Cervical Cancer 101

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Cervical Cancer 101 created for breast health outreach workers and clinic staff.

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  • Learning Objectives-Facts about Cervical CancerPrevention & ScreeningSymptoms & TreatmentsIn addition we will be talking about:What Cervical Cancer isCauses of most Cervical CancersRisk Factors and I’ll leave you with some resources. *Photo Source-www.puruzit.com
  • What/Where is a Cervix?The cervix is inside a woman’s body.It is the opening to the womb inside the vagina.During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix opens to allow the baby to pass through the vagina.http://www.cancer.gov/cancertopics/wyntk/cervix/page2Photo Source: The Office of Women’s Health
  • What is Cervical Cancer?When cells on the cervix become abnormal and grow uncontrollably A Pap test screens for cervical cancerusually part of a well-women visit Almost all cases caused by the Human Papillomavirus (HPV) Source: Http://www.cancer.gov/cancertopics/wyntk/cervix/page4Photo:http://knol.google.com/k/infections-to-cancer#
  • How do you get HPV?Human Papillomavirus = HPVHPV infection = VERY commonTransmitted to both men and women via sexual contact (intercourse or touching skin in the genital area)It is considered a sexually transmitted infection. (STI).Image Source: http://www.designofsignage.com/application/symbol/hands/largesymbols/love-hand-shake.htmlSource: http://www.kaiseredu.org/Issue-Modules/HPV-Vaccines-and-Cancer-in-the-US/Background-Brief.aspx
  • What are your chances?All US Women80% of women are infected with HPV by age 507% of all Paps are abnormal. Of 500,000 Paps done each yearWomen diagnosed with Cervical Cancer (12,000)
  • What is Cervical Cancer?In 2008, there were 530,000 new cases worldwide.*In 2010, there were 12,200 new cases & 4,210 deaths in the U.S.**Half of U.S. women diagnosed with cervical cancer are between the ages of 45-64Each week in Oregon, two women learn they have cervical cancer, and one women dies from it. QUESTION- I just need to source our new quote. You mentioned the “Donor Report” not sure where to find that.
  • HPV Logic Model-(Develop talking Points)-----------
  • What are your chances?All US Women80% of women are infected with HPV by age 507% of all Paps are abnormal. Of 500,000 Paps done each yearWomen diagnosed with Cervical Cancer (12,000)
  • Cervical Cancer: Racial and Ethnic Differences(Insert Talking Points)Source: Lisa-Picture:http://slowmuse.wordpress.com/2010/09/
  • Oregon Cervical Cancer Incidence----Annual Incidence Rate(Cases per 100,000)( Red)-9.4 to 10.6(Orange)- 7.5 to 9.3(Yellow)- 7.1 to 7.4(Light Blue)- 6.4 to 7.0(Medium Blue)- 5.8 to 6.3(Dark Blue)- 5.5 to 5.7(Grey)- Suppressed*/**US (SEER=)NPCRRate 95% C.I.)8.1 (8.0-8.2)Oregon Rate (95% C.I.)6.4 (5.9-7.0)
  • Fact Check
  • Fact Check
  • Risk Factors: Increased RiskCigarette smokingNumber of lifetime sexual partnersAge of first episode of sexNumber of full-term pregnanciesHistory of abnormal PapAny sexually-transmitted infection (including HPV)Weakened immune system Use of birth control pills for 5+ yearsDES use by mother/grandmotherSourcesPictures: (hands) http://peteandpip.com/RSVP.aspx(smoking)http://www.indexonline.org/quit-smoking-easily-lung-cancer/3986(Pap)- http://health.msn.com/health-topics/sexual-health/cervical-cancer/----------------------------------------------------------------------Dolly’s Note: Possible talking points for slide in addition to the aboveLack of regular Pap tests: Cervical cancer is more common among women who don't have regular Pap tests. The Pap test helps doctors find abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer.Smoking: Among women who are infected with HPV, smoking cigarettes slightly increases the risk of cervical cancer.Weakened immune system (the body's natural defense system): Infection with HIV (the virus that causes AIDS) or taking drugs that suppress the immune system increases the risk of cervical cancer.Sexual history: Women who have had many sexual partners have a higher risk of developing cervical cancer. Also, a woman who has had sex with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of HPV infection.Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may slightly increase the risk of cervical cancer among women with HPV infection. However, the risk decreases quickly when women stop using birth control pills.Having many children: Studies suggest that giving birth to many children (5 or more) may slightly increase the risk of cervical cancer among women with HPV infection.DES (diethylstilbestrol): DES may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)Having an HPV infection or other risk factors does not mean that a woman will develop cervical cancer. Most women who have risk factors for cervical cancer never develop it.
  • Risk Factors : Decreased RiskThere are several steps you can take that may help lower your chances of getting HPV and Cervical CancerQuit SmokingUse of barrier methods for contraceptionHPV vaccine (full series before onset of sexual activity)Pap test in the last 3 yearsHysterectomy with removal of cervixHealthy DietSource:Smoking: http://www.indexonline.org/quit-smoking-easily-lung-cancer/3986Condoms: http://www.thenextgreatgeneration.com/2010/12/22/the-churchs-condom-question/Cake: http://www.thenextgreatgeneration.com/2010/12/22/the-churchs-condom-question/Girl/Vaccine: http://www.dailymail.co.uk/news/article-462611/Girls-12-cancer-jab-year.htmlHealthy Food: http://www.katrinatribute.info/healthy-eating-with-heart-healthy-diets.htmlCalendar: http://www.wmich.edu/registrar/calendars/
  • Vaccine InformationThere are 2 HPV Vaccines currently available.*Both vaccines protect against HPV types 16 and 18, which are associated with 70% of cervical cancer cases.Vaccine is not recommended for women over the age of 26 because they have likely already been exposed to the virus. Regular Pap tests and gynecology visits will still effectively reduce your risk for cervical cancer. Additional notes: The 3-dose series should be completed with the same HPV vaccine (Gardasil® or Cervarix®) whenever possible. However, if you do not know or don’t have available the HPV vaccine used earlier, then either HPV vaccine can be used to continue or complete the series to protect against HPV 16 and 18.There are no studies that tell us what happens when the 3-dose series is completed with different vaccine products. It is possible that effectiveness in protection against HPV 16 or 18 related cervical cancers and pre-cancers of a 3-dose series that includes both vaccine products might be reduced compared with a 3-vaccine series that is completed with only one product.The cervical cancer vaccination is given over 3 visits.1) Today 2) then in about 1-2 months 3) then in about 4 months after the second visit.Source:KaiserFamilyFoundation- http://www.kff.org/womenshealth/upload/7602_02.pdfPhoto:http://www.stuff.co.nz/national/606703
  • Recommended age groups of the cervical cancer vaccine
  • Lifetime Risk Reduction for Cervical Cancer after Vaccination
  • Pap Screening Information for women at average riskBeginning at 21Between 21 & 29 (every 2 years)Between 30 & 65-70 (women at a lower risk: every 3 years)Even if you’ve had a Pap test, it is important to report any symptoms of abnormal vaginal bleeding, discharge or pain to your health care provider.Picture Source: http://www.health.com/health/article/0,,20411964,00.htmlSource: ACOG-http://www.acog.org/acog_districts/dist_notice.cfm?recno=13&bulletin=3161
  • Pap TestThe Pap test is an essential part of cervical cancer screening. The health care provider uses the Pap test to see if there are any changes (abnormal cells) in the cervix that occur before you get cancer. Pap tests are important because these cervical changes may occur without you knowing it.What happens during a Pap test?Your health care provider uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix.Then the health care provider uses one or two small brush to get some cells from the cervix and vagina.Source: ACOG (Michelle’s Brochures)Picture Source: http://www.ansci.wisc.edu/jjp1/ansci_repro/misc/project_websites_08/tues/hpv/facts.html
  • Pap Screening in Past 3 yrs (18+) 2008(Develop Talking Points)
  • Fact Check:Abnormal Cell Changes- True or False: You can have the HPV virus and never get cervical cancer? TRUEVaccine-True or False:If I get the HPV vaccine I never have to get a Pap Test again? FALSEPap Screening-True or False: If I get a Hysterectomy with removal of the cervix, I never have to get a Pap test again? TRUERisk Factors Smoking reduces your risk of cervical cancer? TRUE
  • Fact Check:Abnormal Cell Changes- True or False: You can have the HPV virus and never get cervical cancer? TRUEVaccine-True or False:If I get the HPV vaccine I never have to get a Pap Test again? FALSEPap Screening-True or False: If I get a Hysterectomy with removal of the cervix, I never have to get a Pap test again? TRUERisk Factors Smoking reduces your risk of cervical cancer? TRUE
  • What Happens if I have an abnormal Pap?Depends…Sometimes get a repeat Pap in a few monthsUsually need further evaluation (colposcopy)Further evaluation and/or treatment depends on findings at colposcopyMay need follow-up, orMay need LEEP or cone biopsyPhoto Source: http://home.howstuffworks.com/blue-to-purple-perennial-flowers.htm
  • Treatment OptionsColposcopy- Let’s your health care provider look at the cervix through a special device similar to a microscope. It can detect problems of the cervix that cannot be seen with the eye alone. It is not inserted into the vagina. It is a screening methodwhich helps the health care provider decide whether or not further treatment is neededFeels like getting a Pap test, but takes longer** The decision of whether more evaluation or treatment to use is needed (if any) is based on how much cervical tissue needs to be removed and where on the cervix the abnormal cells are located. If nothing worrisome if found, then follow-up is usually either more frequent Paps or another test (HPV test).http://www.riversideonline.com/health_reference/Womens-Health/WO00097.cfm
  • What your provider may see at Colposcopy(Develop Talking Points)Photo Source: http://medicalpptonline.blogspot.com/2010/10/screening-for-cervical-cancer.html
  • LEEPLeep uses a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the surface cells. In most cases LEEP is done in a health care provider’s office or in a clinic on an outpatient basis. It takes about 20 minutes (under an hour, start to finish) Picture Source:http://www.miamiwomencare.com/nature/Surgery.htmlSource: ACOG
  • Cone Biopsy-The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under local or  general anesthesiaRemoving tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Picture Source:http://www.summitmedicalgroup.com/library/womens_health/conization_of_cervix_with_laser_fcwc/
  • Further TreatmentSurgery: Hysterectomy with removal of the uterus and cervixRadiationChemotherapyPhoto Source:http://www.webmd.com/depression/article-player-untrt-dep#1
  • Fact CheckT or FWe know what causes cervical cancer?TRUE- HPVIf you have an abnormal pap you may need what additional procedures to diagnose?Colposcopy, LEEP, or Cone Biopsy.T or FOnce you have a hysterectomy you no longer need a pap? USUALLY- Women only need a Pap after a hysterectomy if they had it done for Cervical Cancer, OR they have a history of abnormal Paps, OR they still have a Cervix. Only pre-menopausal women need Pap tests?USUALLY- Discontinue routine pap if 3 consecutive normal Paps after age 65 AND no abnormal Paps in 10 years (average age of menopause is about 52 or 54 so a whole lot of post-menopausal women still get Paps) Post-menopausal women often still get Paps until age 65 or 70
  • Fact CheckCan you only get HPV through sex?NO! Any contact with the genital areaName 3 ways to reduce your risk of HPV and Cervical Cancer. Quit SmokingUse of barrier methods like condomsGet the HPV vaccineHave Regular Pap testsCan early cervical cancer be curable? YESTRUE- Early detection is key in treating and curing Cervical Cancer.
  • Related NCI materials and Web pages:National Cancer Institute Fact Sheet 3.20, Human Papillomaviruses and Cancer: Questions and Answers(http://www.cancer.gov/cancertopics/factsheet/Risk/HPV)National Cancer Institute Fact Sheet 5.16, Pap Test(http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-test)Cervical Cancer Home Page(http://www.cancer.gov/cancertopics/types/cervical/)Digest Page on HPV (Human Papillomavirus) Vaccines for Cervical Cancer(http://www.cancer.gov/cancertopics/hpv-vaccines)Understanding Cervical Changes: A Health Guide for Women(http://www.cancer.gov/cancertopics/understandingcervicalchanges)What You Need To Know About™ Cancer of the Cervix(http://www.cancer.gov/cancertopics/wyntk/cervix)
  • Cervical Cancer 101

    1. 1. Cervical Cancer 101Training for REACH granteeSamaritan Health System<br />Michelle Berlin, MD, MPH<br />Vice Chair, Department of Obstetrics & Gynecology<br />Associate Director, Center for Women’s Health<br />(Date)<br />
    2. 2. Learning Objectives/Overview<br /><ul><li>Facts about Cervical Cancer
    3. 3. Prevention & Screening
    4. 4. Diagnostics & Treatment</li></li></ul><li>Facts about Cervical Cancer<br />
    5. 5. What is the Cervix? <br /><ul><li>The cervix is inside a woman’s body
    6. 6. It is the opening to the womb inside the vagina</li></li></ul><li>What is Cervical Cancer?<br /><ul><li>When cells on the cervix become abnormal and grow uncontrollably
    7. 7. A Pap test screens for cervical cancer
    8. 8. usually part of a well-woman clinic visit
    9. 9. Almost all cases caused by the Human Papillomavirus (HPV) </li></ul>HPV Capsid, <br />Dr Xiaojiang Chen, <br />University of Colorado Health Sciences Center<br />
    10. 10. What is HPV?<br />Human Papillomavirus= HPV<br />HPV infection = VERY common<br />Transmitted to both men and women via sexual intercourse OR skin to skin contact in the genital area<br />It is considered a sexually <br /> transmitted infection (STI)<br />
    11. 11. All US Women<br />How common is HPV?<br />80% of Women are infected with HPV <br />
    12. 12. Cervical Cancer by Numbers <br />2008: 530,000 new cases worldwide*<br /><ul><li>2010:12,200 new cases & 4,210 deaths in the U.S.**
    13. 13. About 50% U.S. women diagnosed with cervical cancer are between the ages of 45-64</li></ul>Oregon: Each week two women learn they have <br />cervical cancer and one dies from it.<br /><ul><li>International Agency for Research on Cancer, Globoscan 2008</li></ul>** American Cancer Society: Cancer Facts & Figures 2010<br />
    14. 14.
    15. 15. What are your chances of developing cervical cancer?<br />55 Million Annual Paps<br />U.S. Women diagnosed with Cervical Cancer<br />(12,000 per year)<br />3.8 Million<br />Abnormal Paps<br />
    16. 16. There are Racial/Ethnic Disparities <br />Get the message out about prevention, risk reduction and screening!<br />
    17. 17. Cervical Cancer Diagnosis in Oregon<br />(2003-2007)<br /><ul><li>Lincoln
    18. 18. Linn
    19. 19. Benton
    20. 20. Lane</li></ul>Source: SEER State Profile<br />
    21. 21. Fact Check<br />If I have HPV, does it mean I will get cancer?<br />HPV is spread by toilet seats and holding hands. <br />NO!!! <br />Only women with persistent HPV (where the virus does not go away) are at risk for cervical cancer.<br />NO!!! <br />HPV is transmitted through skin to skin contact in the genital area. <br />
    22. 22. Risk Reduction/Preventionand Screening <br />
    23. 23. What INCREASES risk?<br />Smoking<br />Number of sexual partners<br />History of abnormal Pap<br />
    24. 24. What DECREASES Risk?<br />Quit Smoking<br />Get Vaccinated<br />Use Barrier Methods <br />Regular Screening<br />Hysterectomy<br /> with removal <br />of cervix<br />
    25. 25. Prevention: HPV Vaccine<br />2 HPV vaccines approved<br />Both protect against 2 types of HPV that cause 70% of cervical cancer<br />The vaccine works best if you haven’t been exposed to the virus<br />This is why the vaccine is recommended for adolescent girls<br />
    26. 26. Who should be vaccinated?<br />At this time, not approved for Men over 18<br /><ul><li>Best to vaccinate girls prior to any sexual activity
    27. 27. Boys can transmit HPV to girls so many clinicians are also recommending vaccines for boys at an early age</li></li></ul><li>Lifetime Risk Reduction for Cervical Cancer after Vaccination<br />
    28. 28. Pap Screening Guidelines<br />Source: ACOG<br />
    29. 29. How is a Pap Test done?<br />Insert a Speculum<br />Swab the cervix<br />Place cells on a slide to <br />view under a microscope <br />
    30. 30. Are women getting Pap Screenings? <br />Healthy People 2020 goal:<br />93.0% of women 21-65 receive screening based on most recent guidelines <br />U.S. Baseline: 84.5% <br />Oregon needs 10% increase to meet guidelines<br />Past 3 years (18+) 2008<br />
    31. 31. Fact Check<br />If I get a Hysterectomy, I never have to get a Pap test again.<br />You can have the HPV virus, and never get cervical cancer.<br />True<br /><ul><li>If your cervix was removed
    32. 32. AND prior Paps were normal </li></ul>True<br />If I’m over 30, I get a Pap Test every 3 years.<br />If I get the HPV vaccine, I never have to get a Pap Test again.<br />Yes! If your prior 3 Paps were normal <br />NO!!!<br />
    33. 33. Diagnosis and Treatment<br />
    34. 34. What Happens if I have an abnormal Pap?<br />Depends…<br />Sometimes get a repeat Pap in a few months<br />Usually need further evaluation (colposcopy)<br />Further evaluation and/or treatment depends on findings at colposcopy<br />May need follow-up, or<br />May need LEEP or cone biopsy<br />
    35. 35. Uses a lighted microscope to aid in examining the tissue more closely for cancer.<br />A small match stick- sized tissue sample taken for review under a microscope.<br />Procedure done in provider’s office.<br />Colposcopy<br />
    36. 36. What your provider may see at colposcopy<br />Source: http://wegotyourblack.com/tag/african-american-women/<br />
    37. 37. Loop Electrosurgical Excision Procedure (LEEP)<br /><ul><li>LEEP is a electric wire loop used to slice off a thin piece of cervical tissue
    38. 38. In most cases, it is done in your doctor’s office or clinic, taking only 20 minutes
    39. 39. You are given pain relief before the doctor begins.
    40. 40. Can diagnose cervical cancer. </li></ul>Source: ACOG<br />
    41. 41. Cone Biopsy<br /><ul><li>A larger cone-shaped tissues is taken from the cervix
    42. 42. Done in the operating room
    43. 43. Can diagnose and treat early cervical cancer. </li></ul>http://www.summitmedicalgroup.com/<br />
    44. 44. Further Treatment<br />Surgery<br /><ul><li>Hysterectomy with removal of the uterus and cervix</li></ul>Radiation<br />Chemotherapy<br />
    45. 45. Fact Check<br />An abnormal Pap may require what additional procedures? <br />Only pre-menopausal women need Pap tests?<br />Usually, but<br />many post-menopausal women get Paps until they are 65 or 70<br />Colposcopy, LEEP <br />or Cone Biopsy<br />Once you have a hysterectomy, you no longer need a Pap? <br />We know what causes cervical cancer?<br />Usually <br />TRUE<br />
    46. 46. Fact Check<br />Name 3 ways to reduce your risk of HPV and cervical cancer<br />Can you only get HPV through sex?<br />NO! Any contact with the genital area<br /><ul><li>Quit Smoking
    47. 47. Use of barrier methods like condoms
    48. 48. Get the HPV vaccine
    49. 49. Have Regular Pap tests</li></ul>Is early cervical cancer curable? <br />YES!!!<br />
    50. 50. What 3 Steps you can take to prevent Cervical Cancer?<br />Get the vaccine at an early age<br />Learn how you can reduce your risk<br />Get routine Pap tests, even after childbearing years<br />
    51. 51. For more information<br />See “Cervical Cancer Website Resources” handout for list of many informative sites<br />Calculate your own risk with our online cervical cancer risk assessment tool: www.ohsuwomenshealth.com/cervical<br />
    52. 52. Thank You!!!<br />Created by:Dolly England<br />OHSU Knight Cancer Institute<br />Community Health Educator<br />

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