What is cancer?Cancer is a disease of the body’s cells.

Our body is made up of billions of cells, which normally grow and divide in our body. This process is controlled by our genes.

Genes are able to tell the body when to grow new cells and when to replace worn out cells. This is a normal process that occurs continuously in our body.

Cancer can develop when these genes are damaged and can no longer tell the body when to replace worn out cells. When this happens, unhealthy (abnormal) cells may continue to grow and divide uncontrollably.

If the unhealthy (abnormal) cells are left undetected, they may become cancerous over time. They could also spread through the body via the blood supply. This is how cancer spreads from one part of the body to another.

Optional informationEach year, nearly 24,000 Victorians are diagnosed with cancer and about 9,500 Victorians die from cancer.

Today, around 61% of people with cancer survive.

Aboriginal and Torres Strait Islander women are five times more likely to die from cervical cancer than non Aboriginal women.

Many cancers can be avoided through prevention and early detection.

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Why have a Well Women’s Check (Pap test)?Cervical cancer is one of the most preventable cancers.

Just as we need to keep other parts of our body healthy, it’s important to keep the inside of our body healthy too.

One way that we can do this is by having regular Pap tests.

Women aged between 18 and 70 years need to have a Well Women’s Check (Pap test) every two years.

Pap tests are important because they look for unhealthy (abnormal) cells in the cervix, which over time, may lead to cervical cancer.

The human papilloma virus (HPV) is the most common cause of cervical cancer.

However, other co-factors, together with HPV, can increase a woman’s risk of developing cervical cancer.

These include:

age (the risk of developing cervical cancer increases with age)

smoking (for a woman who smokes, it can be more difficult to clear HPV infection. Smoking is also thought to increase the rate of which cancer develops)

use of oral contraceptives for five or more years

Please note these co-factors contribute only a small amount to cervical cancer.

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The reproductive system and locating the cervixThe cervix is located between the vagina and the uterus (baby bag/womb).

The cervix has an important role:

It allows blood to pass from the uterus to the vagina during your period (menstruation).

It allows sperm to travel up into the uterus.

Throughout pregnancy, the cervix holds the developing baby in the uterus and during birth expands (stretches) to enable a baby to be born.

Optional informationOvaries - The ovaries, which are about the size of an olive, are located on each side of the uterus. The two main female hormones, oestrogen and progesterone, are made by the ovaries. The ovaries contain the ova (eggs).

Fallopian tubes - The fallopian tubes connect the ovaries to the uterus. This is where the ovum (egg) is fertilised by a sperm.

Vagina - The vagina is made of elastic muscle tissue that can stretch to allow a baby to be born. Most of the time the walls of the vagina are closed.

Uterus (baby bag/womb) – The uterus is normally the size of a pear. During pregnancy, the walls of the uterus can stretch to the size of a basketball. The endometrium (uterus lining) thickens once a month in preparation for pregnancy and is shed if pregnancy does not occur. This shedding is menstruation (period).

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The Pap test A Pap test looks for unhealthy (abnormal) cells of the cervix (neck of the womb).

If these unhealthy (abnormal) cells are left undetected, they may become cancerous over time.

Cervical cancer usually takes more than 10 years to develop.

Specially trained nurses, doctors and gynaecologists are able to take a Pap test.

It is important to remember that a Pap test is not a test for cancer; it can pick up the early warning signs that cancer might develop in the future.

A Pap test does not look for sexually transmitted infections, ovarian cancer or other cancers of the reproductive system. A Pap test is only designed to detect unhealthy (abnormal) cells of the cervix.

The Pap test is not always 100% accurate. This is why we recommend that women have a Pap test every two years.

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Who should have a Pap test?All women aged between 18 and 70 years who have ever been sexually active should have a Well Women’s Check (Pap test) every two years, this includes:

women who have only had sex once

women who have only had one partner

women who are widowed or divorced

women who are no longer sexually active

women who have gone through menopause

women who have female partners

some women who have had a hysterectomy

Many women feel embarrassed (shamed) about having a Pap test – this is normal. Talk to your Aboriginal health worker, nurse or doctor first. It’s ok to bring a friend or health worker with you to your appointment.

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Pap tests and hysterectomy For most women who have had a hysterectomy, Pap tests are no longer needed.

However, some women who have had a hysterectomy still need to have regular Pap tests (or vaginal smears). This includes women who:

still have a cervix

had a hysterectomy as part of treatment for a gynaecological cancer (e.g. cervical, ovarian, endometrial vaginal cancer)

had a significant abnormality detected on a Pap test in the past

have never had a Pap test

Many women do not know exactly what type of hysterectomy they have had. It is important to find out from your doctor.

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How is a Pap test taken?A Pap test should only take a few minutes.

You will be asked to undress from your waist down (the nurse or doctor will not watch you while you are getting undressed). To make the examination easier, it’s a good idea to wear a top and trousers/skirt, rather than a dress.

You will be asked to lie on your back or side on an examination bed and a sheet will be given to cover yourself.

An instrument called a speculum (duck bill) will be gently inserted inside the vagina so the cervix can be seen. A special spatula or brush is used to gently remove some cells from the cervix. All instruments are sterilised or disposable.

The Pap test should not hurt. It may feel like being gently wiped with a cotton bud.

Your comfort is important– if it does hurt or you feel uncomfortable, tell your doctor, nurse or Aboriginal Health Worker straight away. It’s ok to stop the procedure at any time.

The cells collected are put on a glass slide and protected with a spray. They are then sent to a pathology service for testing.

The speculum is gently removed and then you can get dressed.

Pap test results are usually available within two weeks.

Always ask your doctor, nurse or Aboriginal Health Worker about how you will receive your test results.

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What does an abnormal Pap test result mean?Most Pap test results are normal (one in ten Pap tests show an abnormality).

A Pap test that shows unhealthy (abnormal) cells does not mean you have cancer.

It could be abnormal for many reasons including:

An infection

Minor inflammation, or

Unhealthy (abnormal) cell growth

Most cell changes clear up naturally or can be easily treated.

Cervical cancer is caused by infection with some types of the Human Papilloma Virus (HPV).

What is Human Papilloma Virus (HPV)?Human Papilloma Virus (HPV) is a virus.

There are more than 100 different types of HPV, some of which affect the genital area.

Women can get HPV through genital skin-to-skin contact during sexual activity.

Most women (four in five) will have HPV at some time in their life and never know it.

The virus can sometimes cause genital warts or unhealthy (abnormal) cell changes to the cervix.

HPV is a virus that can be cleared by our immune system, a bit like a common cold. The body usually clears the virus naturally within 1-2 years.

Some HPV types can take longer for our body to clear, and over time, if left untreated can cause cervical cancer.

The majority of women who have HPV will never develop cervical cancer.

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What happens after an abnormal result?When detected early, cell changes are usually easy to treat.

Some will go away by themselves; others will require further investigation.

If you have minor cell changes (a low grade abnormality), it most likely means that you have unhealthy (abnormal) cells due to inflammation or an infection with HPV. Your doctor will watch (monitor) these changes. He/she will ask you to have more frequent Pap tests for a period of time to check if the unhealthy (abnormal) cells have returned to normal.

If you have more serious changes to the cells (a high grade abnormality), you may be referred to a specialist who will do an examination called a colposcopy.

Colposcopy is similar to a Pap test but will take a bit longer.

A colposcopy provides a magnified view of the cervix. This is to look at the unhealthy (abnormal) cells more closely and will help the doctor decide if further treatment is required.

At the time of the colposcopy, a small sample of cells may be taken and sent to a laboratory to be tested. This is called a biopsy.

Women with high-grade abnormalities have a number of options for treatment, depending on the abnormality.

Different methods are used to remove abnormal cells from the cervix. Some women may need to stay in hospital for the day.

You should make an appointment with your doctor to discuss options for treatment if required.

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What is the cervical cancer vaccine?The vaccine protects girls and young women from the two types of HPV that cause most cervical cancers.

The vaccine works best if given to girls before they are sexually active.

Three doses (needles) are required over six months. It is important to have all three injections as this provides the best protection.

The needle is given in the upper arm.

The vaccine is free for girls aged 12 –26 until June 2009. After this date, it will be available to girls in their first year of high school.

The vaccine is available from secondary school, Aboriginal health services, local councils or from your local GP.

The vaccine is voluntary. Girls at school need to have parental consent.

Girls who are pregnant should not have the vaccine.

If girls feel unwell or have a reaction after having the vaccine, tell the health worker, a family member, or a doctor/nurse.

Women, vaccinated or not, still need to have Pap tests every two years.

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The Pap test RegistryEvery Australian state and territory has a Pap test Registry.

The registry is confidential and keeps record of women’s Pap test results.

It is a very important service because the registry notifies women if they are overdue for their next Pap test. They do this by sending a reminder letter.

The registry also follows-up women who have had abnormal Pap test results.

A woman’s Pap test results are automatically forwarded to the registry.

If you do not want your results registered, tell your doctor or nurse.

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Things to rememberCervical cancer is one of the most preventable cancers.

A Pap test every two years is your best protection against cervical cancer.

Young women who have the vaccine, still need to have regular Pap tests.

If you are due for a Pap test make an appointment today.

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