Get the free Breast cancer risk survey - Longmont Clinic

Longmont Clinic Breast Cancer Risk Survey Patients name Date The survey below will help us assess your risk for developing breast cancer. Thank you. 1. Have you ever had breast cancer? YES NO 2. Have

How to fill out breast cancer risk survey

How to fill out breast cancer risk survey?

1. Start by obtaining the breast cancer risk survey form.
2. Carefully read through the instructions provided on the form, ensuring you understand the purpose and questions being asked.
3. Begin by answering the general demographic questions such as age, gender, and ethnicity.
4. Move on to the section that asks about your personal medical history, including any previous breast conditions, surgeries, or family history of breast cancer.
5. Answer questions regarding lifestyle factors that may impact your risk of developing breast cancer, such as smoking habits, alcohol consumption, and physical activity level.
6. Provide information about any hormone replacement therapy or contraceptive pill usage, as these can also affect your risk.
7. Cooperate fully with questions about mammogram history, including the age of your first mammogram and any abnormalities found.
8. If applicable, answer questions about genetic testing or counseling you may have received.
9. Complete the survey by indicating any additional risk factors or concerns you may have.
10. Once finished, review your responses to ensure accuracy and completeness before submitting the survey.

Who needs breast cancer risk survey?

1. Women who have reached a certain age, usually around 40 or older, are recommended to undergo regular breast cancer screenings and may benefit from filling out a breast cancer risk survey.
2. Individuals with a family history of breast cancer, particularly those with close relatives who have been diagnosed with the disease.
3. Women who have previously been diagnosed with breast conditions, such as atypical hyperplasia or lobular carcinoma in situ.
4. Women who have previously been treated for breast cancer and want to assess their ongoing risk.
5. Individuals who have been identified as carrying certain genetic mutations, such as BRCA1 or BRCA2, which are associated with an increased risk of breast cancer.
6. Women who have experienced certain lifestyle factors that might impact their breast cancer risk, such as long-term hormone replacement therapy use or significant exposure to environmental toxins.

Note: It's always best to consult with a healthcare professional or your primary care physician if you have any concerns or questions regarding whether you should fill out a breast cancer risk survey. They can provide personalized guidance based on your individual circumstances.

For pdfFiller’s FAQs

What is breast cancer risk survey?

The breast cancer risk survey is a survey designed to assess an individual's risk of developing breast cancer.

Who is required to file breast cancer risk survey?

Certain individuals, such as women over a certain age or with a family history of breast cancer, may be required to file a breast cancer risk survey.

How to fill out breast cancer risk survey?

The breast cancer risk survey can typically be filled out online or on paper, and will ask for information about personal and family medical history.

What is the purpose of breast cancer risk survey?

The purpose of the breast cancer risk survey is to help identify individuals who may be at increased risk of developing breast cancer, so that appropriate screening or prevention measures can be taken.

What information must be reported on breast cancer risk survey?

The information reported on the breast cancer risk survey may include personal medical history, family medical history, lifestyle factors, and any previous breast cancer screenings.

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