Manitoba Cervical Cancer Screening Program Cervical Common Sense v Manitoba Cervical Cancer Screening Program April 2010

First of all… where is the cervix? www.TellEveryWoman.ca First of all… where is the cervix?

-the female reproductive system

The Cervix Explain where and what the cervix is. The cervix is an opening at the bottom of the uterus/womb. Babies come through the cervix when they are born. The cervix is the doorway to the uterus.

Cervical Common Sense Let the game begin… www.TellEveryWoman.ca Cervical Common Sense Let the game begin…

Cancer of the cervix… is very treatable if found early www.TellEveryWoman.ca Cancer of the cervix… is very treatable if found early has many early symptoms is hereditary (runs in families) all of the above

Cancer of the cervix… is very treatable if found early www.TellEveryWoman.ca Cancer of the cervix… is very treatable if found early has many early symptoms is hereditary (runs in families) all of the above It can be cured if found and treated early. Early cancer of the cervix often doesn’t have symptoms. You can feel healthy and strong and still have early changes in the cells of your cervix or in fact, cancer. Cancer of the cervix does not run in families. The Pap test can be a first step in preventing cancer of the cervix. A Pap test is a test that may find changes in the cervix often long before the changes become cancerous. Monitoring or treating these early changes may prevent cancer of the cervix.

Facts about cervical cancer: www.TellEveryWoman.ca Facts about cervical cancer: Most types grow slowly It can be cured if found and treated early Most women diagnosed with cervical cancer haven’t ever had a Pap test, or haven’t had a Pap test in five years or more since their diagnosis Regular Pap tests with follow-up of abnormal changes can prevent most cancer of the cervix -in most cases, cervical cancer can take up to 15 years to develop

Each year in Manitoba 45 new cases of cervical cancer www.TellEveryWoman.ca Each year in Manitoba 45 new cases of cervical cancer 15 women die from cervical cancer -while this may not seem like a very high number, many of these cases of cervical cancer, and many of the deaths could have been prevented by having regular Pap tests and follow up for abnormal changes on the cervix

www.TellEveryWoman.ca Which of the following women is at risk for developing cervical cancer? Mary who has had only one sexual partner in her lifetime Eve who has worked as a sex trade worker for the last 15 years Sally who started having sex at 14 and has smoked a pack of cigarettes every day for the past 5 years Sylvia who had sex once 5 years ago All of these women

www.TellEveryWoman.ca Which of the following women is at risk for developing cervical cancer? Mary who has had only one sexual partner in her lifetime Eve who has worked as a sex trade worker for the last 15 years Sally who started having sex at 14 and has smoked a pack of cigarettes every day for the past 5 years Sylvia who had sex once 5 years ago All of these women A risk factor is something that may increase the chance of developing a disease. All of these women are at risk for cancer of the cervix. It only takes having sex once to be exposed to the virus that causes cervical cancer. If you have ever had sex, you need Pap tests.

Risk factors for cervical cancer: www.TellEveryWoman.ca Risk factors for cervical cancer: Infection with HPV Exposure to HPV at an early age Having never had a Pap test or have not had one in over 5 years Having HIV Cigarette smoking A risk factor is something that may increase the chance of developing a disease. Risk factors for cancer of the cervix are: -infection with HPV. The more sexual partners you have in your lifetime the more risk for getting HPV. Condoms protect you from many sexually transmitted infections but condoms may not protect you from HPV. Condoms should not be relied upon to prevent transmission of HPV. -exposure to HPV at an early age. Getting some types of HPV at an early age increases your chances of getting cancer of the cervix. Even years later. -having never had a Pap test or not having one in over 5 years: most women diagnosed with cervical cancer haven’t ever had a Pap test or haven’t had one in 5 years or more since their diagnosis. -having HIV or being immunosuppresed -smoking: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.

www.TellEveryWoman.ca How can I reduce my risk? Have regular Pap tests (at least one every 2 years) Ask your health care provider about the HPV Vaccine Delay sex until late teens or older Avoid cigarette smoke Keep your body healthy and strong

Human Papillomavirus (HPV)… www.TellEveryWoman.ca Human Papillomavirus (HPV)… is 100% preventable with the use of condoms is found on the cervix’s of women with cancer of the cervix only affects girls and young women is a new form of HIV

Human Papilloma Virus (HPV)… www.TellEveryWoman.ca Human Papilloma Virus (HPV)… is 100% preventable with the use of condoms is found on the cervix’s of women with cancer of the cervix only affects girls and young women is a new form of HIV -Changes in the cells of the cervix are caused by HPV. -HPV stands for human papilloma virus. -Some types of HPV can cause changes on your cervix and some types can give you genital warts. You can develop problems from certain types of HPV many years after first coming in contact with it. We don’t know why some people develop warts or changes on the cervix while others don’t. -HPV can be passed through any kind of sex or intimate touching. You can get it and spread it without ever knowing. -We encourage women of all ages, who are or who have ever had intimate touching or sex, to assume they may have HPV.

HPV… is very common is spread easily often has no symptoms www.TellEveryWoman.ca HPV… is very common is spread easily often has no symptoms can cause changes on your cervix, that if left untreated, can lead to cervical cancer -75% of Canadians will have at least one HPV infection during their lifetime -is spread easily through any kind of sexual contact -you can feel healthy and strong and have HPV -99.7% of cervical cancers are caused by HPV -over 120 types of HPV -over 70% of cervical cancers are caused by HPV 16 & 18 -HPV is found most commonly in women between the ages of 20 and 24 -chances of getting HPV increase with the number of sexual partners a woman or her partner has had. -most women will clear the infection within 12 months -a few women (9%) will remain infected after 24 months -we do not know the difference between women that

The HPV Vaccine Cannot be used to treat an existing HPV infection www.TellEveryWoman.ca The HPV Vaccine 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 Cannot be used to treat an existing HPV infection 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.

www.TellEveryWoman.ca 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.

www.TellEveryWoman.ca The HPV Vaccine Girls in grade six are offered the vaccine free of charge as of the 2008-2009 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 2008-2009 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 www.gov.mb.ca/health/hpv/ or call (204) 788-6737. 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.

For more information about the HPV Immunization Program in Manitoba… www.TellEveryWoman.ca For more information about the HPV Immunization Program in Manitoba… visit the Manitoba Health website at www.gov.mb.ca/health/hpv/ or call (204) 788-6737

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

www.TellEveryWoman.ca What is a Pap test? Cells from your cervix are examined for changes that may lead to cervical cancer.

The Cervix -this is the view your health care provider will have of your cervix when providing your Pap test

-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.

-the cells taken from the cervix are placed on a slide -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.

The Pap test… The Pap test looks for abnormal cells on the cervix www.TellEveryWoman.ca The Pap test… The Pap test looks for abnormal cells on the cervix It looks for changes BEFORE they turn into cancer If those changes are treated cervical cancer can be prevented.

The Pap test… looks at the health of the uterus only www.TellEveryWoman.ca The Pap test… looks at the health of the uterus only looks at the health of the cervix only looks at the health of the ovaries only checks for sexually transmitted infections (STI’s) all of the above

The Pap test… looks at the health of the uterus only www.TellEveryWoman.ca The Pap test… looks at the health of the uterus only looks at the health of the cervix only looks at the health of the ovaries only checks for sexually transmitted infections (STI’s) all of the above -the Pap test only checks the health of your cervix. -the Pap test does not check the health of the uterus or ovaries. The Pap test does not check for sexually transmitted infections. There are separate tests that check for these. -the Pap test looks for changes in the cells of the cervix. -your health care provider may call these early changes cervical dysplasia. You should talk to your health care provider about other health checks including ones for your ovaries, uterus and breasts. -if you are worried that you have an infection (like yeast, chlamydia, STI etc) talk to your health care provider about other tests that should be done. Tests for an infection can be done at the same time as your Pap test.

A woman should start having regular Pap tests when… www.TellEveryWoman.ca A woman should start having regular Pap tests when… she turns 18 years of age she starts having sex she starts taking the birth control pill she wants to get pregnant

A woman should start having regular Pap tests when… www.TellEveryWoman.ca A woman should start having regular Pap tests when… she turns 18 years of age she starts having sex she starts taking the birth control pill she wants to get pregnant -women need Pap tests if they’ve ever had sex. We all have different meanings for sex. If you have ever had close or intimate genital contact and/or oral, genital or rectal sex, this includes contact during oral sex, sex with fingers or hands, genital rubbing and vaginal sex with toys – you need Pap tests.

The longest a woman should go between Pap tests is… www.TellEveryWoman.ca The longest a woman should go between Pap tests is… one year two years three years five years

The longest a woman should go between Pap tests is… www.TellEveryWoman.ca The longest a woman should go between Pap tests is… one year two years three years five years Most cancers of the cervix are slow growing Most cervical cancers can be prevented by regular screening and treatment or follow-up of abnormal results. We never say that “all” cervical cancers can be prevented. We say “most”. Not one test is 100% perfect. That’s why it is important that you keep going on a regular basis. Women should have a Pap test once a year for three years. If these results are all normal or okay she can change to once every 2 years.

How often do I need a Pap test? www.TellEveryWoman.ca How often do I need a Pap test? 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

Where can I go? Your health care provider www.TellEveryWoman.ca Where can I go? Your health care provider Some clinics have special times Call us or visit our website to find out where you can go in your neighborhood or community!

www.TellEveryWoman.ca How can I help the test? Do not put anything into your vagina for 24 hours No sex toys No vaginal lubricants No tampons Do not have sex for 24 hours -nothing in the vagina for 48 hours before your Pap test -no sex toys -no vaginal lubricants -no tampons

Women may be able to stop having Pap tests when they… www.TellEveryWoman.ca Women may be able to stop having Pap tests when they… are not having sex more than twice per week stop having their periods are 70 years of age begin regular exercise

Women may be able to stop having Pap tests when they… www.TellEveryWoman.ca Women may be able to stop having Pap tests when they… are not having sex more than twice per week stop having their periods are 70 years of age begin regular exercise -at 70 years of age a woman can consider stopping having Pap tests if she has had three or more negative Pap tests in the previous 10 years with no change in partner.

I had a hysterectomy… do I still need a Pap test? www.TellEveryWoman.ca I had a hysterectomy… do I still need a Pap test? Maybe…ask your doctor or nurse

A woman can get a copy of her Pap test results from… www.TellEveryWoman.ca A woman can get a copy of her Pap test results from… her doctor her pharmacist her neighbor the Manitoba Cervical Cancer Screening Program her doctor and/or the Manitoba Cervical Cancer Screening Registry

A woman can get a copy of her Pap test results from… www.TellEveryWoman.ca A woman can get a copy of her Pap test results from… her doctor her pharmacist her neighbor the Manitoba Cervical Cancer Screening Program her doctor and/or the Manitoba Cervical Cancer Screening Registry The Manitoba Cervical Cancer Screening Registry can give you a copy of any Pap test you have had in Manitoba since 2001. The Manitoba Cervical Cancer Screening Registry is confidential. Only the woman and her health care providers can access the results. This allows you to have your results and helps your health care provider give care. You don’t have to do anything to have your results go to the registry. Every woman between 18 and 69 is automatically in the Manitoba Cervical Cancer Screening Registry. Action is required if you do 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.

The Registry Central Confidential Easy to access All Manitoba women Opt out option Will send you your results!!

www.TellEveryWoman.ca If you have an abnormal Pap test it is important that you keep all appointments related to your abnormal Pap test because… You probably don’t have cancer but the cells from your cervix look like they have changes You probably have cervical cancer

www.TellEveryWoman.ca If you have an abnormal Pap test it is important that you keep all appointments related to your abnormal Pap test because… You probably don’t have cancer but the cells from your cervix look like they have changes You probably have cervical cancer In most cases, an abnormal Pap test is because the cells of the cervix are showing changes. Most of the time, abnormal cells detected by a Pap test will disappear on their own without any treatment. In some cases, however, these abnormal cells – called cervical dysplasia - may need to be treated. It is important to keep all appointments related to an abnormal Pap test so that it can be decided if you need treatment to prevent cervical cancer. Most cervical cancers could be prevented if women had regular Pap tests with follow-up of abnormal results.

What happens if my results aren’t normal? www.TellEveryWoman.ca What happens if my results aren’t normal? Repeat Pap test in 6 months Referral to colposcopy -if you receive an abnormal result you will be asked to come back for a repeat Pap test in six months, or you may be referred for colposcopy.

Colposcopy A colposcopy refers to an examination of the cervix and vagina using a low-powered magnifying instrument known as a colposcope. It is done to assess any abnormalities on your cervix and to determine if any treatment is necessary. A gynecologist who is specially trained as a colposcopist does this examination.

www.TellEveryWoman.ca Mary is 50 years old. She had a normal Pap test two months ago. Last night she had some bleeding after she and her partner had sex. Mary is not having her period. Mary should…

relax – menopause does weird things to your body www.TellEveryWoman.ca relax – menopause does weird things to your body wait a month and see if she feels better have sex again to see if the bleeding happens again see her health care provider

relax – menopause does weird things to your body www.TellEveryWoman.ca relax – menopause does weird things to your body wait a month and see if she feels better have sex again to see if the bleeding happens again see her health care provider Mary should see her health care provider. Bleeding after sex is not normal. It can have many causes but it can be a symptom of cancer of the cervix. Because of cancer of the cervix often doesn’t have symptoms it is important for any woman who bleeds after sex to see her health care provider for a thorough investigation of the problem.

When was your last Pap test? www.TellEveryWoman.ca When was your last Pap test? Are you due?

Remember… most cervical cancers can be prevented! www.TellEveryWoman.ca Remember… most cervical cancers can be prevented!

We are here to answer your questions! www.TellEveryWoman.ca We are here to answer your questions! We have pamphlets in many languages Most of our resources are available off our website For more information: you can call us at 788.8626 or 1.866.616.8805 or visit our website