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Case Name Case NumberWorker Breast and Cervical Cancer Medical (ACCM) Program Redetermination of Eligibility If you have a disability and need this form in an alternate format, please call 18003599517 or
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To fill out a breast and cervical cancer form, follow these steps:
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Start by providing your personal information such as your name, age, and address.
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Next, answer questions regarding any previous medical conditions or surgeries related to breast and cervical cancer.
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Provide details about your family medical history, particularly if any close relatives have been diagnosed with these types of cancer.
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Answer questions about your lifestyle, including smoking habits, alcohol consumption, and any exposure to environmental factors that may increase the risk of breast and cervical cancer.
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Who needs breast and cervical cancer?

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Breast and cervical cancer screenings are recommended for the following individuals:
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- Women of appropriate age, typically starting in their 20s for cervical cancer and 40s for breast cancer, depending on guidelines in your country.
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- Women who have experienced previous abnormalities in Pap smears or mammograms.
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- People who have been exposed to certain risk factors such as HPV infection, smoking, or a weakened immune system.
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