Worker Health Study Summaries

Research on long-term exposure

Dry Cleaners (2) – Cervical Cancer

1996

Study Background

The National Institute for Occupational Safety and Health (NIOSH) conducts research on workers’ health. Our scientists completed a study of 1708 men and women who had worked for at least one year before 1960 in a dry cleaning shop that used percholorethylene. We got the names and work records from the dry-cleaning workers’ unions in the metropolitan areas around New York City; Detroit, Michigan; Chicago, Illinois; and Oakland/San Francisco, California. We studied the workers through 1996. The following has information about minimizing the risk of cervical cancer among women working in the dry cleaning industry.

A Risk of Cervical Cancer

A number of scientific studies, including research by the National Institute for Occupational Safety and Health (NIOSH), have found a higher than usual risk of cervical cancer among women working in the dry cleaning industry. Cervical cancer is a health problem that only women can get. It affects a part of the body called the cervix, which is the opening to a woman’s womb.

Since many factors can cause cervical cancer, the exact reason for the higher rates among dry cleaning workers is not certain. But whatever the reason, women in this industry need to know that they should get checked for this disease.

Fortunately, there are good medical treatments for cervical cancer. If cervical cancer is found in its early stages, the chance of full recovery is very high.

How Do Doctors Check for Cervical Cancer?

The most important test for cervical cancer is called a Pap test (also called a Pap smear). In this test, the doctor takes some cells from the surface of the cervix and sends them to a laboratory where they are checked for signs of cancer. The procedure is quick and most women find it painless. A doctor, nurse, or some other medical provider usually does the test during a routine pelvic examination.

How Often Should I Be Checked?

These guidelines have been developed by the American Cancer Society, the National Cancer Institute, the American College of Obstetricians and Gynecologists, the American Medical Association, and the U.S. Centers for Disease Control and Prevention:

All women between the ages of 18 and 65 should get a pelvic examination and Pap test once every year, unless their doctor suggests less frequent testing.
Women who are under the age of 18 and are sexually active should also get a pelvic examination and Pap test once every year.
Women with a higher risk of cervical cancer may need to be examined more often. This would apply to you if previous Pap tests have shown a possible problem.

After age 65, the risk for cervical cancer decreases and your doctor may recommend that you no longer need to be tested every year. However, if you are over 65 and have never been tested, you should talk to the doctor about getting a Pap test and how often you need to be checked from now on.

PAP Testing After Hysterectomy

In the United States, approximately a third of all women over 50 years of age have had a hysterectomy ~ a surgical operation in which the womb (uterus) is removed for medical reasons. The vast majority of women who have had a hysterectomy do not have a cervix anymore, and are not at risk for developing cervical cancer.

However, a small percentage of women have had a “supracervical hysterectomy.” These women have had their womb and/or their ovaries removed, but they still have a cervix. They are still at risk of developing cervical cancer and should get Pap tests yearly, or as recommended by the doctor.

If you have had a hysterectomy and are not sure whether you still have a cervix, talk to your doctor. The doctor can check for the presence of a cervix during a pelvic examination.

Human Papilloma Virus (HPV) Testing

Depending on your personal health history, your doctor may suggest that you also be tested for Human Papilloma Virus (HPV). HPV is a common virus that spreads through sexual contact. The more sex partners a person has, the higher the risk of getting HPV. Many people have HPV without knowing it, because often there are no symptoms. Having HPV does not mean that you have cancer, but it can increase the risk for developing cervical cancer.

HPV testing is not routine, but your doctor can include this test in your physical exam if you need it. Like the Pap test, the HPV test is easy and painless. Talk with your doctor about whether or not you should get tested for HPV in addition to your Pap test. Your doctor will be able to answer any questions you may have.

Covering the Costs of Screening

In New York City, dry cleaning workers are represented by the Amalgamated Service and Allied Industries Joint Board, UNITE! (Union of Needletrades, Industrial and Textile Employees, AFL-CIO, CLC).

For Union members, the Amalgamated Service and Allied Industries Insurance Fund will cover the cost of getting a Pap test once a year, or more frequently if your doctor recommends it. HPV testing is also covered if your doctor recommends it.

As a Union member, you can get these tests done when you visit the doctor using your annual “GOOD HEALTH DAY.” A list of union-affiliated medical clinics in the New York metro area is included on this site. The clinics are also listed on the back of your medical card (Multi plan).

If you know someone who does not belong to the union and she has no other form of medical insurance, tell her that non-union insurance programs will usually cover annual Pap testing. She may also be eligible for free or low-cost Pap testing funded under the National Breast and Cervical Cancer Early Detection Program. (Call 888-842-6355.)

Need More Information?

If you have questions about getting tested, here are some places you can contact for advice:

Amalgamated Service & Allied Industries Insurance Fund
275 7th Avenue, 15th floor
New York, NY 10001
212-206-8900
www.uniteunion.org

Union Health Center
212-924-2510
English and Spanish)

1115 Medical Center (SEIU)
212-542-1180, 212-997-7505

National Breast and Cervical Cancer Early Detection Program
in New York City
800-422-6237 or 800-227-2345

New York City Health Department. Women’s Health Line
212-230-1111

If you want more information about cancer and cancer screening, contact:

National Cancer Institute
800-4-CANCER
(that’s 800-422-6237)
http://www.cancer.gov/

American Cancer Society
800-ACS-4235
http://www.cancer.org

U.S. Centers for Disease Control and Prevention National Breast and Cervical Cancer
Early Detection Program
888-842-6355
https://www.cdc.gov/cancer/nbccedp/

If you would like more information about health research that has been done by the National Institute for Occupational Safety and Health (NIOSH), contact:

NIOSH toll-free information line
Monday through Friday, 8:00 A.M. to 4:00 P.M.
800-356-4674

You can read the study reports by visiting the following NIOSH web site:

https://www.cdc.gov/niosh/

Once at this site, click on “Safety and Health Topics”. The study reports can be found under the topic /’Organic Solvents”. The NIOSH Internet special web site containing more information about work in the dry cleaning industry is now under construction and should be added to this list in the next few months. At that time, you will be able to get more information about perc and other dry cleaning solvent exposures.

To request copies of the NIOSH study reports on occupational health published by NIOSH, please contact:

NIOSH Publications Office: 513-533-8120
email: pubstaft@cdc.gov
www.cdc.gov/niosh

What You Need to Know . . . About Preventing Cancer of the Cervix

Every year almost 7000 women in the United States die of cancer of the cervix. Most of these women could be alive if they had had regular Pap tests. Pap tests help doctors find cervical cancer early when it is almost always 100% curable. Every woman should start having Pap tests when she begins having sex (or reaches the age of 18) and continue having them for the rest of her life.

Many cases of cervical cancer are found among black, Hispanic, and Native American women. Regular Pap tests are the best way for these women — and all women — to protect themselves from this disease.

Who gets cervical cancer?

Any woman can get cervical cancer. But studies show some things seem to put women at greater risk:

Having sex before the age of 18.
Having several sex partners. The more partners a woman has, the greater her chances are of getting a venereal disease. Certain VDs, especially genital warts, have been found in many women who have cervical cancer or show signs of developing it.

If these risks apply to you, it’s important to have a Pap test at least once a year. In fact, a yearly Pap test is a good idea for most women. If you have already had an abnormal Pap test result, you may need to be checked more often. Follow the checkup schedule your doctor suggests.

How is a Pap test done?

A Pap test is usually part of a routine pelvic exam at the doctor’s office or clinic. It may cause some discomfort, but most women do not find it painful. During the exam, the doctor or nurse puts a cotton swab in your vagina and gently touches your cervix to pick up some cells. This part of the exam takes less than a minute. The cells are then sent to a lab to be studied.

What happens next?

If all the cells from the Pap test look healthy, you can continue your regular checkup schedule. If some cells are starting to show abnormal changes, you will need to see your doctor again for more tests or for treatment.

Any abnormal cells should be removed before they become cancerous. Sometimes this can be done in the doctor’s office; sometimes it may need to be done in a hospital. It’s important that you get treatment as soon as possible.

Some women put off treatment because they are worried that they will not be able to have children afterwards. In many cases, women treated for early cervical cancer are still able to have babies. You can have sex again as soon as the treated area heals. Early treatment gives the best chance of being able to have children later on.

What you can do…

Have a Pap test at least once a year if the risks for cervical cancer apply to you. If none of the risks applies, ask your doctor how often you should have a Pap test.
Have any vaginal infection or VD treated as soon as you notice it. If your partner says he has VD, see your doctor right away — even if you have no symptoms.
Talk to your partner about using condoms. Condoms will help protect you from the viruses that cause genital warts, which have been linked with cervical cancer. Condoms also help protect you from other VDs, unwanted pregnancy, and AIDS .
Don’t smoke. Smoking seems to make cervical cancer more likely, although no one is sure why.
If you notice:
- bleeding after sex
- bleeding between periods
- discharge from your vagina

For more information…

To learn more about any kind of cancer, call 800-462-1884 toll-free. Or call the New York State Health Department at 518-474-1222.

State of New York Department of Health 9/96

The Pap Smear – All Women Need It

Who is at Risk for Cervical Cancer and Who Needs to Get Pap Smears?

All women who are, or who have ever been sexually active, may be at risk for cervical cancer.

Women who may be most at risk are women who…

do not have regular Pap smears.
have ever had a sexually transmitted disease.
have ever had more than one sex partner – or whose sex partner has ever had other partners.

Regular Pap smears are the most common way to find cell changes that may lead to cancer. All women who are sexually active should have a Pap smear once a year. Women who are not sexually active should start having Pap smears when they turn 18.

What is a Pap Smear!

The Pap smear can help your doctor find changes in the cells on your cervix that might lead to cancer.

Cervical cancer can be prevented. Cells go through many changes before they turn into cancer. The Pap smear finds these changes early, while they can still be treated and cured. A lot of women feel embarrassed or scared by the Pap smear. Some are afraid they may find out they have cancer. Remember, cancer is rare. Your Pap will be looking for cells that might turn into cancer if they are not treated.

Getting Your Pap Smear:

The Pap smear is often part of a yearly check-up. During your visit, the doctor or nurse might also be checking for other things like breast cancer, diabetes, or heart disease. During your Pap smear your doctor or nurse will insert a tool called a speculum, into your vagina to open it and make it easier for them to see your cervix.

A brush and a wooden spatula (like a popsicle stick) are used to collect a sample of cells from the cervix.

The sample of cells is then sent to a lab where it is examined for changes.

How to Prepare for your Pap Smear:

Make your appointment for a day you will not be having your period.
Do not have sex for 2 days before your Pap smear.
Do not use douches, vaginal creams, foams, gels or tampons for 2 days before your Pap smear.

During your Appointment:

When you put your feet in the stirrups, let your knees fall open to the sides. If you hold them open, you are using your muscles and you will be tense.
Take a couple of slow deep breaths through your mouth to relax.
The Pap smear doesn’t take long. It is a quick and easy way for you to take care of yourself.

What is Follow-up Care?

Once your Pap smear is over, it is important to get the results. Different clinics give out results in different ways.

To make sure you get the right follow-up care:

Ask your doctor or nurse when and how you will get your results.
Plan to schedule your next Pap smear for 1 year later.
If cell changes are found, your doctor or nurse may want to:

repeat a Pap smear every 4 to 6 months to recheck your cervix
do other tests to check for the human papillomavirus (HPV)
look at your cervix with a special lens called a colposcope -4 take a sample of tissue, called a biopsy, from the cervix

Follow-up is not the same for every woman. Friends or family members might have different follow-up plans than you do. Follow the plan your doctor sets for you.

What Causes Cell Change?

A sexually transmitted virus called human papillomavirus (HPV) causes most cell change on the cervix.

HPV is very common but most people don’t know they have it. It is passed during sex from the genital skin of one person to the genital skin of another. There are more than 70 different types of HPV. Some types cause genital warts that you can see. Some types cause cell change on the cervix that might lead to cervical cancer.

Ask your provider what’s new about cervical cancer tests, treatments and prevention.

For more information about Pap smears, cervical cancer and HPV, please call:
800-653-4324

American Social Health Association
P.O. Box 13827 Research Triangle Park, NC 27709
www.ashastd.org
www.iwannaknow.org (for teens)

Funding for this brochure was provided by the
Centers for Disease Control and Prevention
through Cooperative Agreement #U50/CCU415013-L

The Pap Test – It Can Save Your Life

Get your appointment for a Pap test today!

Could I have cancer of the cervix and not know it?
Yes—often there ¡s no pain. And this kind of cancer kills many women every year.
What does that mean for me?
It means get a Pap test. A Pap test can find cancer early. If it’s found early, it’s easier to cure.
How often should I get a Pap test?
Get a Pap test every year.
How is the Pap test done?
The nurse or doctor wipes a swab on the cervix in your vagina. This takes only a few seconds.
Where do I get a Pap test?
1. Family doctor
2. OB/GYN Medical clinic
3. Local health department
Who needs to have a Pap test?
You do if:
1. You are over 18, or
2. You are 18 or under and have sex. There is no upper age limit for the Pap test. Even women who have gone through the change of life (menopause) need a Pap test every year.
Why is a Pap test important to me?
Because it can tell if you have cancer of the cervix early—while it’s still easier to cure.

It can save your Life!

For more information on the Pap test, call the National cancer Institute’s cancer Information Service at:
800-4-CANCER 800-422-6237.
Persons with TTY equipment, dial 800-332-8615.

Call your family doctor or local medical clinic today for your Pap test appointment.

NIH Publication No. 96-3213
July 1996
RL-3

U.S. Department of Health and Human Services
Public Health Service • National Institutes of Health

P048

Having a Pelvic Exam and Pap Test

Getting Ready for the Pelvic Exam

A nurse will ask you about your health.
You will go into the exam room. You will have a paper gown to put on and a sheet to cover you.
You will lie down on the table with a sheet over your legs and stomach. You will let your knees fall to the side and put your feet in holders called stirrups.

Here’s Some Good Advice From Women Who Have Had

This Exam:

“If I start to feel embarrassed, I take some deep breaths and then I feel better.”

“It feels funny to lie on the table with your knees up in the air, but you don’t have to be there very long.”

“The nurse told me not to have sex, use vaginal creams, or douche for 24 hours before the exam.”
“She also told me not to have the Pap test when I am having my period. ”

Having the Exam

The nurse or doctor will look at your vaginal area to see if you have any signs of infection or other problems.
The nurse or doctor will slide a thin piece of plastic or metal that looks like a duck bill into your vagina to check inside.
During the Pap test, the nurse or doctor will use a small brush to take a few cells from your cervix (the opening to the womb). A lab will check these cells for cancer or other problems. If cancer is found early, it is easier to cure.
After the Pap test, the nurse or doctor will check your tubes, ovaries, and uterus (womb) by putting two gloved fingers inside your vagina. With her other hand, she will feel from the outside for any lumps or tenderness. This takes only a few minutes.
The exam is over and you can get dressed.
Be sure to ask any questions before the nurse or doctor leaves the room.

Most Pap test results are normal.

The doctor or clinic will contact you if yours is not.

Call 800 4 CANCER (800-422-6237) for more information about the Pap test

National Cancer Institute – NIH Publication N. 99-3416
Reprinted April 1999 – RL-6

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service · National institutes of Health P047

Health Centers

Union Health Center

212-812-3665 English
212-812-3666 Spanish

Directions:
1 & 9 or N to 23rd or 28th Streets

275 7th Avenue, 4th Floor
New York, New York 10001
between 25th & 26th Streets)

Clinic Hours:
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Friday 9:00 to 6:00 P.M.
Saturday 9:00 to 4:30 P.M.

1115 Health Center
516-541-1180

Directions:
LIRR to Post Ave.
Bus: N35

761 Merrick Avenue
Westbury, New York 11590
between Old County Rd & Stewart Ave)

Clinic Hours:
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Tues & Thur 8:00 to 8:00 P.M.
Saturday 9:00 to 1:00 P.M.

1115 Health Center
718-275-1115

Directions:
R or G train, 63rd Road

95-45 Queens Boulevard, 7th Floor
Rego Park, New York 11374

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Peekskill Center
914-734-8800

Directions:
Bus:
14/15 or 16 Metro North to Peekskill

1037 Main Street
Peekskill, New York
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Tuesday 8:00 to 8:00 P.M.
Friday 8:00 to 5:00 P.M.
Saturday 9:00 to 12 Noon

Beacon Center
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249 Main Street
Beacon, New York 12508
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Boro Medical Centers

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540 Atlantic Avenue, Lower Level)
Brooklyn, New York 11217

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164-01 Goethals Avenue, 1st Floor
Jamaica, New York 11437

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Yonkers
914-966-3500

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Cross County Shopping Center
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