
Collect information to help improve our understanding of the cancer of the cervix.
Helps us to improve pap test services across MB
Send your HcP a letter if you fail to get recommended follow-up testing when an abnormality has been detected.
Make it possible to send women reminder letters for regular pap tests.

37. Who has access to the Registry?
Who has access to the Registry?
Health care provider
The laboratory that reads your Pap test
MCCSP staff involved in the registry
You

38.
The HPV Vaccine
Gardasil protects against 4 kinds of HPV (16, 18, 6 & 11)
HPV 16 & 18 cause over 70% of cervical cancer
HPV 6 &11 cause 90% of genital warts
The Public Health Agency of Canada has approved a new HPV Vaccine, “Gardasil”. This vaccine provides protection against 4 types of human papilloma virus: HPV 16, 18, 6 & 11. HPV 16 and 18 cause over 70% of all cervical cancers. HPV 6 and 11 cause 90% of all genital warts. The vaccine is given in 3 doses over 6 months. It cannot be used to treat existing HPV infection.

39.
The HPV Vaccine
Cervarix protects against 16 & 18 (not yet recommend by National Advisory Committee on Immunization, NACI)

40.
The HPV Vaccine
Works best when it is given to young women before they start having sexual contact
Does not cure existing HPV infections
Ask your health care provider about the vaccine
The vaccine is for females in between the ages of 9 and 26. The vaccine works best when it is given to young women before they start having sexual contact. 
The vaccine will not cure existing HPV infections. If you have previously been infected with one of the 4 HPV types listed above, the vaccine will still protect you against the remaining 3 types. If you receive the vaccine before exposure to HPV 16, 18, 6 & 11, it will be almost 100% effective in preventing infection from these 4 types.
Ask your health care provider about how you can get the vaccine.

41. The HPV Vaccine Still need Pap tests!!
The HPV Vaccine
Girls in grade six are offered the vaccine free of charge as of the school year.
Anyone outside of the program must pay for the vaccine, $500 for a series of three injections over the course of 6 months
Still need Pap tests!!
If you receive the vaccine you still need Pap tests because a) the vaccine does not protect you
against all types of HPV that can cause cervical cancer, b) you may have already had an HPV infection when you were immunized, and c) you may not have full protection from the vaccine.
What is the HPV Immunization Program?
In the school year, Manitoba Health and Healthy Living will introduce a voluntary, publicly funded HPV vaccine program for grade six girls. The program will be delivered by public health nurses. Before any female student is immunized, information about HPV, the vaccine, and a consent form will be distributed to parents and/or legal guardians. For more information about the HPV Immunization Program visit the Manitoba Health website at or call (204)
Who should not get the vaccine?
The vaccine is not recommended for females under the age of 9 and pregnant women.
Is there a cost for the vaccine?
The HPV vaccine will be covered for grade six girls getting immunized through the HPV Immunization Program. The vaccine is currently not covered for women who wish to receive the vaccine outside of the program.
HOW WOULD YOU SIMPLIFY THESE SLIDES?

42.
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
-Go to TellEveryWoman.ca
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.
English only

43.
DVDs and Videos
Explain that:
-we have 2 videos
-they can be found on our website and in libraries across the province
- website: TellEveryWoman.ca, click on the link and then click on the Resources section
-available in 12 languages
Available in the following languages: English, French, Chinese, Cree, Hindi, Ojibwe, Portuguese, Punjabi, Spanish, Tagalog, Urdu, Vietnamese

44. When was your last Pap test?
When was your last Pap test?
Are you due?

45. Most cervical cancers can be prevented!!
Remember…
Most cervical cancers can be prevented!!
With regular screening!

46. We are here to answer your questions!
We are here to answer your questions!
For more information:
you can call the MCCSP at
or or
visit our website