Form:	DCIS Team Project Clinical v1.0

CDE ID	CDE Description
* 2777	Site participant ID (Go To: 422)
* 422	EDRN Site ID (Go To: 2709)
* 2709	Specimen identifier: (Go To: 423)
* 423	EDRN Protocol ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 3455)
* 3455	Data collected for: (Go To: 3407)
	Permissible Values (value): Validation (1)
	Discovery (2)
	Unknown (99)
* 3407	Date of surgery (MM/YYYY): (Go To: 1292)
* 1292	Height [in inches] (What is your total current height in inches?) (Go To: 1212)
* 1212	Weight (lbs) at time of diagnosis: (Go To: 3413)
* 3413	Has the participant had a mastectomy? (Go To: 2784)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
* 2784	Family cancer history in first-degree relatives? (Go To: 1601)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
* 1601	Have you ever used hormonal birth control (such as birth control pills)? (Go To: 3386)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3385)
	Unknown (99)
* 3385	Was the participant using hormonal birth control at the referent time? (Go To: 3386)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
* 3386	Did the participant ever use estrogen-only menopausal hormone therapy? (Go To: 3387)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 2789)
	Unknown (99)
* 2789	Estrogen-only therapy used? (Go To: 3387)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
* 3387	Did the participant ever use estrogen+ progesterone therapy? (Go To: 3401)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 2799)
	Unknown (99)
* 2799	Estrogen + progesterone hormone therapy used? (Go To: 3401)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
* 3401	Date of prior screening test (MM/YYYY): (Go To: 3391)
* 3391	Reason (or indication) for procedure that led to diagnosis: (Go To: 3374)
	Permissible Values (value): Screening (asymptomatic) (1)
	Additional evaluation (2)
	Surveillance (3)
	Symptomatic (4)
	Unknown (99)
* 3374	Breast condition: Check all that apply (Go To: 3371)
	Permissible Values (value): Abnormal mammogram/radiology exam (1)
	Abnormal mammogram with calcifications (2)
	Breast mass (patient or physician feels) (3)
	Nipple inversion, retraction, induration (4)
	Pathologic/spontaneous nipple discharge (5)
	Incidental findings (10)
	N/A (98)
	Unknown (99)
* 3371	Site of breast condition: (Go To: 3389)
	Permissible Values (value): Left breast (1)
	Right breast (2)
	Bilateral (5)
	Other, specify: (97) (Go To: 3398)
	Unknown (99)
* 3398	Site of breast condition (Other, specify): (Go To: 3389)
* 3389	Breast quadrant(s) of disease: (Go To: 3372)
	Permissible Values (value): Upper inner (1)
	Upper outer (2)
	Lower inner (3)
	Lower outer (4)
	12:00 (5)
	3:00 (6)
	6:00 (7)
	9:00 (9)
	Central (10)
	Other (95)
	Unknown (99)
* 3372	Type of surgical procedure: (Go To: 2477)
	Permissible Values (value): Excisional biopsy (2)
	Incisional biopsy (3)
	Duct excision (4)
	Mastectomy (5)
	Lumpectomy (6)
	Axillary lymph node dissection (7)
	Sentinel lymph node biopsy (8)
	Core biopsy (needle) (9)
	Unknown (99)
* 2477	Radiation therapy used? (Go To: 2286)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1262)
	Unknown (99)
* 1262	Radiation therapy start date: (MM/YYYY): (Go To: 2304)
* 2304	Radiation therapy site: (Go To: 2286)
	Permissible Values (value): Right whole breast (1)
	Right partial breast (2)
	Left whole breast (3)
	Left partial breast (4)
	Right chest wall (5)
	Left chest wall (6)
	Right breast, NOS (10)
	Left breast, NOS (11)
	Internal mammary nodes (13)
	Other, specify: (97) (Go To: 2548)
	Unknown (99)
* 2548	Radiation therapy site (Other, specify): (Go To: 2286)
* 2286	Hormone therapy received? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3402)
	Unknown (99)
* 3402	Hormone therapy start date (MM/YYYY): (Go To: 2285)
* 2285	Hormone therapy name: (Go To: 1097)
	Permissible Values (value): Raloxifene (6)
	Tamoxifen (7)
	Aromatase inhibitor (24)
	Other, specify: (97) (Go To: 2475)
	Unknown (99)
* 2475	Hormone therapy name (Other, specify): (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)