| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 423) |
| * 423 | EDRN Protocol ID (Go To: 422) |
| * 422 | EDRN Site 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: 1320) |
| * 1320 | Gender (What is your gender?) (Go To: 578) |
| | | Permissible Values (value): | Female (2) |
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| * 578 | Age at specimen collection (Go To: 1322) |
| * 1322 | Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315) |
| | | Permissible Values (value): | No (0) |
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| * 1315 | Race (What is your race? Check all that apply.) (Go To: 4221) |
| | | 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: 4221) |
| * 4221 | Height (value): (Go To: 4222) |
| * 4222 | Height (unit): (Go To: 4223) |
| | | Permissible Values (value): | cm (centimeters) (1) |
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| * 4223 | Weight (value): (Go To: 4224) |
| * 4224 | Weight (unit): (Go To: 5648) |
| | | Permissible Values (value): | kg (kilograms) (1) |
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| * 5648 | Did you learn about this project through a source other than this site? (Go To: 5032) |
| | | Permissible Values (value): | No (0) |
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| * 5032 | Has a doctor ever diagnosed you with Hereditary Non-Polyposis Colon Syndrome (HNPCC), also called Lynch Syndrome? (Go To: 4892) |
| | | Permissible Values (value): | No (0) |
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| * 4892 | Has a doctor ever diagnosed you with complex atypical hyperplasia (CAH) of the endometrium? (Go To: 2594) |
| | | Permissible Values (value): | No (0) |
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| * 2594 | Currently pregnant? (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: 2215) |
| | | Permissible Values (value): | No (0) |
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| * 2215 | When was your last menstrual period? (Go To: 5005) |
| * 5005 | Is the participant using any form of contraception? (Go To: 1300) |
| | | Permissible Values (value): | No (0) |
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| | | | Oral contraceptive pills (OCP) (1) |
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| | | | Intrauterine device (IUD) (2) (Go To: 5008) |
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| | | | Contraceptive implant (3) |
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| | | | Other, specify: (97) (Go To: 5006) |
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| * 5008 | Type of intrauterine device (IUD) (Go To: 1300) |
| | | Permissible Values (value): | Hormonal (1) |
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| * 5006 | Type of contraception, other, specify (Go To: 1300) |
| * 1300 | Ever smoke cigarettes regularly, at least one a day for a year or more? (Did you ever smoke cigarettes regularly, at least one a day for a year or more?) (Go To: 2977) |
| | | Permissible Values (value): | No (0) |
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| * 1299 | Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 1297) |
| | | Permissible Values (value): | No (0) (Go To: 1298) |
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| * 1298 | Age quit smoking cigarettes? (How old were you when you permanently quit smoking cigarettes?) (Go To: 1297) |
| * 1297 | Age first began smoking cigarettes regularly, at least one a day? (How old were you when you began smoking cigarettes regularly, at least one a day?) (Go To: 1325) |
| * 1325 | Average number of cigarettes smoked per day? (During the time you have smoked, on average, how many cigarettes did you smoke per day?) (Go To: 1301) |
| * 1301 | Total number of years smoked? (How many years total have you smoked?) (Go To: 1715) |
| * 1715 | Total number of pack years smoked. (Go To: 2977) |
| * 2977 | Has a doctor diagnosed you with any of the following inflammations? (Check all that apply) (Go To: 5018) |
| | | Permissible Values (value): | Rheumatoid arthritis (1) |
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| | | | Inflammatory bowel disease (3) |
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| | | | Collagen vascular disease such as lupus or scleroderma (8) |
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| | | | Connective tissue disorder (10) |
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| | | | Diabetes mellitus, Type I (early onset) (11) |
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| | | | Vasculitis (inflammation of the blood vessels) (14) |
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| | | | Other, specify: (97) (Go To: 3216) |
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| * 3216 | Medical condition (Other, specify): (Go To: 5018) |
| * 5018 | Has the participant had a transplant (either organ or bone marrow)? (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: 1349) |
| | | 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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| | | | Primary peritoneal cancer (46) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| | | | Other, specify: (97) (Go To: 1339) |
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| * 1339 | Cancer type/location (Other, specify) (Go To: 1305) |
| * 1305 | Date of diagnosis - Year (Go To: 4889) |
| * 4889 | Did the cancer spread beyond its origin? (Go To: 2148) |
| | | Permissible Values (value): | No (0) |
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| * 2148 | Primary cancer treatment(s) received: (Go To: 1929) |
| | | Permissible Values (value): | Cytotoxic chemotherapy (10) |
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| * 1929 | Treatment stop date (MM/DD/YYYY): (Go To: 5444) |
| * 5444 | Did the cancer recur? (Go To: 3158) |
| | | Permissible Values (value): | No (0) |
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| * 1221 | Recurrence date (MM/YYYY): (Go To: 3158) |
| 3158 | Loop-specific comments: (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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| | | | Primary peritoneal cancer (46) |
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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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| | | | Primary peritoneal cancer (46) |
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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) |