Guidelines and Protocols Advisory Committee - Mammography - Protocol for the Use of Diagnostic Facilities

GPAC: Guidelines and Protocols Advisory Committee

Mammography - Protocol for the Use of Diagnostic Facilities

Effective Date: July 15, 2007

Summary | Flow Sheet | Patient Guide | Full Guideline in PDF

Recommendations and Topics

Scope

1. Diagnostic Mammograms

2. Screening Mammograms in Diagnostic Facilities

Administration and Audit Implications

Sponsors

Scope

This protocol applies to mammography services which are provided through diagnostic mammography facilities and billed to the Medical Services Plan (MSP). Except for circumstances identified in this protocol, all screening mammography should be provided by the Screening Mammography Program of British Columbia (SMPBC)* and should not be billed to the Medical Services Plan.

RECOMMENDATION 1: Diagnostic Mammograms

The indication(s) for a diagnostic mammogram must be entered on the requisition form. Acceptable indications would include, for example:

women with signs and symptoms suggestive of breast disease - to include lump or discrete thickening, localized nodularity, dimpling or contour deformity, serous or sanguineous nipple discharge, non-cyclical localized pain or tenderness
follow-up of women with proven breast cancer, and those with previous biopsy result of atypia or proliferative disease and lobular carcinoma in situ (LCIS)
search for unknown primary malignancy
suspected complications of breast implants, i.e. rupture, pathological capsule
first postoperative mammogram following a benign biopsy
work-up of patient with abnormal screening mammogram
surveillance follow-up as recommended based on diagnostic work-up

RECOMMENDATION 2: Screening Mammograms in Diagnostic Facilities

Screening mammograms may be performed in diagnostic facilities and billed to the Medical Services Plan only under the following circumstances:

for women who have breast implants (but otherwise following the SMPBC policy for women without implants), or
for women under age 40 who have a confirmed BRCA1 or BRCA2 mutation, or have a very strong family history of breast cancer**, or
for women who qualify for the SMPBC service but do not have reasonable access. Reasonable access is defined as: available appointment with the SMPBC (centre or mobile vans) within two months and travel time to a SMPBC facility of less than one hour under ideal conditions.

Notes:

The Screening Mammography Program of BC also accepts women under age 40 with physician referral, provided they do not have breast implants or an indication for a diagnostic mammogram. These may include women with a confirmed BRCA1 or BRCA2 mutation or women who have a very strong family history** of breast cancer. The Chief Radiologist, in consultation with physicians, may decide on exceptional cases and determine which facility is most appropriate for such cases.

Each SMPBC screening exam for women under 40 or over 79 years-of-age is to be arranged by the primary health care provider after consultation with a radiologist at the screening centre of choice. Refer to the SMPBC policies and procedures regarding women under 40 or over 79, available here.

All women who meet the referral criteria for Hereditary Breast and/or Ovarian Cancer testing should be referred to the Hereditary Cancer Program*** at the BC Cancer Agency (BCCA).

*The Screening Mammography Program of British Columbia is a program of the BC Cancer Agency which is a member of the Provincial Health Services Authority.

**A very strong family history of breast cancer may be defined as:

2 cases of breast cancer in close female relatives (mother, sister, daughter, aunt, grandmother, great-aunt) on the same side of the family, both diagnosed before age 50; or
3 or more cases of breast cancer in close female relatives (mother, sister, daughter, aunt, grandmother, great-aunt) on the same side of the family, with at least one diagnosed before age 50.

***Hereditary Cancer Program Referral Guidelines from the BCCA can be found here.

For additional information, physicians and patients are encouraged to contact:

Screening Mammography Program of BC
8th Floor - 686 West Broadway
Vancouver B.C. V5Z 1G1
Telephone: (604) 877-6200
Fax: (604) 660-3645
www.bccancer.bc.ca/breastscreening
Email: www.bccancer.bc.ca/ContactUs.htm

Administration and Audit Implications

Responsibility for Documentation:

Referring/Ordering Physician

Recommendation 1 - Diagnostic Mammograms
Physician must document indication(s) for a diagnostic mammogram consistent with this protocol in the patient's clinical record, and on the requisition form.
Recommendation 2 - Screening Mammograms in Diagnostic Facilities
When a screening mammogram is requested from a diagnostic facility, the physician must provide adequate documentation in both the patient's clinical record and the requisition to show that the request is consistent with Recommendation 2.

Diagnostic Facility

Recommendation 1 - Diagnostic Mammograms
In order for the service to be covered by MSP, the facility must ensure that the indication for a diagnostic mammogram is adequately documented on the patient's requisition form.
Recommendation 2 - Screening Mammograms in Diagnostic Facilities
The facility must ensure that documentation on the patient's requisition form meets one or more of the criteria listed under Recommendation 2.

The principles of the Guidelines and Protocols Advisory Committee are to:

encourage appropriate responses to common medical situations
recommend actions that are sufficient and efficient, neither excessive nor deficient
permit exceptions when justified by clinical circumstances.

Disclaimer

The Clinical Practice Guidelines (the "Guidelines") have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problems.

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Last Revised: September 30, 2008