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Healthy Women Project: Frequently Asked Questions

Cervical Cancer Screening Questions

1. What is cervical cancer?
2. Who is at risk for cervical cancer?
3. What is the Human Papillomavirus (HPV)?
4. What can I do to prevent cervical cancer?
5. How often do I need to be screened for cervical cancer?
6. At my age, do I still need to be screened?
7. I am not sexually active. Do I need to be screened?
8. I had a hysterectomy. Do I need to be screened?
9. My doctor hasn’t offered to screen me, so why should I bother?
10. Why should I make time for a test that is probably negative anyway?
11. How can I find offices that are accessible for my particular disability?
12. What if I can’t afford screening tests?
13. What if I have Medicare or MediCal?
14. How can I get to a screening test?
15. Will my mobility issues interfere with my Pap smear?
16. Will my chronic pain issues interfere with my Pap smear?
17. Will my allergies or chemical sensitivities interfere with my Pap smear?
18. Will my bladder and/or bowel control interfere with my screening?
19. What if this kind of test is in conflict with my cultural or religious beliefs?
20. What if I have been abused?
21. Is the test itself scary or painful?
22. What if the test comes back positive?
23. What should I do after a test?

1. What is cervical cancer?

Cervical cancer happens when cells on the cervix, the narrow opening into the uterus, change and grow out of control. The cervix is deep inside your body, so this kind of cancer can grow undetected for years. Symptoms (usually a bloody vaginal discharge) typically do not appear until 5 or 6 years after the cancer has begun to grow. Cervical cancer affects 1 out of 128 women by age 85.

2. Who is at risk for cervical cancer?

All women age 25 and over. Age is a risk, as over half of cervical cancer occurs in women over 55. Women who have Human Papillomavirus (HPV) have an elevated risk, as do women who have a family history of cervical cancer, have a suppressed immune system, use oral contraceptives, smoke, or were exposed to a drug called DES while in their mother’s womb. In general, however, this cancer can strike any woman, which is why it is so important to have regular Pap smears.

3. What is the Human Papillomavirus (HPV)?

HPV is a common sexually transmitted disease, and one that typically does not have symptoms. There are more than 30 types of HPV, some of which can cause genital warts. Certain strains of HPV may cause cervical cancer, and more than 70% of cervical cancers have been linked to this virus. Click here to read more about HPV.

4. What can I do to prevent cervical cancer?

Get regular Pap smears! There is no self-examination you can do. While cervical cancer is associated with HPV, it can strike any woman over 25. The most important thing you can do is get Pap smears regularly. A Pap smear is a very quick procedure that involves taking a sampling of the cells on the cervix with a swab during a pelvic exam.

Before the invention of the Pap smear in the 1950s, cervical cancer was the most common cancer in women in the U.S. Now more than 70% of the women who might have died get cured because of the Pap smear test.

5. How often do I need to be screened for cervical cancer?

The American Cancer Society recommends that women get a Pap smear every two years. If you have had an abnormal Pap smear before, or if you have reason to believe you are at greater risk for developing cervical cancer, more frequent Pap smears are recommended.

6. At my age, do I still need to be screened?

Yes. Though HPV, a sexually transmitted disease, can play a part in cervical cancer, the disease can strike any woman, sexually active or not. Over half of all cervical cancer cases are in women over age 50. Women age 65-70, who have had three normal, consecutive Pap tests and no abnormal Pap tests in the last 10 years, may decide after talking to her doctor to stop having the Pap test.

7. I am not sexually active. Do I need to be screened?

Yes, absolutely. Though HPV (a sexually transmitted disease) and sexual activity can play a part in cervical cancer, these are by no means the only cause of the disease. Furthermore, whether or not you are sexually active now, if you ever have been, you may have HPV and not know it, as the virus usually does not produce any symptoms.

8. I had a hysterectomy. Do I need to be screened?

It depends on whether or not your cervix has been removed. Consult your doctor.

9. My doctor hasn’t offered to screen me, so why should I bother?

Your provider may be so focused on other ongoing health issues related to your disability that this screening test has gone unmentioned. Also, some providers forget to recommend gynecological exams, neglecting to see women with disabilities as whole people. Don’t let your provider’s attitude prevent you from being proactive. You can schedule a Pap smear and pelvic exam for yourself, without a referral. It’s an important part of taking care of yourself.

10. Why should I make time for a test that is probably negative anyway?

Cervical cancer usually produces no symptoms until the cancer has spread or become difficult to treat. There is no self-examination you can do for this kind of cancer. Every woman is at risk for this disease. You may feel overwhelmed by other health issues, However, keeping up with cancer screening is an important part of taking care of yourself. Early detection can save your life!

11. How can I find offices that are accessible for my particular disability?

Having a disability may affect your experience getting the exam. If you live in Alameda County, click here for a directory of clinics and doctors that have experience and equipment that better accommodates women with disabilities. If you live elsewhere, check out Table Manners, a great resource on Pap smears and pelvic exams for women with disabilities.

12. What if I can’t afford screening tests?

A state program called Every Woman Counts assures access to Pap smears for women with low incomes. Call (800) 511-2300 to see if you qualify.

13. What if I have Medicare or MediCal?

Medicare Part B will pay for most of an annual screening, or you will be charged the usual 20 percent deductible if you have not met your annual Part B deductible. Call Medicare at (800) MEDICARE or visit them online www.medicare.gov for more information.

If you live in Alameda County, please check the provider directory for facilities that will accept MediCal and Medicare. In the unlikely circumstance that you are diagnosed with cervical cancer, free treatment is available to Californians who qualify at the Breast and Cervical Treatment Program. Call (800) 824 0088 to see if you are eligible or to get more information.

14. How can I get to a screening test?

If you live in Alameda County, you can click on these links to learn more about accessible transportation options, including Paratransit, a door-to-door service for people unable to use public buses or BART.

Paratransit links:
http://www.actransit.org/riderinfo/paratransit.wu
www.sfparatransit.com

Public buses and BART
www.actransit.org
www.bart.org

15. Will my mobility issues interfere with my Pap smear?

You may need extra time if you have mobility issues, due to the transfer up onto the examination table. Alert the provider of your situation beforehand. A wheelchair with removable arms will make the transfer easier, and there are some alternative positions for pelvic exams ( such as the “side”,“V”, “Diamond”, or “M” positions) that may make the experience more comfortable for you. OB stirrups may also help hold you in position. You may want to consider bringing a friend or attendant along to assist with your positioning and make you more comfortable. If you have spasticity, you may want to pre-medicate, stretch, or try topical Lidocaine 2% cream to numb your muscles.

Check out Table Manners a great resource on Pap smears and pelvic exams for women with disabilities.

16. Will my chronic pain issues interfere with my Pap smear?

Some women may experience some discomfort during a Pap smear, or this experience may temporarily exacerbate the pain women with chronic pain feel daily. With chronic pain, you may never be pain free, but you may be able to manage the amount of discomfort felt. It’s very important to alert your provider to any chronic pain issues BEFORE the exam. To minimize your discomfort, never go to a Pap smear while menstruating (going at this time can also make the results inaccurate), pre-medicate with the pain reliever of choice, try relaxation techniques, and bring supports such as a pillow, foam wedges or crutches. If you have neuropathy, any prolonged touching may be uncomfortable. Try pre-medication, topical Lidocaine 2% cream for local numbness, or ice packs.

Tell your provider about your pain issues when you make the appointment and again when you arrive. Though getting this brief exam is important, if your pain overwhelms you at any point, insist that the provider STOP.

17. Will my allergies or chemical sensitivities interfere with my Pap smear?

Some women may have latex allergies. Alert your provider and insist on silicone and/or plastic gloves. If you have non-latex gloves at home, you may wish to bring them. If you have multiple chemical sensitivities, also alert your provider, and prepare for the exam ahead of time by getting lots of fresh air and slowly increasing your exposure before the exam.

18. Will my bladder and/or bowel control interfere with my screening?

It’s very important to alert the provider if you have urinary or bowel incontinence issues. If you self-catheterize, ask beforehand if you need to give a urine sample. If you don’t, follow your usual routine. If you do need to give a sample, don’t void until you get to the doctor’s office, and use a new catheter for this procedure to cut down on bacteria.

If you have bowel management issues, try to schedule your appointment for a time after you usually have your bowel movement. If for some reason you void during the exam, remember that these are medical professionals who are capable of dealing with this situation.

19. What if this kind of test is in conflict with my cultural or religious beliefs?

First and foremost, keep in mind this is a medical procedure that may save your life. You may choose to see a female provider if this makes your more comfortable. A nurse should be in the room the entire time to oversee the pelvic exam, or you may wish to have a woman friend or relative in the room with you for the duration of the exam. Providers should be able to explain every step of the process to you as it is being done. You will be disrobed for a pelvic exam, but should be covered by a paper gown.

20. What if I have been abused?

Taking care of yourself is a great way to take control of your body and life. Being physically or sexually abused is devastating, but don’t let it keep you from moving forward. You may want to talk to someone or attend a support group if this is an ongoing issue. These organizations may be able to support you:

Domestic violence:
www.fvlc.org
www.co.alameda.ca.us/health/index.htm
www.bfwc.org
www.save-dv.org

Sexual assault:

21. Is the test itself scary or painful?

The Pap smear itself is a brief swabbing of the cervix to collect cells. The provider will insert a speculum inside your vagina to examine the cervix and do a pelvic exam. The pelvic exam allows the provider to check your uterus and ovaries for change and general health. Together, they only take a few minutes. Your provider is checking for pain, so if you feel pain or discomfort, it’s important to speak up, as this can indicate certain medical conditions. Let your provider know beforehand if you have issues with chronic pain. You may not enjoy the procedure, but it sure beats getting cancer.

22. What if the test comes back positive?

The vast majority of tests come back negative. A positive Pap smear may also show abnormal cells that are not cancerous, or a condition preceding cancer, which allows the cancer to be caught before it has a chance to spread. In the unlikely scenario that a Pap smear does show cancer, catching cervical cancer in its early stages greatly increases a chance for a cure and a larger variety of treatment options.

Cervical cancer used to be the number one killer of women, and still is in countries where regular pap smears are not performed. Cervical cancer is one of the most treatable cancers. In the US, the number of women who die from cervical cancer has decreased by 74% since the 1950s, and is dropping annually.

Getting regular screening ensures that you will find any changes in your cervix early before it becomes serious. Remember, early detection can save your life!

23. What should I do after a test?

It’s important to get the results of the test - provider silence does not always mean negative results. And celebrate! Do something nice for yourself after the test. You’re doing a great job taking care of yourself!