Code

What is the patient’s age? (years) [35-85]

What is the patient’s race/ethnicity?
White Black Hispanic Chinese Japanese Filipino Hawaiian Other Pacific Islander Asian

Has the patient ever had a breast biopsy with a benign (not cancer) diagnosis?
Unknown Yes No

How many breast biopsies with a benign diagnosis has the patient had?
Unknown no biopsies 1 biopsies 2 or more biopsies

Has the patient ever had a breast biopsy with atypical hyperplasia?
Unknown Yes No

What was the woman’s age at the time of her first menstrual period?
Unknown Less than 12 years old 12 through 13 years old Greater than 13 years old

What was the woman’s age when she gave birth to her first child?
Unknown No births Less than 20 years old 20 through 24 years old 25 through 29 years old 30 years old and greater

How many of the woman’s first-degree relatives (mother, sisters, daughters) have had breast cancer?
Unknown 0 relatives 1 relatives 2 or more relatives

Does the patient drinking alcohol?
Yes No

Is the patient breastfeeding?
Yes No

Clinical breast exam (CBE) by clinician?
Yes (having “extremely” or “heterogeneously” dense breasts as seen on a mammogram) No

Breast self-exam (BSE)?
Yes (suspected) No

2D or 3D mammograms?
Yes (mass was detected) No

Does the patient have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes?
Unknown Yes No

Does the patient have a known BRCA1 or BRCA2 gene mutation (based on genetic testing)?
Unknown Yes No