Questions and Answers to Support Informed Consent

Questions and answers to support informed consent

What is cervical cancer and cervical testing?

Cervical cancer is cancer in your cervix. Your cervix is at the top of your vagina at the entrance to your womb(also known as youruterus). Your cervix, like all parts of your body, is made up of tiny cells. Cancer means the cells in your cervix start growing abnormally and harm the healthy cells in your cervix and can spread to the rest of your body.
Cervical cancer usually takes many years to develop.
Regular cervical tests check the health of your cervix. The test does not diagnose cancer but looks for theearly warning signs ofchanges to cells, known as abnormal cells, whichcan lead to cancer. By finding these abnormal cells early, they can be checked regularly to see if they heal naturally or need to be treated long before they turn into cancer.
This means cervical cancer can be prevented because abnormal cells in your cervix can be treated before they turn into cancer.
A regular cervical test reduces your risk of getting cervical cancer by 90%.
In New Zealand it is recommended that women aged 20 to 70 have three yearly cervical tests – or more often if something abnormal is found.
The cervical test results for about one in every 20 women will show some cell changes that need to be watched or treated. Most of these changes will not lead to cervical cancer but it is important to keep an eye on these cells to make sure they return to normal naturally or need treatment.

What is HPV?

Most cervical cancer is caused by very common viruses called human papilloma virusesor HPV. Most women get HPV during their lives. HPV causes an infection in your cervix. Some of these infections clear up by themselves but some stick around and change or damagethe cells in your cervix. Over a long time, sometimes up to 20 years later, this damage can cause cervical cancer.
HPVs are passed on by sex or skin to skin contact but do not cause any symptoms. You could have HPV for many years without knowing it
The sample taken during acervical test can also be tested for HPV.
Two types of HPV - 16 and 18 – cause most cervical cancers (about 70 percent).

What is HPV immunisation?

Why do I still need a cervical test if I’ve been immunised?

Getting immunised for HPV before having sex can protect a woman against the high risk types of HPV, types 16 and 18. Immunisation protects you from viruses.
Type 16 and 18 HPV cause about 70 percent of cervical cancer.
Women who have been immunised still need regular smears because they can be infected by other types of HPV that lead to cancer.

What else can I do to stop getting HPV and cervical cancer?

Screening and immunisation are the best protection against cervical cancer.

What is a cervical test (also known as a smear test or pap smear)?

A cervical test uses a brush to take a small sample of the cells on your cervix to test for any damage to the cells which could turn into cancer if not treated.

We carefully put the speculum into your vagina until it reaches your cervix. Then we push the brush through the end of the speculum to brush your cervix to gather some cells. Then we pull out the speculum and brush. The sample of cells is sent off for testing. Use diagrams and real equipment to explain where the cervix is and what happens using the speculum and brush.

(Have diagrams on website - replace the word ‘smear’ with ‘sample’; remove ‘cervical canal’; put ‘(womb)’ beside ‘uterus’.

You will spend 15-20 minutes with the doctor or nurse but once you’re ready and relaxed, it only takes a few minutes to collect the sample of cells from your cervix.
There is a private space where you undress from the waist down- or pull up your skirt/dress and remove underwear. You lie back on the bed with your knees bent - there’s a sheet or blanket to cover your legs.
The doctor or nurse will give you a few minutes to undress. The door is locked during the test so no-one will walk in unexpectedly.
You can bring a support person with you if that would help you to relax.

Where can I get the test and who does it?

A doctor or a nurse will carry out your cervical tests
You can go to your usual doctor or nurse or one of the other organisations providing cervical tests, including:
The Family Planning Association
Sexual health services
Maori health centres and marae-based health services
Community health services, Pacific and women’s health centres.
You can ask for a female to do your cervical test. If there is no female trained at your medical centre you can go to one of these other organisations.
You should feel comfortable with the person doing your cervical test.
If you had a bad experience last time you had a cervical test, you can go to a different person next time. It helps if you tell the new person about your past experience.
A cervical test will cost what you normally pay to see your doctor or nurse. Some organisations offer free or low-cost cervical tests. You can ring some of the health services in your area to find out what they charge for a cervical test.

Will the test hurt?

It will be uncomfortable and sometimes a bit painful. Let the doctor or nurse know if it hurts so they can see if they can do anything to reduce it.
It helps if you relax – you can be shown some relaxation techniques that can help.

Is a cervical test safe – are there any risks?

A cervical test is a screening test – this means it can show that something is not normal but it cannot tell exactly what the problem is. Further tests are needs for that. These tests are known as diagnostic tests because they diagnose the problem.
Having a regularcervical test will not always find every sign of abnormal cells, it does reduce the chance of developing cervical cancer by 90%, but cannot guarantee it will never happen.

Is a cervical test safe if I’m pregnant or just had a baby?

If you’re pregnant or have just had a baby and get a reminder that you’re due for a cervical test, it’s a good idea to check with your specialist, Lead Maternity Carer or midwife about when to have a cervical test.

Is a cervical test safe if I’m trying to get pregnant?

Yes it is safe, plus it’s a good idea to be up to date with cervical testing before you get pregnant.

What if I don’t want to have a cervical test?

You can choose not to have a cervical test. You can tell you doctor or nurse and they will put this in your notes. They may still check with you occasionally if you would like a cervical test in case you have changed your mind.

If you decide not to have a cervical test, make sure you see your doctor of you have bleeding between periods, bleeding after sex, bleeding after menopause, unusual discharge from your vagina, ongoing pain in your pelvis, or pain during sex. These could be caused by many things and should be checked by your doctor.

What is an HPV test and when is it done?

The sample taken during a cervical test can also be tested for HPV.
It can be helpful to know if you have high riskHPV types 16 and 18 in your cervix as these are more likely to cause cervical cancer than other types.

Why do I need to have cervical tests so often?

Woman between the ages of 20-70 should have a cervical test every three years to check for cell damage or HPV. More regular tests are recommended if something abnormal is found. This is often enough to pick up changes to the cells in your cervix.
The best protection against cervical cancer is a regular cervical test. It reduces your risk of getting cervical cancer by 90%.

How will I get my results?

Yoursample takes two weeks to be checked at a laboratory.
If it is your first smear, you’ll be sent a letter with your results. It may take up to four weeks for your letter to arrive.
We will ring you if we find anything abnormal and you’ll be sent a letter.
We will also ring you to let you know your results are normal – or if you don’t hear from us it means your results were normal.
You can also ring us to check your results after two weeks.

What if my results show something is wrong?

Even if your test shows there is something abnormal, most results show early changes in your cells – long before there is any cancer. Sometimes you will be asked to have another test in a year because these cells can return to normal on their own. Or you may be sent to a specialist to see if you need treatment.

What other symptoms of cervical problems should I be looking for?

Even if you have a regular cervical tests, see your doctor of you have bleeding between periods, bleeding after sex, bleeding after menopause, unusual discharge from your vagina, ongoing pain in your pelvis, or pain during sex. These could be caused by many things and should be checked by your doctor.

What is the National Cervical Screening Programme?

The National Cervical Screening Programme was set up to prevent cervical cancer.
The Programme is managed by the Ministry of Health.
When you have your first cervical test you are automatically enrolled in the National Cervical Screening Programme.
The Programme keeps your details on a Register - your name, address, date of birth and national health index (a number) are stored by the programme along with your medical history. This means that even if you change doctor, you will still be sent a letter when you need to have another cervicaltest.
The Programme will send you a reminder letter if you are overdue for a cervical smear and make sure you get the right follow-up after an abnormal smear.
The Programme keeps yourmedical history, cervical test results and treatment details. All your information is confidential.

Who can see or use my information on the Register?

All your information is confidential. This means only you, the person carrying out your test and the laboratory whoanalyses your sample have access to your information on the Register.
Some researchers request access to information on the Register so they can research cervical cancer and cervical screening. Researchers will never be given the names of women on the Register.

Why do you need to know my ethnicity?

The Programme collects information about your ethnicity to make sure that no ethnic group is disadvantaged. It helps the Programme check if there are differences in cancer prevention and treatment between ethnicities, and identify ways to better meet the needs of different ethnic groups.

How can I stop my enrolment in the Programme?

All woman who have a cervical test are automatically enrolled in the Programme.
You can get your name taken off the Programme by filling in a form or writing to the Programme. We can give you the form if you want it.
You can re-join the Programme at any time.

Do I need to be tested if I’m not having sex anymore?
Do I need to be tested if I’m only having sex with my husband?
Do I need to be tested after menopause?
Do I need to be tested if I am a lesbian?

Cervical cancer usually takes many years to develop – up to 20 years. Regular cervical tests look for the warning signs of abnormal cells which lead to cancer, so these can be treated long before they turn into cancer.
You or your partner may have come into contact with HPV many years ago but it can stay in your body for a very long time. Both men and women can carry HPV.
Even after menopause it is important to check the health of your cervix by having regular tests.
Once you turn 70, regular cervical tests are not recommended as it is unlikely that you will develop cervical cancer after this age.

Do I need to be tested if I’ve had a hysterectomy?

Please check with your doctor. If you have had a subtotal hysterectomy you still have a cervix and need to have regular cervical tests.
Even if you’ve had a total hysterectomy please check with your doctor as you may still need regular tests, particularly if you’ve had cervical problems in the past.

Why do I need to be tested if I’ve just had a test for STIs/STDs?

Testing for HPV is not the same as the tests for other sexually transmitted diseases so needs to be done separately.

Can a cervical test be done another way?

No. A sample of cells needs to be collected from your cervix and this is the only way we can do it.