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Page 2 <br /> Contract Addendum <br /> B. Breast Screening and Follow-Up: <br /> 1. Protocols <br /> Protocols for breast screening and follow-up will be in accordance with Breast Health: A Guide <br /> for Health Departments, (DEHNR, October, 1994). <br /> 2. Screening <br /> a. All women will receive instruction in self breast examination (SBE). <br /> b. All women aged 20 - 39 years will receive a clinical breast examination (CBE) every three <br /> years. Women in the high risk group for breast cancer, beginning at age 30, may receive a <br /> CBE screening every year.** <br /> c. All women aged 40 -49 years will receive a CBE every year and a screening <br /> mammogram every other year.** <br /> d. All women aged 50 years and older will receive a CBE and screening mammogram <br /> every year. <br /> ** A woman at high risk for breast cancer may receive a screening mammogram every year. <br /> High risk definitions are found in Breast Health- A Guide for Health Departments, page 3. <br /> 3. Follow-Up <br /> Women having an abnormal breast screening result will be referred for additional evaluation. <br /> BCCCP funds may be.used for the following diagnostic services: <br /> a. Repeat or diagnostic mammogram (including cone-down view); <br /> b. Consultation Visits for Surgical Evaluation; <br /> c. Fine needle aspiration (FNA) and pathology, if needed; <br /> d. Office visits for surgical evaluation and/or FNA; and <br /> e. Breast ultrasound, when preceded by a screening mammogram and in accordance with the <br /> Breast Health_guidelines. <br /> The contractor will assure that a referral system for the diagnosis and treatment of all abnormal <br /> findings is in place. The contractor will designate a person who will be responsible for <br /> implementing a protocol which ensures, to the best of its ability, that all patients receive follow-up <br /> services or medical treatment when required. For all abnormal mammogram and clinical breast <br /> examination results the following information will be documented and reported to the BCCCP <br /> within 60 days of the initial screening date: <br /> a. Follow-up appointment information (date and follow-up location); <br /> b. Patient contact information (number and date of attempts made to follow-up); and <br /> c. Referral information (date and referral source). <br />