| CDE ID | CDE Description | | * 1063 | Site Participant ID (Go To: 422) |
| * 422 | EDRN Site ID (Go To: 423) |
| * 423 | EDRN Protocol ID (Go To: 929) |
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 1219) |
| * 1219 | Date of contact (MM/DD/YYYY): (Go To: 1319) |
| * 1319 | Date participant signed consent form (MM/DD/YYYY): (Go To: 4738) |
| * 4738 | Reason for breast biopsy (check all that apply) (Go To: 1320) |
| | | Permissible Values (value): | Clinical exam (4) |
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| | | | Screening mammography (7) |
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| * 1320 | Gender (What is your gender?) (Go To: 1291) |
| | | Permissible Values (value): | Female (2) |
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| * 1291 | Date of birth (What is your date of birth?) (MM/DD/YYYY): (Go To: 1315) |
| * 1315 | Race (What is your race? Check all that apply.) (Go To: 1322) |
| | | Permissible Values (value): | White (1) |
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| | | | Black or African-American (2) |
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| | | | American Indian or Alaska Native (3) |
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| | | | Native Hawaiian or other Pacific Islander (7) |
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| | | | Other, specify: (97) (Go To: 1294) |
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| * 1294 | Race (Other, specify) (Go To: 1322) |
| * 1322 | Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1292) |
| | | Permissible Values (value): | No (0) |
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| * 1292 | Height [in inches] (What is your total current height in inches?) (Go To: 1295) |
| * 1295 | Weight [in pounds] (What is your current weight [in pounds]? (Go To: 2594) |
| * 2594 | Currently pregnant? (Go To: 2588) |
| | | Permissible Values (value): | No (0) |
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| * 2588 | Currently breast-feeding? (Go To: 1316) |
| | | Permissible Values (value): | No (0) |
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| * 1316 | Have menstrual periods stopped due to natural menopause, hysterectomy, the removal of both ovaries, or radiation or chemotherapy treatment? (Have your menstrual periods stopped due to natural menopause, hysterectomy, the removal of both ovaries, or radiation or chemotherapy treatment?) (Go To: 1307) |
| | | Permissible Values (value): | No (0) |
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| * 1307 | Ever had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor? (Have you ever had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor?) (Go To: 1614) |
| | | Permissible Values (value): | No (0) |
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| * 3142 | Number of cancers to record: (Go To: 3200) |
| | | Permissible Values (value): | 1 (1) |
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| 3200 | Line number or identifier (system-generated): (Go To: 1341) |
| * 1341 | Cancer type/location (Go To: 1305) |
| | | Permissible Values (value): | Bladder (1) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| * 1305 | Date of diagnosis - Year (Go To: 3158) |
| 3158 | Loop-specific comments: (Go To: 1614) |
| * 1614 | Have you ever had a breast biopsy? (Go To: 1349) |
| | | Permissible Values (value): | No (0) |
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| 1615 | How many breast biopsies have you had? (Go To: 3201) |
| * 3201 | Line number or identifier 2 (system-generated): (Go To: 1716) |
| * 1716 | Year of biopsy: (Go To: 4740) |
| * 4740 | Diagnosis from breast biopsy (Go To: 3163) |
| | | Permissible Values (value): | Normal biopsy (0) |
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| | | | Benign breast disease (1) |
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| | | | Invasive breast cancer (2) |
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| | | | Non-invasive breast cancer (3) |
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| | | | Recurrent breast cancer (4) |
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| 3163 | Loop-specific comments 2: (Go To: 1349) |
| * 1349 | Have any of the participant´s living and deceased first degree blood relatives been diagnosed with cancer [other than basal/squamous cell skin cancer]? (Have any of your living and deceased first degree blood relatives (biological parents, siblings, children) been diagnosed with cancer [other than basal/squamous cell skin cancer]? [Not including half-siblings, step-siblings, step-parents, or step-children]. (Go To: 1097) |
| | | Permissible Values (value): | No (0) |
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| * 3143 | Number of relative´s cancers to record: (Go To: 3202) |
| | | Permissible Values (value): | 1 (1) |
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| * 3202 | Line number or identifier 3 (system-generated): (Go To: 1351) |
| * 1351 | Relative type (mother, brother, etc) (Go To: 1354) |
| | | Permissible Values (value): | Brother (1) |
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| * 1354 | Cancer type/Location (Go To: 1430) |
| | | Permissible Values (value): | Bladder (1) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| * 1430 | Relative´s age when diagnosed (Go To: 1317) |
| * 1317 | Subsequent primary cancer(s): (Go To: 3272) |
| | | Permissible Values (value): | None (0) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| 3272 | Loop-specific comments 5: (Go To: 1097) |
| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |