1	Health Information That Could Save Your Life HPV and Cervical Cancer Carolyn Jacobson Coalition of Labor Union Women August 18, 2005
2	Program Overview Cervical Cancer Prevention Works is CLUW’s new health awareness project Our mission is to empower union women by providing them with information on how to prevent this deadly disease CCPW is funded through an unrestricted educational grant from Digene Corporation
3	Anatomy Overview
4	Cervical Cancer Overview Since the introduction of the pap test rates of cervical cancer have dramatically declined However, according the American Cancer Society more than 10,000 women will be diagnosed with cervical cancer in 2005 Approximately 4,000 will die
5	Cervical Cancer Overview Cervical cancer is a caused by a virus The Human Papillomavirus (HPV) HPV is very common More than 80% of women will acquire an HPV infection before their 50^th birthday In most women, the body’s immune system fights off the virus before it causes problems However, when the infection doesn’t go away on its own, certain types of high-risk HPV can cause cell changes that MAY develop into cervical cancer if not detected and treated early
6	Cervical Cancer Overview How do you get HPV? HPV is spread from person to person through sex or skin-to-skin contact. Condoms provide some protection but cannot prevent the infection completely because they do not cover the entire genital region HPV infection is not a sign of promiscuity or infidelity While having more than one sexual partner may increase the risk of getting HPV, it is possible to get the virus from just one person Women who have had just one sexual partner for many years are still at risk for cervical cancer. HPV can “hide” in cervical cells for a long period of time and not be detected It is impossible to determine when you acquired an HPV infection or how long you have had it
7	Cervical Cancer Overview Additional risk factors for cervical cancer Smoking Illnesses which reduce the body’s ability to fight off infections (such as HIV/AIDs) Developing cervical cancer Once cervical cells start to change it typically takes 10-15 years before cancer develops As cells change they become “pre-cancerous”- a condition also known as dysplasia Cervical dysplasia is easily treated with cryotherapy (freezing pre-cancerous cells) or a LEEP procedure (very thin, electrically charged wire is used to cut out abnormal cells)
8	Cervical Cancer Screening What is a Pap test? During a pap test your doctor scrapes a small sample of cells from your cervix and sends it a laboratory A technologist looks at the cells under the microscope for signs of abnormal changes How accurate are Pap tests? A conventional (dry slide) pap test is about 50-60% accurate Detects abnormal cells 50-60% of the time when they are present The new liquid based pap test (ThinPrep) is about 50-85% accurate Detects abnormal cells 50-85% of the time when they are present
9	Cervical Cancer Screening What is the HPV test? The HPV test uses advanced, molecular technology to determine whether one of the virus types that causes cervical cancer is present in cervical cells In March of 2003 the test was approved by the FDA for use with a pap test for routine screening of women aged 30 and older The HPV test identifies 95-100% of women with cervical disease
10	Cervical Cancer Screening How should I be screened for cervical cancer? If you are under the age of 30 you should be screened yearly with a pap test Ask your doctor to use the ThinPrep or a liquid-based pap test to ensure the best results If you pap test comes back abnormal you should then receive an HPV test If your HPV test is negative you are not at risk for cervical cancer If your HPV test is positive your doctor will perform a colposcopy
11	Cervical Cancer Screening How should I be screened for cervical cancer? If you are age 30 or older you should be screened with both a pap test and an HPV test An HPV test sample is taken at the same time as the pap test sample-it does not require a separate procedure or trip to the doctor If the results of both tests are negative, you can safely wait 3 years before being screened with both tests again American Cancer Society and American College of Obstetrics and Gynecology both support combination screening
12	Asking For the HPV Test Helpful hints for obtaining the HPV test with your pap test Call your doctor’s office before your next exam to find out if they offer the HPV test as part of routine screening for cervical cancer If your doctor does not offer the HPV test for screening, ask if it is possible to do so for you If your physician (or office staff) believe HPV testing is unnecessary, say that you would like the test “for my extra piece of mind” Most physicians will honor your request. If they do not, you will need to determine if having a physician that makes you a partner in managing your own health is important to you
13	What Your Results Mean 95/100 women aged 30 and above will get a negative HPV result If you are HPV positive it does not mean you have or will get cervical cancer but it does mean you are at slightly higher risk There is a very high chance you will get rid of the HPV on your own To be certain, you should repeat both the pap and the HPV test in 6-12 months If you are still HPV positive (even if you pap is normal) it is recommended that you have a colposcopy
14	Insurance Coverage HPV testing is covered by the majority of public and private payers including some of the largest national payers as well as regional payers Aetna, Cigna, United Healthcare, Wellpoint, and CareFirst BCBS Coverage is based on the contract your union negotiated with its payer To be certain its covered call your insurance company before your visit Should your test not be covered and you do receive a bill ask the lab to discount the price because you are paying cash for the test For insurance related problems call the patient hotline 1-866-DNA-PAP1 (8:30-5:30pm EST)
15	What Unions Can Do Demand coverage for all FDA-approved cervical cancer screening technologies Work with union trustees to ensure you and your family have coverage Cover annual office visits with obstetrician or gynecologist for counseling on contraception, sexually transmitted infections, breast and other cancer screening, and, as deemed appropriate by the clinician, cervical cancer screening With combination screening you may only need cervical cancer screening every three years, but it is still important to visit your gynecologist ever year for other preventative screenings Protect patient confidentiality HPV testing is a personal decision
16	Additional Resources www.cluw.org/cervcancer.html (CCPW, CLUW) www.thehpvtest.com www.cancer.org (American Cancer Society) www.ashastd.org (American Social Health Association) www.cdc.gov (Centers for Disease Control) www.womeningoverment.org (Women In Government) www.popsmear.org (Popsmear.org)