COVER
Cervical cancer screening with the HPV test and the Pap test
When to get tested, and how to make sense of your test results
[Diversity of Images of Women]
Keep this booklet until you get your test results back from your doctor.
INSIDE COVER
This booklet is for women who got screened for cervical cancer with a Pap test and a new HPV test. It will help answer common questions about:
• The Pap test and cervical cancer… Page #
• Human papillomavirus (HPV)… Page #
• Cervical cancer screening tests Page #
The HPV test and Pap test Page #
• What your Pap test result means … Page #
How often to be screened Page #
• What your Pap and HPV test results mean together… Page #
• What to do now to prevent cervical cancer… Page #
• What you should ask your doctor… Page #
• How to talk to your partner about your test results… Page #
• Common questions about HPV… Page #
• Where to get more information… Page #
Glossary of bolded words… Page #
Getting abnormal results does not mean that you have cervical cancer now.
For specific questions about your test results, talk to your doctor.
See pages [XX-YY] for definitions of bolded words.
PAGE 1
What is a Pap test?
The Pap test is a screening test for cervical cancer. It looks for abnormal cells on your cervix that could turn into cancer over time. That way, problems can be found and treated before they ever turn into cancer.
Cervix Illustration Here
Caption: The cervix is the opening of your uterus (womb). It is part of a woman’s reproductive system.
What is the cervix?
The cervix is the opening of your uterus (womb). It is part of a woman’s reproductive system.
What is cervical cancer?
Cancer can grow on your cervix—the same way it can grow on other body parts. Most times, cervical cancer forms slowly. It can take 10 to 15 years (or more) for abnormal cells to turn into cancer. Cervical cancer often does not cause symptoms until it is advanced. Women with advanced cervical cancer may have abnormal bleeding, discharge, or pain.
[INSERT IMAGE OF CELL CHANGES: normal abnormal cancer]
Caption: Abnormal cells are sometimes called “pre-cancer” because they are not normal, but they are not yet cancer.
What causes cervical cancer?
A virus, called human papillomavirus (pap-ah-LO-mah-VYE-rus)—also just called HPV— can cause normal cells on your cervix to turn abnormal. Over many years, abnormal cells can turn into cancer if they are not found and treated by your doctor. You cannot see or feel HPV or these cell changes on your cervix.
Box: Every year in the United States, about 10,000 women get cervical cancer and almost 4,000 women die from it. But it is the most preventable female cancer with regular screening tests and early treatment.
PAGE 2
What is HPV?
HPV is a common virus. There are about 40 types of HPV that infect the genitals or sex organs of men and women. HPV is so common that most people get it at some time in their lives. But HPV usually causes no symptoms so you can’t tell that you have it.
What can HPV do to my body?
HPV can infect the genital areas in different ways:
* Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time.
* Other HPV types can cause changes that lead to genital warts in men and women1. But the HPV types that can cause genital warts are different from the types that can cause cervical cancer.
Most of the time, HPV goes away by itself within two years and does not cause health problems. It is thought that the immune system fights off HPV naturally. Experts do not know why HPV goes away in most, but not all cases. It is only when HPV stays on a woman’s cervix for many years that it can cause cervical cancer.
How could I get HPV?
HPV is passed on through genital (skin to skin) contact, most often during vaginal or anal sex. Most people never even know they have HPV, or that they are passing it to their partner. So it may not be possible to know who gave you HPV or when you got it. HPV is so common that most people get it soon after they start having sex. And it may only be found years later.
Therefore, all women who ever had sex are at risk for cervical cancer.
HPV is NOT the same as HIV (the AIDS virus) or Herpes. All of these are viruses that can be passed on during sex. But they do not cause the same symptoms or health problems.
PAGE 3
Cervical Cancer Screening Tests
How can I prevent cervical cancer?
You can prevent cervical cancer with regular screening tests, like the Pap test. A new HPV test can also be used with the Pap test. Screening tests can find early problems before you get sick. That way, problems can be found and removed before they ever become cancer.
Box: Cervical cancer often does not cause symptoms until it is advanced. So it is important to get screened even when you feel healthy.
You took the first step to prevent cervical cancer by getting a Pap test. If you’re reading this booklet, you may also have gotten the new HPV test with your Pap. These tests are often done at the same time.
The Pap and HPV tests look for different things:
The Pap test
|
Checks your cervix for abnormal cells that could turn into cervical cancer. |
The HPV Test |
Checks your cervix for the virus (HPV) that can cause abnormal cells and cervical cancer. |
The Pap and HPV tests can find early problems that could lead to cervical cancer over time. These tests do not:
Check for early signs of other cancers
Check your fertility
Check for all HPV types – There are many types of HPV. The HPV test only checks for specific HPV types that are linked to cervical cancer.
Check for other sexually transmitted infections (STIs)
Screening for cervical cancer with both the HPV test and the Pap test is an option for women ages 30 and older.
Do doctors recommend getting the HPV test with the Pap test?
The HPV test is an option according to some expert organizations for women if:
• You are 30 years or older or
• You are 21 years or older and yourPap test result is unclear (see page 4).
*If you can’t have both tests, having your regular Pap test, without an HPV test, is still a good way to prevent cervical cancer.
Why don’t doctors recommend the HPV test for younger women and teens?
HPV is very common in women under age 30. But it is not useful to test young women for HPV, since most HPV that is found in these women will never cause them health problems. Most young women will fight off HPV within a few years.
HPV is less common in women over the age of 30. HPV is also more likely to signal a health problem for these women, who may have had the virus for many years. Doctors may use the HPV test to tell if these women are at higher risk for cervical cancer and if they need to be screened more often.
Regular Pap tests (alone) are still good screening tests for cervical cancer—for both younger and older women.
[INSERT GRAPHIC OF CC INCIDENCE RATES BY AGE]
Title: In the US, cervical cancer is rare in women in their 20s. It is much more common in women over 30.
PAGE 4
What does my Pap test result mean?
Your Pap test will come back as either “normal,” “unclear,” or “abnormal.”
Box:
Normal
A normal (or “negative”)result means that no cell changes were found on your cervix. This is good news. But you still need to get Pap tests in the future. New cell changes can still form on your cervix.
Unclear
It is common for test results to come back unclear. Your doctor may use other words to describe this result, like: equivocal, inconclusive, or ASC-US. These all mean the same thing: that your cervical cells look like they could be abnormal. It is not clear if it’s related to HPV. It could be related to life changes like pregnancy, menopause or an infection. The HPV test can help find out if your cell changes are related to HPV.
Abnormal
An abnormal result means that cell changes were found on your cervix. This usually does not mean that you have cervical cancer.
Abnormal changes on your cervix are likely caused by HPV. The changes may be minor (low-grade) or serious (high-grade). Most of the time, minor changes go back to normal on their own. But more serious changes can turn into cancer if they are not removed. The more serious changes are often called "pre-cancer" because they are not yet cancer, but they can turn into cancer over time. It is important to make sure these changes do not get worse.
In rare cases, an abnormal Pap test can show that you may have cancer. You will need other tests to be sure. The earlier you find cervical cancer, the easier it is to treat.
[End box]
If your Pap test results are unclear or abnormal, you will likely need more tests so your doctor can tell if your cell changes could be related to pre-cancer or cancer. See page 9 for more information.
PAGE 5
[INSERT FIGURE- Each year in
the U.S., over 3,000,000 women get unclear or abnormal Pap tests.
About 10,000 of these women will actually have cervical cancer.]
More than 99% of women with unclear or abnormal Pap tests do not have cancer. But many of them will have abnormal cells that could turn into cancer in the future if they are not treated.
Be sure to follow your doctor’s advice for more tests or treatment.
PAGE 6
Making Sense of Your Pap and HPV Test Results
[Image of woman-- “I see my doctor as recommended for a Pap test. This year, my doctor told me the test was abnormal. He also said I have HPV. I was confused. What does this mean?”]
It can be confusing to get your Pap and HPV test results at the same time.
Your HPV test will come back as either “positive” or “negative”:
• A negative HPV test means you do not have an HPV type that is linked to cervical cancer.
• A positive HPV test means you do have an HPV type that may be linked to cervical cancer. This probably does not mean you have cervical cancer now. But it could be a warning.
HPV test results are only meaningful WITH your Pap test results. To understand what these tests mean together:
If your HPV test is negative (normal), see page 7.
If your HPV test is positive (abnormal), see page 8.
Page 7
Making Sense of Your Pap and HPV Test Results:
For Women who got a Negative HPV Test
If your HPV test is Negative (normal), and your Pap test is…
Pap test is Normal
|
This means: - you do not have HPV - your cervical cells are normal - you have a very low chance of getting cervical cancer in the next few years.
You should: - wait three years before getting your next Pap and HPV test - ask your doctor when to come in for your next visit. Experts used to suggest yearly Pap tests. But now you can safely wait longer to have the HPV test with your Pap test |
Pap test is Unclear (ASC-US) |
This means: - you do not have HPV, but your Pap test was unclear - even if you do have cell changes, it is unlikely that they are caused by HPV.
You should: - get another Pap test in a year just to be sure. You may also get an HPV test at that time. |
Pap test is Abnormal
|
This means: - your Pap test found abnormal cells - your HPV test did not find HPV. It’s important to find out why the two tests are showing different things. For minor cell changes, your doctor will: - take a closer look at your cervix to find out if your cells look abnormal.
For major cell changes, your doctor will: - take a closer look at your cervix and/or treat you right away Depending on how abnormal your Pap test is: You should go to colposcopy |
Page 8
Did you know that…if you have a normal Pap test and a negative HPV test, it is safe to wait 3 years until your next cervical cancer screening exam? Now, that’s good news!
Making Sense of Your Pap and HPV Test Results:
For Women who got a Positive HPV Test
If your HPV test is Positive (abnormal), and your Pap test is…
Pap test is Normal
|
This means: - your cervical cells are normal, but you have HPV. You may fight off HPV naturally and never get cell changes. Or, you may not fight off HPV, and HPV could cause cell changes in the future. Most women fight off HPV within two years. It is not known why some women fight off HPV and others do not.
You should: - get another Pap and HPV test in one year. Cell changes happen slowly. Some time must pass before your doctor can tell if HPV will go away or cause cell changes. |
Pap test is Unclear (ASC-US) |
This means: - you have HPV, but your Pap test was unclear.
Your doctor will: - take a closer look at your cervix to find out if your cells are abnormal. Your doctor may need to remove the abnormal cells or make sure they do not get worse. |
Pap test is Abnormal
|
This means: - you have HPV - your cervical cells are abnormal This does not usually mean you have cancer. For minor cell changes, your doctor will: - take a closer look at your cervix to find out if your cells look abnormal. Your doctor will: - take a closer look at your cervix to find out how serious the cell changes are. Your doctor may need to remove the abnormal cells or make sure they do not get worse. |
PAGE 9
When to screen
Your results on the HPV test and Pap test will tell your doctor how long it is safe for you to wait before getting screened again.
Remember:
if you have a normal Pap test and a negative HPV test, it is safe to wait 3 years until your next cervical cancer screening exam
If I have HPV, do I have cervical cancer?
No, HPV is not the same as cervical cancer. HPV is the virus that can cause cervical cancer. Many women have HPV. Few of them get cervical cancer if they follow their doctor’s advice for more testing and/or treatment.
What will happen if I need to come back for more testing?
Your doctor will do what’s right for you, based on your test results. Your doctor may:
• Ask you to wait several months before re-doing the Pap and/or HPV test. This is called “watchful waiting.” It is common.
• Take a closer look at your cervix. This is done using a special lens that makes your cervical cells look bigger (called a colposcopy).
• Take a small sample of your cervix (biopsy) to study it more carefully.
• Treat you. This involves destroying or taking out the abnormal cells. These treatments may be uncomfortable, but they can be done during one visit to your doctor.
• Refer you to a specialist. This might happen if your test results suggest that you may have cancer.
Why wait for more tests if I could have cancer?
It is possible that the cells changes you have will never turn into cancer. They may go back to normal without any treatment. And since treatment can have risks and side effects, it is best to make sure you really need treatment before getting it. But cervical changes happen very slowly. Some time must pass before your doctor can tell if these changes need to be treated . Be patient. But be sure to go back to your doctor when told -- for all appointments and testing.
BOX: Remember: Many women get HPV or abnormal Pap tests. But few of them get cervical cancer—as long as they get the tests and treatments their doctor recommends. Most times, problems that are found can be treated before they ever turn into cervical cancer.
PAGE 10
What else can I do to prevent cervical cancer?
• Keep your next doctor’s appointment. Mark your calendar or post a note on your fridge, so you remember it.
• Go back for more testing or treatment if your doctor tells you to.
• Keep getting regular Pap tests—at least once every three years.
•
• Do not smoke. Smoking harms all of your body’s cells, including your cervical cells. If you smoke and have HPV, you have higher chances of getting cervical cancer. If you smoke, ask your doctor for help quitting.
Questions To Ask Your Doctor
• How do I know if I got an HPV test?
• When and how should I expect to get my test results?
• What do my test results mean?
• What other tests or treatment will I need if my Pap and/or HPV test is abnormal?
• When do I need to come back for more testing or treatment?
• What should I expect during and after these tests or treatments?
• Are there risks or side effects?
• Will the testing or treatment affect my chance to get or stay pregnant?
• Will the added tests or treatment be covered by my insurance?
• Where can I get help to cover the costs?
• __________________________________
• __________________________________
• __________________________________
Be sure to ask your doctor about anything you don’t understand.
It is still important to see your doctor every year—even if:
your Pap and HPV tests are normal
you feel healthy
you are past your child-bearing years
The well-woman’s visit is a chance to talk to your doctor about:
your menstrual cycle (period)
birth control
sexuality
infertility
menopause (the change of life)
depression
other health concerns
Your doctor may also want to screen you for:
breast cancer
blood pressure
other health problems
Page 11
How Do I Talk to My Partner about HPV?
You and your partner may benefit from talking openly about HPV. You can tell your partner that:
Use of the HPV test with the Pap test can safely increase screening intervals up to 3 years for women who do not have HPV and have a normal Pap test result even if they have new sexual partners.
Having HPV does not mean that you or your partner is having sex outside of your relationship. There is no sure way to know when you got HPV or who gave it to you. A person can have HPV for many years before it is found.
Most sexually active people get HPV at some time in their lives, though most will never know it. Even people with only one lifetime sex partner can get HPV, if their partner had it.
If your sex partner is female, you should talk to her about the link between HPV and cervical cancer, and encourage her to get a Pap test to screen for cervical cancer.
Page 12
Common Questions about HPV
Is there a treatment for HPV or abnormal cells?
There is no treatment for HPV (a virus). But there are treatments for abnormal cervical cells, which can be destroyed or removed. Treating abnormal cells will stop them from growing into cancer. But it may not remove the virus (HPV). That’s why it’s important to go back to your doctor as told, to make sure abnormal cells do not grow back. You may need to get Pap tests more often for a while. But most people do eventually fight the virus off.
Does having HPV or abnormal cervical cells affect my chances of getting pregnant or having healthy babies?
Having HPV or cell changes on your cervix does not make it harder to get or stay pregnant. The type of HPV that is linked to cancer should not affect the health of your future babies. But if you need treatment for your cell changes, the treatment could affect your chances of carrying a baby to term, in rare cases. If you need treatment, ask your doctor if the treatment can affect your ability to carry your baby to term.
Will I pass HPV to my current partner?
If you have been with your partner for a while, your partner likely has HPV too. But your partner likely has no signs or symptoms of HPV. Partners usually share HPV, until your bodies fight it off naturally. There is no way to know if your partner gave you HPV, or if you gave HPV to your partner.
Can I prevent passing HPV to a new partner?
Condoms may lower your chances of passing HPV to your new partner, if used all the time and the right way. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV. The only sure way to prevent passing HPV to a new partner is to not have sex.
Can my male partner get tested for HPV?
Right now, there is no HPV test for men. HPV is just as common in men as in women, but it is easier to find in women. The types of HPV that put you at risk for cervical cancer rarely cause health problems for most men.
I heard about a new HPV vaccine. Can it help me?
A new HPV vaccine is now recommended for 11-12 year-old girls. It can also be given to 9-10 year-old girls and to women up to age 26 if they did not get the vaccine when they were younger. The vaccine protects against the four HPV types that cause most cervical cancers and genital warts. But it does not treat existing HPV, cervical cell changes, or genital warts. It will be most effective in females who have not yet had sex since they are unlikely to have HPV. The vaccine has not yet been tested with women older than 26 years. It may one day be available to women over 26, if it is found to be safe and effective for them. In the meantime, if you or a female relative or friend is 9-26 years old, ask your doctor if this vaccine can help.
If I’ve had a hysterectomy, do I still need to get screened for cervical cancer?
This depends on why you got your hysterectomy, and if you still have your cervix. If you got a total hysterectomy for reasons other than cancer, you may not need cervical cancer screening. Talk to your doctor to find out if you still need to get screened.
Page 13
Free or Low-Cost Cervical Cancer Screening Tests
You may be able to get cervical cancer screening and follow-up tests for free or at low cost if you:
have health insurance. If you have questions about coverage, talk to your insurance company.
are eligible for Medicaid. To learn more, call 1-800-MEDICARE (1-800-63342273). You can also find your nearest Medicaid office by visiting the US Center for Medicare and Medicaid Services at www.cms.hhs.gov/RegionalOffices/
are age 65 or older. Medicare pays for the Pap test every 2 years, or every year for some women. To learn more about Medicare’s Pap test coverage, call 1-800-MEDICARE (1-800-633-4227). The call is free and you can speak to someone in English or Spanish.
have a low income or do not have health insurance.
To find out if you can get free or low-cost tests and where to go, call or visit:
Your state or local health department
To find your state health department, visit: www.cdc.gov/mmwr/international/relres.html
To find your local health department, visit: http://healthguideusa.org/local_health_departments.htm
CDC’s National Breast and Cervical Cancer Early Detection Program
To find local or state programs:
Call 1-888-842-6355 (choose option 7)
Visit www.cdc.gov/cancer/nbccedp -- click on Find a Local Program
Federally Qualified Health Centers
To find a local clinic, go to http://ask.hrsa.gov/pc/
Title X-Funded Family Planning Clinics
To find a family planning clinic in your region, state or territory, click on http://opa.osophs.dhhs.gov/titlex/ofp-service-grantees.html
National Cancer Institute (NCI)
To find out where else you can get free or low-cost screening and follow-up care, call 1-800-4-CANCER (1-800-422-6237). 1-800-332-9615 (TTY).
Planned Parenthood
1-800-230-PLAN (1-800-230-7526)
To find a local health center, visit www.plannedparenthood.org/
National Family Planning and Reproductive Health Association
To find a local clinic, visit www.nfprha.org and click on Clinics near you
Page 14
Learn More
Centers for Disease Control and
Prevention (CDC)
1-800-CDC-INFO (1-800-232-4636)
Cervical Cancer homepage
www.cdc.gov/cancer/cervical/
HPV homepage www.cdc.gov/std/hpv/
American Cancer Society
(ACS)
1-800-ACS-2345
(1-800-227-2345)
www.cancer.org
American Social Health
Association (ASHA)
1-877-HPV-5868
(877-748-5868)
www.ashastd.org/hpv/hpv_overview.cfm
Association of Reproductive
Health Professionals (ARHP)
(202)
466-3825
www.arhp.org
GLOSSARY
Abnormal (ab-NOR-mal): A finding that is not normal. An abnormal result means that your cervix has cell changes. Your doctor may use medical terms to describe these results. You may hear that your result came back as “LSIL” or “HSIL”. LSIL stands for “low-grade squamous intra-epithelial lesions”— which means minor cell changes on the cervix. HSIL stands for “high-grade squamous intra-epithelial lesions”— which means more serious cell changes. Abnormal results do not mean you have cervical cancer. But you need to follow up as told by your doctor.
ASC-US (ASK-us): This word stands for “Atypical Squamous Cells of Undetermined Significance”. Doctors may use this word to describe a Pap test result that is unclear. Your doctor may also use words like “equivocal” or “inconclusive” to describe this result (see below).
Biopsy (BUY-op-SEE): Your doctor uses this test to study abnormal cells. A small piece of tissue is taken from your cervix and checked under a microscope.
Cancer (KAN-ser): A disease that starts when cells in the body turn abnormal and begin to grow out of control. Abnormal (damaged) cells begin in one part of the body and can spread to other body parts. When they spread, the damaged cells replace normal cells. There are many types of cancer. Cancers are named based on where the abnormal cells first started growing.
Cervical cancer is when the abnormal cells begin in the cervix.
Cells: The basic unit that makes up all living things.
Cervix (SUR-viks): The part of the womb (or uterus) that opens to the vagina.
Colposcopy (kol-POS-coe-pee): A method your doctor can use to magnify the cervix to see any abnormal cells.
Equivocal (ee-QUIV-o-kal): A Pap test result that is unclear. Your doctor may also use the term “ASC-US” to describe this result.
Fertility (fer-TIL-i-tee): The ability to have babies.
Follow-up: Going back to see your doctor for more testing or treatment.
Genitals (JEN-i-tlz): The reproductive organs, especially the external sex organs.
HPV or human papillomavirus (pap-ah-LO-mah-VYE-rus): A very common virus that infects the skin cells. There are many types of HPV. About 40 types, called genital HPV, affect the genital areas of men and women. Some of these types can cause cervical cancer in women. Other types can cause genital warts in men and women.
HPV test: A test that looks for HPV on a woman’s cervix. Doctors take DNA cells by swabbing the cervix. This is often done at the same time as a Pap test.
Inconclusive (in-kuhn-kloo-siv): A Pap test result that is unclear. Your doctor may also use the term “ASC-US” to describe this result.
Pap test: Screening test that looks for early signs of cervical cancer. It finds abnormal cells on a woman’s cervix. For this test, your doctor takes cells from your cervix so that they can be looked at with a microscope.
Pelvic exam (PEL-vik ex-am): Exam to check the female reproductive organs. This exam is part of a woman’s routine health care visit. Your doctor will look at the outside of your genitals, or sex organs, to look for problems. Your doctor will also look at and feel your internal organs—such as your vagina, cervix, ovaries, and womb.
Prevent: Avoid or stop from getting.
Pre-cancer: Cell changes that are not normal, but have not yet turned into cancer.
Screening test: Getting tested for early signs of disease so the problem can be treated before the disease ever develops. Cancer screening tests look for early signs of cancer so you can take steps to avoid ever getting cancer. The Pap and HPV tests screen for early signs of cervical cancer.
Uterus (YOO-tuh-rus): The uterus, or womb, holds a growing baby and helps push the baby out during labor.
Virus (VYE-rus): Something that lives in the body and can cause infections. Viruses are so small that they cannot even be seen with a regular microscope.
[Back cover]
Screening for cervical cancer using an HPV test along with the Pap test is optional for women age 30 years and older.
If you are 30 years or older, your Pap test is normal, and your HPV test is negative, you can wait 3 years before being tested again for cervical cancer.
1 woman + 2 negative tests = 3 years!
Know the Facts
If you have a normal Pap test and a negative HPV test, you can wait 3 years until your next cervical cancer screening exam.
All women should have a regular visit with a health care provider to stay healthy.
Cervical cancer is caused by a common virus called HPV. Anyone who ever had sex can get HPV.
• Cervical cancer can be prevented with regular screening tests and follow-up care.
• The Pap test—either alone or with the HPV test—is the best way to find early signs of cervical cancer.
If you get an abnormal test result, be sure to follow up as told by your doctor.
• Most women who get abnormal Pap test results or who have HPV do not get cervical cancer—as long as they follow their doctor’s advice for more tests or treatment.
For more information, call 1-800-CDC-INFO (1-800-232-4636) or visit www.cdc.gov/std/hpv or www.cdc.gov/cancer/cervical/
For information on free or low-cost screenings, please contact:
Illinois Breast and Cervical Cancer Early Detection Program
Illinois Department of Public Health
Women’s Health-Line at 1-888-522-1282
http://www.cancerscreening.illinois.gov/
You are taking part in a CDC study that will help save women’s lives. This study is endorsed by your doctor.
For information regarding this study, please contact:
ADD STUDY STICKER WITH CONTACT INFO and IRB#
Anyone who has ever had sex can get HPV. Almost every woman will have HPV at some point in her lifetime.
Having HPV does not mean you have cervical cancer (but it does mean you might be at higher risk)
Most women never even know they have HPV because their body fights it off. HPV rarely leads to cervical cancer but occasionally a woman will have an HPV infection that does not go away.
The best thing you can do to protect yourself from cervical cancer is to get regular cervical cancer screening
1 For information about genital warts, see www.cdc.gov/std/hpv or www.ashastd.org/hpv/hpv_learn_warts.cfm
Attachment
E3. Patient Brochure
| File Type | application/msword |
| File Title | What You Should Know About Your Pap and HPV Test Results |
| Author | Ogilvy User |
| Last Modified By | Battelle |
| File Modified | 2009-01-29 |
| File Created | 2009-01-29 |