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Page 2 <br /> Contract Addendum • <br /> i. Personal history of breast cancer; <br /> 2 . Personal history of biopsy-proven benign breast <br /> disease; <br /> 3 . A mother, sister or daughter had breast cancer; or <br /> 4 . Not having given birth prior to age 30 . <br /> If these American Cancer Society (ACS) guidelines are updated, <br /> the BCCCP will abide by the new ones . <br /> Diagnostic mammographies are performed when medically <br /> appropriate. <br /> CERVICAL SCREENING AND FOLLOW UP: For women who are or have <br /> been sexually active and are 18 years old or older, the screening <br /> includes a bimanual pelvic exam, and a Papanicolaou smear every <br /> year. After a woman has had three or more consecutive satisfactory <br /> normal annual examinations , the pap test may be performed less <br /> frequently at the discretion of her physician. Repeat pap tests <br /> and colposcopy directed biopsies will be provided as medically <br /> indicated. <br /> Breast and Cervical Cancer Screenings will be provided to 191 <br /> women during the contract period: <br /> 1.78 of these women are 40 years and older and will receive <br /> breast cancer screenings and follow-up. <br /> 178 of these women are 40 years and older and receive <br /> cervical cancer screenings and follow-up. <br /> 13 of these women are under the age of 40 and receive <br /> cervical cancer screenings and follow-up. <br /> QUALITY ASSURANCE AND CONTINUOUS QUALITY IMPROVEMENT: The <br /> contractor must provide or assure the provision of high quality <br /> services throughout the program's components. For laboratories, <br /> this means Clinical Laboratory Improvement Amendments of 1988 (CLIA <br /> ' 88) certification. The Bethesda System of reporting will be <br /> required for results of pap tests. <br /> For mammography facilities, American College of Radiology <br /> (ACR) accreditation must be obtained. Any facility that provides <br /> screening services to this program must apply for ACR creditation <br /> prior to January 1, 1993 . Reporting results will be, in accordance <br /> with the Categories from the ACR Breast Imaging Reporting and <br /> Database System. <br /> ACS guidelines must be followed regarding the frequency of <br /> screenings. The contractor will assure compliance with the <br /> certifications, accreditations and guidelines. <br />