Appendix 2: Education and Counseling

Transcription

1 Appendix 2: Education and Counseling A. MCCSP Resources The MCCSP has a wide range of resources for the public, some of which are multilingual. HCPs are encouraged to refer their clients to the MCCSP website, TellEveryWoman.ca where they may view our resources online. All of our resources are available to the public and HCPs for free and can be ordered by downloading our order form and faxing it back to the MCCSP. To order and review these resources, please visit: Be sure to review our resource list below. The staff at the MCCSP is also available to answer questions from the public and HCPs. We can be reached in Winnipeg at , or toll free at (866)

2 Manitoba Cervical Cancer Screening Program (MCCSP) Resource List RESOURCE New! Pap Test Learning Module For Health Care Providers Pap Tests: What you need to know New! Abnormal Results/ Colposcopy Bookmarks New! Greeting Cards Where Can I Go List Image Gallery HPV Clinician Fact Sheet HPV Vaccine Fact Sheet New! Screening Guidelines Posters Flyers Pens DESCRIPTION Introduces HCP s to all aspects of cervical screening in Manitoba, including the management of cytology results, procedures for taking a Pap test and special client considerations. Includes a written document and a DVD demonstrating how to take a Pap test and illustrating abnormalities of the cervix. This resource is for all HCP s seeking to a) initiate learning about Pap tests and acquire Pap test competence, b) mentor colleagues to become competent, and c) review components of cervical cancer screening in Manitoba. Available at TellEveryWoman.ca Brochures Describes the Pap test, what the cervix is, frequency, where to go, abnormal results, colposcopy and the HPV vaccine. Defines all Pap test results and appropriate follow up recommendations for each. Defines colposcopy and illustrates the various procedures that may be performed during colposcopy. Various Items Questions and Answers about Pap tests. Available in 26 languages. TellEveryWoman Greeting Cards promote awareness about Pap tests. Distribute in your health centre, community and between friends/family. Themes: Thinking of You, Happy Mothers Day, Happy Birthday, Happy Anniversary and Thank You. Come with envelopes and Greeting Card Stand. For Winnipeg. Outlines where a woman can go for a Pap test in Winnipeg.. A four page laminated card with cervical screening images and plain language definitions. A 2 sided card (8.5 x by 11) with research based information on HPV, for professional use. Describes the HPV Vaccine what it is, who should get it/not get it, the HPV Immunization Program in Manitoba, the content and cost of the vaccine, its safety and effectiveness. A 2 sided card outlining recommended screening guidelines and follow up. TellEveryWoman or Every woman should know about Pap tests versions. To promote your Pap clinic view, download and print at TellEveryWoman.ca TellEveryWoman version. To promote your Pap clinic view, download and print at TellEveryWoman.ca With our toll free phone number and website address 165

3 New! Pap Test Learning Module DVD The Pap Test Colposcopy Reduce Your Risk Cervical Display Board Combined Screening Display Board Reduce Your Cancer Risk Facilitator Tool Kit Common Sense Game Pap Test Toolkit Videos/DVDs Accompanies the Pap Test Learning Module for HCP s. Demonstrates how to take a Pap test and illustrates abnormalities of the cervix. A 15 minute video that reviews cancer of the cervix, risk factors, how to reduce your risk, what is a Pap test, how often women should have Pap tests, what happens during the procedure. Available in 12 languages. Can be viewed on our website, call to borrow. An 11 minute video that reviews why you have been referred for a colposcopy, what happens during a colposcopy, what you can expect after the procedure and possible treatments Available in 12 languages. A 23 minute video that reviews risk reduction for cancer and screening for breast, cervical and colorectal cancer. Available in 11 languages. Can be viewed on our website, call for a copy. Other Every Woman Should Know About Pap Tests, tri-fold display board, available for loan, call to borrow. Tri-fold display. Illustrates guidelines and importance of screening for breast, cervical and colorectal cancer. A facilitator resource for community volunteers and professional health educators in Manitoba. Contains the Reduce Your Risk Video, information on getting a group together, how to prepare for a presentation, a presentation agenda, activity suggestions, background information, sample resources, and an order form. Also available for download off our website. Q & A Common Sense Game, available on our website, call to borrow a laminated version. Kit contains speculum, spatula, cytobrush, slide, slide case, cervix model, image gallery, and Pap test description. Designed for educators who teach women about Pap tests. 166

4 About Pap Tests Cervical Common Sense Pap Tests: Immigrant Version Bingo Jeopardy PowerPoint Presentations Describes cervical cancer, Pap tests, who should have Pap tests and why, risk reduction, how to help the test, screening guidelines, where a person can go, the HPV Vaccine and the MCCSP. Describes cervical cancer, risk factors, HPV, the HPV Vaccine, Pap tests, guidelines for cervical screening, colposcopy and the MCCSP. Information is presented in a game and lecture format. Describes Pap tests, who should have Pap tests, how often, how to get the test, where a woman can go, the HPV Vaccine and the MCCSP in a simple, easy to understand format aimed towards immigrant women. Games Describes Pap tests, recommended frequency, HPV, HPV Vaccine, coloposcopy, treatments for abnormal results and follow-up recommendations. Describes Pap tests, HPV, HPV Vaccine and appropriate follow up for a Pap test and/or abnormal result. 167

5 B. About Pap tests and the MCCSP: Common Questions and Answers for the Public What causes cervical cancer? Human Papillomavirus (HPV), a very common sexually transmitted infection, can cause changes on a woman s cervix which may lead to cervical cancer. Almost all cases of cervical cancer are linked to Human Papillomavirus (HPV). Other types of HPV may cause genital warts. 3 out of 4 people will come in contact with HPV at some point in their lives. HPV transmission occurs easily through sexual intercourse as well as through skin to skin contact. Sexual activity includes oral sex, sex with fingers or hands, genital rubbing and sex with toys. Most people do not experience any symptoms from HPV. Condoms may not always protect you against HPV. Warts or cervical changes may happen years after getting HPV. Currently, in Manitoba, the Pap test is the only way to find out if a woman has abnormal changes on her cervix due to HPV. Regular Pap tests with follow-up of abnormal changes can prevent most cancer of the cervix. Is one sexual partner really all you need to put yourself at risk for cervical cancer? Yes. When should I have a Pap test? You should start having Pap tests three years after your first sexual activity (intimate touching OR sexual intercourse). Most women need a Pap test every two years. Talk to your health care provider about what is best for you. If my Pap test is abnormal, does it mean I have cancer? No, it does not. In most cases, cancer is not the reason for an abnormal Pap test. Most of the time, abnormal cells detected by a Pap test will disappear on their own without any treatment. You may need a repeat Pap test, or in some cases you may need colposcopy. Most women who have abnormal Pap test results and who have follow-up tests and/or treatment will never get cancer of the cervix. What are the symptoms for abnormal cell changes and cervical cancer? There are no symptoms for abnormal cell changes. The only way to find out if cells have changed is to have a Pap test. If a woman does have cervical cancer there may be symptoms. These include bleeding at times other than monthly menstruation, bleeding after sexual intercourse or unusual discharge. Any of these symptoms should be checked by a doctor within a few weeks. 168

6 How can I reduce the risk? Not having sex is the surest protection. Ask your health care provider if you should receive the HPV vaccine. Delay sex until your late teens or older. Getting HPV at an early age increases a woman s chances of getting cervical cancer. If you have sex: always use condoms. limit the number of people you have sex with in your lifetime. keep your body healthy and strong so it can fight off infections. Eat healthy, exercise and get enough rest. avoid cigarette smoke as it affects the cells on a woman s cervix. If I am past menopause, do I still need Pap tests? Yes. A post-menopausal woman should continue to be screened regularly. A woman may be able to stop having Pap tests at age 70 if she has had Negative Pap tests results and has had no change in her partner. I ve had a hysterectomy. Do I still need Pap tests? Maybe. A woman who has had a hysterectomy should meet several conditions before she can discontinue screening. Speak to your doctor about what is right for you. Should women over the age of 69 have Pap tests? Screening can be discontinued if a woman is 70 years of age or older and has had 3 or more Negative Pap tests in the previous 10 years with no change in partner. Can a pregnant woman have a Pap test? Yes, if a woman is pregnant she can have a Pap test. Does a woman who has never had sexual intercourse still need a Pap test? One of the risk factors for cervical cancer is the Human Papillomavirus (HPV). This virus can be spread not only though sexual intercourse but also through intimate genital contact. If a woman has not had sexual intercourse but has had intimate genital contact with one or more partners then she should start having Pap tests three years after becoming sexually active. What is meant by the Pap test being a screening tool? The Pap test is considered a screening tool because it is a method of testing people who are considered healthy and have no symptoms. The Pap test can find early cervical cell abnormalities before the condition becomes symptomatic and when treatment can take place. 169

7 What does a woman do after a Pap test? After a Pap test the health care provider should tell a woman when the results will come back. If not, it is advised to ask the health care provider. If the result is normal the woman will likely not receive any correspondence from her provider. If the results are abnormal or difficult to read, then a woman should receive a phone call from someone at the health care providers office or clinic indicating what the next steps are. Pap test results can be obtained, free of charge, directly from the MCCSP upon request from any Manitoban women. How accurate is a Pap test? In Manitoba, the Pap test is the most effective method for finding abnormal changes on the cervix. The Pap test is like other medical tests in that it is not perfect. Therefore, it is important to be tested on a regular basis (every two years) to reduce the chance of missing any abnormal cells that may be present. Where can I go for a Pap test in Manitoba? Ask your health care provider for a Pap test. If you need a family doctor call the Family Doctor Connection Line at or There are a number of places in Winnipeg and rural Manitoba that you can go for a Pap test. To see a list of clinics offering walk-in Pap tests, call the MCCSP in Winnipeg at or toll free at (866) , or visit our website at TellEveryWoman.ca and click on where can I go? Does the Pap test check for sexually transmitted infections (STIs)? This is a frequent misconception. No, the Pap test does not check for sexually transmitted infections. This requires a separate test. What happens during a colposcopy? A colposcopy is completed by a gynaecologist with special training. The process is quite similar to a Pap test. A woman lies down on an examination table and puts her feet in stirrups. A speculum is used to open the vagina so the cervix can be seen. The doctor uses a colposcope, a powerful magnifying tool, to look closely at the cervix. The colposcope stays outside the body and helps the doctor see changes better. At that time a sample of tissue may be taken to determine if treatment is needed. How are abnormal cells able to return to normal? Many women who have abnormal results for a Pap test go back six months later and find out that the abnormal cells have cleared or returned to normal on their own. Sometimes if a woman has had an infection, like a yeast infection, it can cause her cells to appear abnormal. Once the infection is cleared the results are normal. Abnormal cell changes appear to be connected to the immune system. A 170

8 woman's immune system may fight off the HPV infection, so the abnormal cells are destroyed. Most women are able to get rid of the virus but some women can not get rid of the virus. Therefore, regular Pap tests are needed to monitor abnormal cells. What is HPV? HPV is human papillomavirus. More than 100 types of this virus can infect humans. Some types of HPV cause the warts commonly found on hands and feet. Other types of HPV (genital HPVs) cause warts on your genitals or cause changes on a woman s cervix which may lead to cervical cancer. The types of HPV that cause warts on your hands and feet do not infect your genitals. The types of HPV that infect your genitals do not infect your hands and feet. How common is HPV? HPV is very common. At least 3 out of 4 people will come in contact with genital HPV at some point in their lives. Not everyone will get genital warts or changes on their cervix. Is there a test for HPV? There are tests for HPV available in some provinces, but they are not routinely available in Manitoba. HPV testing detects types of HPV DNA on the cervix. It does not tell if you have been infected in the past. Women can have a Pap test to find changes on the cervix caused by HPV. How do I get HPV? You can get HPV easily from being sexually active with same sex or opposite sex partners. Sexual activity includes oral sex, anal sex, sex with fingers or hands, genital rubbing and sex with toys. You can spread HPV even if you are not aware of any symptoms (warts, bumps or cervical changes). If I have sex with someone of the same sex, should I be concerned about HPV? Yes, HPV can be passed between any sexual partners. Can I tell who I got HPV from? It is usually impossible to tell when or from whom you got the infection. Can men get HPV? Yes, men can get HPV. There are usually no symptoms unless a male has a type of HPV that causes genital warts that are visible bumps on the skin that may feel itchy or irritated. 171

9 Can condoms protect against HPV? Condoms can protect you from many sexually transmitted infections. Condoms may not always protect you against HPV. Is there a cure for HPV? No. There is no cure for the virus. The warts and some cervical changes caused by the virus may disappear on their own or they can be treated. Is there a vaccine for Human Papillomavirus (HPV)? Yes. The Public Health Agency of Canada (Health Canada) has approved Gardasil for females and males. Gardasil provides protection against 4 types of HPV: HPV 16, 18, 6 & 11. Health Canada has also approved Cervarix for females which provides protection against 2 types of HPV: 16 & 18. HPV 16 and 18 cause over 70% of all cervical cancers. HPV 6 and 11 cause 90% of all genital warts. The vaccine is administered in 3 doses over 6 months. It cannot be used to treat existing HPV infection. If you receive any HPV vaccine, you still need to have regular Pap tests because the vaccine doesn t protect against all HPV types that cause cervical cancer. Talk to your health care provider, Manitoba Health or the Manitoba Cervical Cancer Screening Program about how to access the vaccine and what is best for you. Who is the vaccine for? The vaccine is for females and males between the ages of 9 and 26. The vaccine works best when given to young men and women before they start having sexual contact. Who should not get the vaccine? The vaccine is not recommended for females under the age of 9 and pregnant women. What is the HPV Immunization Program? In the school year, Manitoba Health introduced a vaccine program for grade six girls. It is voluntary. It is given by public health nurses. Before any female student is immunized with Gardasil, parents and legal guardians will receive information about HPV and the vaccine, and a consent form. For more information about he HPV Immunization Program visit the Manitoba Health website at: or call (204) Is there a cost for the vaccine? Gardasil is free in Manitoba for girls who meet the following eligibility criteria: Grade six females through the HPV Immunization Program, 172

10 Females who missed the vaccine in grade six and are born on or after January 1, 1997, Children who are part-way through an immunization series in another jurisdiction as part of a universal program. If the HPV vaccine is not accessed through the school-based system, it is also available at physician s offices. Physician s may order the vaccine from the provincial warehouse in limited quantities for individuals who are included in the eligible cohort only. Neither Gardasil nor Cervarix is free for women or men outside the program. The vaccine can be purchased through one s HCP, however, a prescription may be necessary. If I am vaccinated, will I still have to go for Pap tests? Yes, you will still need to have regular Pap tests because: the vaccine does not protect you against all types of HPV that can cause cervical cancer, you may have already had an HPV infection when you were immunized, or you many not have full protection from the vaccine Women who have ever been sexually active should have regular Pap tests. Most women need a Pap test once every two years. Ask your health care provider or the MCCSP when you are due for your next Pap test. What are the treatments for genital warts? Visible warts can be treated. Your health care provider may treat your skin in the office or give you a prescription for you to apply. Do not use drugstore wart treatments. These are meant for warts on the hands or feet only. 173