[In Vietnamese]

p.1 -- Cervical cancer is the most common cancer among Vietnamese women in the United States.

This disease is very dangerous if not detected early. Thanks to modern medicine, cervical cancer can be cured in almost 100% of cases if it is detected and treated early. Therefore, every woman should get a Pap test once a year. After 3 years of normal results, a doctor may recommend less frequent screening. The Pap test is a simple procedure to detect early cervical cancer. Be sure to make an appointment with your doctor for a Pap test and remember to keep that appointment. We women all together, 
Let's have Pap tests to detect cancer

p.2 -- What Is a Pap Test?

A Pap test is a very simple procedure that tests the cervix for cancer and helps to detect it at an early stage. A Pap test is done during a pelvic examination:

• Using a small brush, the doctor takes a sample of cells from the cervix and sends it to a laboratory to test for cervical cancer. This is a simple procedure that does not cause pain. Having a Pap test is very important because 90-95% of all cervical cancer is diagnosed this way.

p. 3 -- Why Do I Need a Pap Test?

• A Pap test can help detect cancer of the cervix at an early stage.
• Cancer of the cervix can be cured in nearly 100% of the cases if detected early.
• Most deaths from cancer of the cervix occur among women who have never had a Pap test. If those women had had Pap tests, their deaths could have been avoided.

Who Needs to Get a Pap Test?

• All women age 18 and older (or women under age 18 who are sexually active) should have a Pap test and pelvic examination once a year.

p. 4 -- Where Do I Get a Pap Test?

• At your family doctor's office
• At an obstetrician's or gynecologist's office
• At clinics or hospitals

p. 4-6 -- How Is a Pap Test Performed?

Before a Pap test is performed, the doctor will ask you about your medical history and menstrual pattern. The doctor will ask questions such as: At what age did you start menstruating? Are your menstrual periods regular? How long does your period usually last? How often do you have your period? Do you feel pain? When was the last time you had your period? The more information you give, the easier it is for the doctor to diagnose disease. Do not think, "This doctor is too curious; this is so embarrassing."  Please remember that this is the doctor's daily work, and the doctor needs this information to understand your health status.

During the Pap Test

• First of all, you remove your clothes and put on a hospital gown. Then you lie down and put your feet up.
• The doctor examines the outside of the vagina for abnormalities.

1. He/She then puts a small instrument shaped like a duck's beak into the vagina to examine the cervix.
2. He/She gently takes a sample of cells from the cervix with a small brush.
3. He/She puts this sample on a slide and sends it to a medical laboratory for analysis.
4. Then the doctor does a pelvic examination to check for abnormalities of the uterus, fallopian tubes, and ovaries. He/She does this by putting two fingers into your vagina and pressing on the lower stomach with the other hand. This may feel a little uncomfortable, but the doctor will do it very quickly and gently.

p. 7 -- Pap Test Results

If the results of your Pap test are normal, then you don't have cervical cancer. If your Pap test is normal, you should make an appointment to have another one done next year and remember to keep that appointment. If you have 3 years of normal results, your doctor may recommend less frequent screenings.

p. 8 -- Abnormal Results

If the results of your Pap test are abnormal, the doctor will let you know right away. An abnormal Pap test doesn't necessarily mean that you have cervical cancer but may simply indicate that you have a viral or other infection. If your Pap test is abnormal due to infection, your doctor may treat the infection and then perform another Pap test. But if your abnormal Pap test isn't due to infection, your doctor will examine your cervix and vagina by a technique called "colposcopy" and may remove a small sample of cells from the cervix (biopsy) for analysis. You should follow your doctor's advice because such tests help the doctor to detect the disease early.

p. 9 -- Who Can Get Cervical Cancer?

Any woman can develop cervical cancer, but the factors listed below increase the risk of getting cervical cancer:

• Having sexual intercourse before the age of 16
• Having many sexual partners (or having a sexual partner who has had many sexual partners)
• Having genital human papilloma virus or other sexually transmitted disease
• Having sex with partners who have human papilloma virus or other sexually transmitted disease
• Having had an abnormal Pap test in the past
• Not having regular Pap tests
• Smoking cigarettes or being exposed to second-hand smoke
• Vietnamese women are especially at risk because the incidence of cervical cancer in Vietnamese women in the United States is higher than in any other ethnic group.

p. 10 -- What Are the Symptoms of Cervical Cancer?

At the beginning there may be no symptoms. Later, you may experience:

• Vaginal bleeding after intercourse
• A menstrual period that lasts longer than usual
• Menstrual bleeding that is heavier than usual
• Vaginal bleeding occurring between periods
• Vaginal bleeding (even scanty) after menopause
• Pains in the lower part of the abdomen (not related to your menstruation)
• White vaginal discharge

p. 11 -- Questions and Answers About Cervical Cancer Prevention and the Pap Test

It's so expensive to see the doctor; how can I afford it?

If you have health insurance, it can help pay some costs. If you qualify for Medicaid, you may not have to pay for a visit to the doctor and a Pap test. For more information on Medicaid, call your nearest medical assistance office. If you are age 65 or older, Medicare helps pay for Pap tests, generally once every 3 years. For more information about Medicare coverage for Pap tests, call 1-800-MEDICARE (1-800-633-4227). Those who have low income or no insurance can go to public hospitals or clinics for Pap tests and pay depending on their income.

p. 12 -- Do those who are over age 50 years old, or those who are post-menopausal, or those who rarely or never have sexual relations need to get Pap tests?

Many older women refuse pelvic examinations or Pap tests, often saying: "I am old, post-menopausal, or rarely or never have sexual relations. I think that I couldn't get a disease But according to the medical studies, 80% of those who die from cervical cancer are age 50 years old or older. Therefore, the older you are, the more important it is for you to make sure to get regular Pap tests.

Do those who have had hysterectomies need to get Pap tests?

Women who have had hysterectomies, especially those who had them because of cancer, still may need to have regular Pap tests and should talk to their doctor.

p. 13 -- Do virgins need to get Pap tests?

You should ask your doctor.

Can smoking or being exposed to second-hand smoke cause cervical cancer?

Women who smoke or are exposed to second-hand smoke have an increased risk of developing cervical cancer.

"The medium will conjure up ghosts, sweeping creates dirt": I am not ill, why should I look for disease?

"I also thought so, so I didn't get a Pap test. Then I had vaginal bleeding and I went to see the doctor when it was too late. I had to have surgery to remove the uterus and then chemotherapy. I advise you to get a yearly Pap test and not to wait like I did because cancer has no symptoms at the beginning. Better to spend a few minutes to have peace of mind and avoid later pain."
- Hoang Thinh

p.14-15 -- My doctor doesn't do a Pap test. I am embarrassed to ask for one. What should I do?

"I agree that the majority of women are embarrassed when they remind their doctor to do Pap tests. Because of our culture, we aren't used to talking about the sexual and intimate parts of the body. Therefore it takes a brave woman to ask her doctor for a Pap test, especially if she has a male doctor. But because of our health, try not to be embarrassed - simply ask your doctor to perform a Pap test once a year
- Le Hieu De, M.D.

If I have no symptoms, why should I go see the doctor?

"Many people may have cervical cancer but are not aware of it because there are no symptoms at the beginning. So I advise you to make an appointment for a Pap test once a year even if you have no symptoms. Remember if it is detected early, cervical cancer can be cured in almost 100% of cases."
- Phan My Dung, M.D.

p. 15 -- Do Pap tests hurt?

"No. Since before performing the Pap test my doctor told me to relax and I followed my doctor's advice, I had no pain or discomfort."
- Ha Van

p. 16 -- Conclusion

If we want to take care of ourselves and want to protect our family's happiness, we women should take care of our health. We can best take care of others if we remain healthy. To do so, we must get regular checkups, including Pap tests.

Getting a Pap test only takes a few minutes of your time and it's a simple procedure. Pap tests help to detect cervical cancer early. The earlier cervical cancer is detected, the easier it is to treat, the less pain is experienced, and the less time and money are lost.

SO PLEASE MAKE AN APPOINTMENT WITH YOUR DOCTOR FOR A PAP TEST AND REMEMBER TO KEEP THAT APPOINTMENT.

Inside Back Cover

The National Cancer Institute is grateful to Suc Khoe La Vang (Health Is Gold), the Vietnamese Community Health Promotion Project at the University of California, San Francisco for permission to adapt their publication "Cervical Cancer Screening: What Vietnamese Women Should Know" for national distribution and extends thanks to the expert development team, writers, and reviewers.

Department of Health and Human Services
Public Health Service
National Institutes of Health

To order copies of this brochure or to talk to an information specialist in English, call the National Cancer Institute's toll-free Cancer Information Service at 1-800-422-6237. Persons with TTY equipment dial 1-800-332-8615

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