1. Cervical Cancer and HPV
This presentation was developed by Cancer Screening Programs, Alberta Health Services in partnership with a committee of Aboriginal health workers. These presentations are updated versions of the ones that were developed in 2006.
This presentation will take 30 to 45 minutes if you use all the slides. Not all the slides need to be used.
There is one brochure that can be given out as you go through this presentation.
It is called “Cervical Screening: Human Papillomavirus (HPV) What You Need to Know and Do”
April 2010

2. Learning Objectives Cervical cancer facts HPV HPV & cervical cancer
Risks
HPV vaccine
This presentation will focus on HPV and the connection to cervical cancer.
Please share this information. If you like, take extra brochures for your friends and family. The second presentation in this kit focuses on Pap testing and cervical cancer.
Note: HPV is a complex topic and there still some unanswered questions in this field.

3. Sometimes there are things that may be hard to talk about…
But not talking about them is even harder
While it may be hard or embarrassing for some of you to talk about cervical cancer, since we don’t often talk about that part of our bodies with others, not talking about it can cost lives. Some of you may know friends or family members who have been diagnosed or died from this type of cancer. This presentation will help you to learn more about this cancer and how it can be prevented or caught early enough to treat.
(Presenters may ask the group who has friends or family with cervical cancer).

4. Cervical Cancer
Cancer is a disease that starts when cells in one part of the body begin to grow out of control
Cervical cancer is the #2 cancer killer worldwide in women, but only the 11th in Canada
Note: Cervical cancer is one of the most preventable cancers
The reason that cervical cancer is the #2 cancer killer worldwide in women, but only the 11th in Canada is because many women in Canada get Pap tests regularly and follow-up on any abnormal results.
Additional general information on cancer
Cancer is a disease that starts when cells in one part of the body begins to grow out of control. As then number of extra cells increases they form lumps or tumours. Sometimes a tumour is not cancerous (benign). A benign tumour does not spread to other parts of the body and is not usually life-threatening. A tumour that is cancerous (malignant) can spread to other parts of the body and can pose serious danger to a person’s life. Cancer cells that spread to other parts of the body are called metastases.

5. Cervical Cancer Facts
In 2009, 160 new cases of cervical cancer were expected in Alberta
40 deaths due to cervical cancer were expected in Alberta in 2009

6. More Cervical Cancer Facts
Cervical cancer is almost entirely preventable with regular Pap tests
If cervical cell changes are found early and treated, they will not develop into cancer
Regular Pap tests have reduced the number of cervical cases and deaths by 1/3

7. Approximately 30% of eligible women in Alberta are not getting regular Pap tests
This is an important slide to discuss.
We know that cervical cancer is almost entirely preventable with regular Pap tests and yet 30% of eligible women are not having them done.
This may be a good opportunity to talk about why you think some women are not having regular Pap tests.

8. Cervical Cancer and First Nations
Some Canadian research shows that:
Screening rates are lower for Aboriginal women
Cervical cancer rates are higher for Aboriginal women than the general population in some provinces
Cervical cancer mortality (death) rates are higher in First Nations women than the general population

9. What is HPV? Human Papillomavirus (HPV) is a virus
There are many types of HPV that can affect different parts of the body
About 45 types of HPV are spread by skin-to-skin sexual contact
Note: the definition of a virus is: A tiny organism that can enter cells and change the cells function
Skin-to-skin sexual contact can involve touching, oral sex, &/or intercourse with a partner from either sex
The important message here is that HPV can be spread through genital contact, it does not have to be through sexual intercourse.

10. HPV
HPV is very common
Over 70% of sexually active people will get HPV in their lifetime
The 2 key messages that should be made when discussing this slide are:
HPV is very common. Anyone who has ever been sexually active at any point in her life is at risk of getting HPV as it is sexually transmitted. HPV is the most common sexually transmitted infection.
HPV is not only common in women, but common in men as well.

11. HPV causes cervical cancer
About 15 types of high risk HPV can cause cell changes on a woman's cervix if the HPV infection does not go away
If untreated these cell changes can develop into cervical cancer over many years
Some other types of low risk HPV can cause genital warts
Some types of HPV are considered “high risk” and can cause abnormal cells on a woman’s cervix
Some other types of HPV are considered “low risk” and can cause genital warts.
Note: There are other types of HPV that are not transmitted sexually. Some of these types of HPV cause warts on the hands and feet. The warts that people get on their hands and feet (as well as genital warts) are not connected to abnormal cell changes on the cervix.

12. HPV causes cervical cancer
For most women their bodies fight off HPV and they DO NOT develop abnormal cells
A regular Pap test is the only way to find abnormal cells
If found early, abnormal cells can be followed-up closely
If needed, these abnormal cells can be treated so cervical cancer does not develop
Note:
Most people who get HPV do not show symptoms. The body’s immune system usually clears the virus within 2 years. For some women their bodies can’t completely get rid of HPV.
The types of HPV (high risk) that cause cell changes on the cervix may lay dormant for years. Those types could, at some point, cause cell changes. This is why regular Pap tests are so important.

13. This slide is meant to act as a visual representation of how HPV causes cervical cancer.
Important things to note on this slide:
*A woman’s body usually fights HPV and it goes away on its own within 2 years
*If HPV does not go away on its own and a woman has abnormal cells found on a Pap test- this does not mean she has cancer.
*Abnormal cells are very common. Cell changes often return to normal on their own.
*If a woman has regular Pap tests, she will almost always find these cell changes before cancer develops.
*Any abnormal results need to be followed-up closely so that changes can be treated if necessary so that cancer does not develop.

14. How does someone get HPV?
HPV spreads easily through skin-to-skin contact in the genital area (with a partner of either sex)
touching
oral sexual activity
intercourse
It can go undetected for many years
It is hard to know when someone was infected or who infected them
Note: Women can have HPV and never know it because her Pap test results are normal. As discussed on the previous slides, a woman may have an HPV infection for years and not know it.
It is also important to remember that men can get HPV as well.
If a man is infected with a low risk type of HPV, he can develop genital warts.
If a man is infected with a high risk type of HPV (that can cause abnormal cells on a woman’s cervix), he will not show any symptoms. But- a man can transmit this type of HPV infection to women they are intimate with.

15. How do I know if I have HPV?
Most often a woman doesn’t know
HPV testing (DNA test):
Can determine type of HPV at time of testing
Helps decide whether women with borderline cell changes should have more specialized tests
Not recommended for women younger than 30
Not currently used regularly in Alberta
Talk to your healthcare provider for more information
Remember- most often a woman will not know she has an HPV infection since she will not have any symptoms and may even have a normal Pap test. HPV infection can lay dormant in a woman’s system.
HPV DNA testing is a way to determine what type of HPV a woman has. This test is done by testing a sample from the woman’s Pap test for high risk HPV. This test is not recommended for women younger than 30 since HPV is very common in this younger group and usually goes away on its own.

16. Can HPV be treated?
Most HPV infections will go away on their own within 2 years
The HPV infection itself can’t be treated to make it go away but,
abnormal cell changes can be treated to prevent cervical cancer
talk to your healthcare provider about treatment for genital warts
To be very clear:
The HPV infection itself can’t be treated to make it go away. But- abnormal cervical cell changes and genital warts caused by HPV can be treated.
We will discuss treatment of abnormal cells in the other presentation.

17. Risk Factors
All women who have ever had sexual contact are at risk for developing cervical cancer
Women who have never had a Pap test or do not have Pap tests regularly are at the greatest risk of cervical cancer
The important message to get across here is that all women (and men) who have ever been sexually active are at risk of getting HPV.
We have already mentioned it, but this does not need to be sexual intercourse, HPV can be transmitted through any skin-to-skin contact in the genital area (touching, oral sex, or intercourse).

18. What can women do to reduce their risk of HPV?
Find out more about the HPV vaccine
Practice safer sex:
Limit the number of sexual partners
Use condoms (they offer some protection against HPV)
Start sexual activity later in life
There is research that tells us that women may be at higher risk of contracting HPV if they:
*have multiple sexual partners
*if they start having sexual relations at a younger age
Condoms: Although condoms work well to prevent other sexually transmitted infections, they offer less protection against HPV. This is because HPV can be spread through skin-to-skin contact that condoms do not cover.

19. What can women do to reduce their risk of developing cervical cancer?
Have Pap tests regularly starting at age 21 (or 3 years after becoming sexually active, whichever is later)
Follow-up on any abnormal Pap test results
Protect themselves from HPV (see previous slide)
Limit tobacco use & exposure to second hand smoke
Note: the risk factors for HPV and the risk factors for cervical cancer are separated because there are factors that increase risk of HPV and then there are protective things a woman can do if she has HPV to prevent cervical cancer.
Tobacco use in women with HPV has been linked to a higher risk of cervical cancer

20. HPV Vaccine GARDISIL® HPV Vaccine protects against:
2 types of high risk HPV (16 & 18) that cause about 70% of cervical cancer
2 types of low risk HPV (6 & 11) that cause 90% of genital warts
The vaccine works best when given before a girls becomes sexually active
The vaccine works best when given before sexual activity begins- before any exposure to HPV. But- women will still benefit from the HPV vaccine even if they have been exposed to some types of HPV. The vaccine may protect them from the types of HPV they haven’t been exposed to yet.
The most important message is that women still need Pap tests regularly even if they are vaccinated against HPV. The HPV vaccine does not protect against all the types of HPV that cause cervical cancer.

21. HPV Vaccine
Alberta Health & Wellness offers a provincial HPV Immunization Program free of charge to:
Grade 5 girls
Grade 9 girls (until 2012)
For more information see:

22. HPV vaccine- do I still need Pap tests?
YES, you still need Pap tests regularly even if you are vaccinated against HPV
The HPV vaccine does not protect against all the types of HPV that cause cervical cancer

23. Remember HPV is common and most people don’t know they have it
Having Pap tests regularly:
Can find abnormal cell changes early
Helps prevent most cervical cancer
Is important even if you are vaccinated against HPV

24. Go for regular Pap tests!
Women, as the givers of life have a responsibility to the Creator, themselves, their family and the community to maintain their physical, spiritual, emotional and mental well-being

25. Questions? For more information contact: Cancer Screening Programs
Phone
Web screeningforlife.ca