1. Empowering Women in Your Community Through Cervical Cancer Awareness Advocate Training Module

2. Who Are We? Illinois Women Against Cervical Cancer is a group of concerned individuals and organizations including the Illinois Department of Public Health Center for Minority Health Services and the Illinois Public Health Association. Our goal is to eliminate cervical cancer by educating women about the prevention and detection of cervical cancer and HPV.

4. Your Role Begin Begin healthy dialogue with families in your community Influence Influence young women to make smart healthcare decisions To To encourage our sisters, mothers, daughters, aunts, grandmothers and girlfriends to get screened for cervical cancer empower women of all ages with the knowledge to prevent cervical cancer

5. Today’s Agenda What are your expectations for this training? Knowledge, attitudes and behaviors Hard facts about HPV and cervical cancer Barriers to cervical cancer screening IWACC communication tool kit Learn, laugh and motivate!!!

6. Knowledge, Attitudes & Behaviors ABOUT HEALTH Lack of knowledge Lack of knowledge Passivity, fear and fatalism Passivity, fear and fatalism Inaction Inaction  The good news: as knowledge increases, so does willingness to take action

7. Knowledge, Attitudes & Behaviors ABOUT CERVICAL CANCER VACCINE Open mindedness, despite lack of knowledge 1,2 Open mindedness, despite lack of knowledge 1,2 Lack of knowledge, however, fertile ground for misinformation Lack of knowledge, however, fertile ground for misinformation Much better acceptance if explained as cancer prevention vs. STD prevention Much better acceptance if explained as cancer prevention vs. STD prevention  Communication needs to appeal to women’s self- interest -- what’s really at stake here? 1. Davis K1. Davis K, Dickman ED, Ferris D, Dias JK. Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents. The Medical College of Georgia, Augusta, GADickman EDFerris DDias JK 2. Zimet GD2. Zimet GD.Improving adolescent health: focus on HPV vaccine acceptance. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana

8. New Health Care Model Old Treat illness Treat illness Someone else pays most costs Someone else pays most costs Few incentives to lower costs or increase quality of care Few incentives to lower costs or increase quality of careResult:  Runaway health care costs and undesirable outcomes/quality of care New Prevent illness Prevent illness Consumer paying higher percentage of costs Consumer paying higher percentage of costs More incentives to lower costs and improve quality of care More incentives to lower costs and improve quality of care Future Goal:  Slow rate of cost increases and improve outcomes/quality of care

9. New Healthcare Outlook More aggressive attempts -- even mandates -- to reduce rates of cancer and other illnesses More aggressive attempts -- even mandates -- to reduce rates of cancer and other illnesses  Tobacco lawsuits, no smoking ordinances  Anti-obesity measures (trans fats, etc.) Actions to reduce societal costs of treating disease Actions to reduce societal costs of treating disease In medical, scientific and business communities, more incentives to find new ways to prevent illness and control costs In medical, scientific and business communities, more incentives to find new ways to prevent illness and control costs  Result: We will see new ways to intercept illness early in life -- because it will save money and improve health

10. Cervical Cancer in the U.S. 12,000+ New Cases 12,000+ New Cases 4,000+ Deaths 4,000+ Deaths Five-year relative survival rate for localized stage: 92% Five-year relative survival rate for localized stage: 92% Five-year relative survival rate for all stages combined: 72% Five-year relative survival rate for all stages combined: 72%

11. Cervical Cancer in Our Communities Black women are twice as likely as white women to be diagnosed with cervical cancer Black women are twice as likely as white women to be diagnosed with cervical cancer Black women have the highest cervical cancer death rate of any group of women in the U.S. Black women have the highest cervical cancer death rate of any group of women in the U.S.

12. Importance of Early Detection Early detection of abnormal cell changes or cervical cancer greatly increases a woman’s chance of survival. Survival for women with pre- invasive lesions is nearly 100%. Invasive cervical cancer, when detected at an early stage, is one of the most successfully treatable cancers with a 5-year survival rate of 92% Early detection of abnormal cell changes or cervical cancer greatly increases a woman’s chance of survival. Survival for women with pre- invasive lesions is nearly 100%. Invasive cervical cancer, when detected at an early stage, is one of the most successfully treatable cancers with a 5-year survival rate of 92%

13. Cervical Cancer Prevention Cervical cancer is one of the few women’s cancers that can be prevented Cervical cancer is one of the few women’s cancers that can be prevented A disease that’s very costly to society but relatively easy to stop through inexpensive interventions A disease that’s very costly to society but relatively easy to stop through inexpensive interventions  Pap tests  New cervical cancer vaccine -- can cut the 6.2 million cases of annual HPV infection in half and significantly reduce the number of cervical cancer cases  HPV tests

14. About Cervical Cancer Cervix: lower part of womb connected to vagina Cervix: lower part of womb connected to vagina Deadly and common disease disproportionately affecting women of color and/or low income Deadly and common disease disproportionately affecting women of color and/or low income

15. What is HPV? Cervical cancer is almost always caused by a common virus, the human papillomavirus (HPV) Cervical cancer is almost always caused by a common virus, the human papillomavirus (HPV) There are over 100 kinds of HPV but only a dozen or so are linked with cervical cancer these are “high-risk” HPV There are over 100 kinds of HPV but only a dozen or so are linked with cervical cancer these are “high-risk” HPV HPV is usually harmless HPV is usually harmless If you have high-risk HPV it does NOT mean you will get cervical cancer. Most women who have HPV will NOT develop cancer If you have high-risk HPV it does NOT mean you will get cervical cancer. Most women who have HPV will NOT develop cancer

16. Kinds of HPV Over 100 types Over 100 types High risk High risk Cancer causing Cancer causing Types 16 and 18 cause 70% cases of cervical cancer Types 16 and 18 cause 70% cases of cervical cancer Also associated with some head and neck cancers Also associated with some head and neck cancers Low risk Low risk Genital warts Genital warts Types 6 and 11 cause 90% cases Types 6 and 11 cause 90% cases

17. Modes of Transmission Skin-to-skin contact Skin-to-skin contact  Vaginal intercourse  Anal and oral sex

18. About Cervical Cancer Vaccine A series of three injections over six months A series of three injections over six months Not recommended for pregnant women Not recommended for pregnant women Duration of immunity is still unclear Duration of immunity is still unclear Preliminary evidence that it may also prevent head and neck cancers Preliminary evidence that it may also prevent head and neck cancers

19. About Cervical Cancer Vaccine Vaccine intercepts HPV before it causes infection Vaccine intercepts HPV before it causes infection  HPV usually acquired during initial sexual experiences  Young women between 14-25 have highest rates of HPV infection -- more than 4 million a year in U.S.  74 percent of all new cases among American women acquired between ages 15-24  45 percent of women 20-24 already have HPV infection

20. About Cervical Cancer Vaccine These statistics support the rationale behind having young girls receive the vaccine These statistics support the rationale behind having young girls receive the vaccine  Vaccine immunizes before young women have sexual contact  As a result, young women don’t become infected with HPV and become at-risk for cervical cancer

21. About Pap Tests Pap tests have saved countless lives since introduction in 1950s Pap tests have saved countless lives since introduction in 1950s Detects cell changes at early, treatable stage Detects cell changes at early, treatable stage Not the same as a pelvic exam! Not the same as a pelvic exam! All women should receive regular Pap tests, even if they receive vaccine All women should receive regular Pap tests, even if they receive vaccine  Vaccine not a replacement of Pap tests -- an enhancement

22. Where to Go and How to Pay Where Where  Doctor’s office or public health clinic, including family planning clinics How to pay How to pay  Private insurance plans May have co-pay or deductible May have co-pay or deductible  Medicaid Vaccine free for girls 12-18 meeting household low- income requirements Vaccine free for girls 12-18 meeting household low- income requirements Pap free for all women who meet indications Pap free for all women who meet indications

23. Overcoming Objections TO THE VACCINE “My daughter doesn’t need it -- she’s too young” or “My daughter will think it’s OK to have sex.” “My daughter doesn’t need it -- she’s too young” or “My daughter will think it’s OK to have sex.”  Your response: Receiving the new vaccine now gives your daughter the best chance of having a cervical cancer-free future. Without the vaccine, many young women will obtain the HPV virus, which can cause cervical cancer. Before the vaccine was available, researchers estimated that more than 4 million women in their teens and early 20s obtained the virus each year. For the vaccine to work, young women must receive the vaccine before having sexual contact. Don’t use this important cancer-prevention method to discourage sex; there are many better ways to discourage sex

24. Overcoming Barriers VACCINE “The vaccine costs too much” “The vaccine costs too much”  Your response: The costs are often covered by private insurance or Medicaid

25. Overcoming Barriers VACCINE “The vaccine is not needed if regular Pap tests are taken” “The vaccine is not needed if regular Pap tests are taken”  Rather than preventing cervical cancer like the vaccine can, a Pap test detects precancerous cells or cervical cancer. A diagnosis of cancer will require treatment that may cause disability or financial hardship. For example, follow-up care for abnormal Pap test results costs the healthcare system $6 billion a year 5  The vaccine can eliminate the chance of an abnormal Pap test 5. Dailard, C. 2006. Achieving Universal Vaccination Against Cervical Cancer In the United States: The Need and the Means. Guttmacher Policy Review, Vol. 9, No. 4.

26. Overcoming Barriers VACCINE Vaccine is unsafe Vaccine is unsafe  The vaccine was tested on thousands of patients before receiving FDA approval. Millions of Americans have received the vaccine, and it has been approved in more than 70 countries worldwide.  In some cases, minor side effects  Vaccine is not a live virus

27. Most Important Messages SUMMARY Cervical cancer can cause death, disability and the inability to have children There are two ways to stop cervical cancer: the cervical cancer vaccine and the Pap test There are two ways to stop cervical cancer: the cervical cancer vaccine and the Pap test The vaccine prevents cancer. Young women should get it as soon as possible after they turn age 12 -- the vaccine works best this way. The vaccine prevents cancer. Young women should get it as soon as possible after they turn age 12 -- the vaccine works best this way. The Pap test can detect precancerous cells or cancer at an early, treatable stage. Women should receive regular Pap test throughout life, even if they get the vaccine The Pap test can detect precancerous cells or cancer at an early, treatable stage. Women should receive regular Pap test throughout life, even if they get the vaccine Make an appointment today; insurance or public health often cover the costs Make an appointment today; insurance or public health often cover the costs

28. Delicate Messages SUMMARY Studies show that women are much more receptive to preventing cancer vs. preventing an STD Studies show that women are much more receptive to preventing cancer vs. preventing an STD  Explain the vaccine as a cancer prevention, not an STD prevention If they don’t get the vaccine, many if not most young women will acquire HPV during their teen years If they don’t get the vaccine, many if not most young women will acquire HPV during their teen years  Explain that the vaccine works best when it is received as close to age 12 as possible -- without getting too clinical about the reasons

29. Communications Toolkit http://www.livecancerfree.org/ct.html http://www.livecancerfree.org/ct.html http://www.livecancerfree.org/ct.html  Direct mailer  Poster  Flyer  Brochure  Fact sheet and pledge card  Op-ed article

30. Thank You! Next steps Next steps

31. Resources See Web site -- http://www.livecancerfree.org/ccped_7.html See Web site -- http://www.livecancerfree.org/ccped_7.html http://www.livecancerfree.org/ccped_7.html

32. Q & A