[EDITORIAL NOTE 1]{.underline}**:** This questionnaire includes a solid
set of family history questions that determines the relevant
denominators and covers first- and second-degree relatives. Changes you
might want to consider are to ask the corresponding questions to Q2c.
and Q2d. for the parents' siblings: Is this a full or half-sibling of
the parent? If a half-sibling, do they share the

same mother? father?

[EDITORIAL NOTE 2]{.underline}: If your study were focused not on breast
cancer but on a different cancer, you might want to make other choices
for the cancers in Q4a, Q4b, Q5a, Q5b, etc.

**Cancer Risk in X-Ray Technologists: Genetics Studies**

**Data Retrieval Questionnaire for**

### Breast Cancer Cases

### 

### University of Minnesota

**American Registry of Radiologic Technologists**

**National Institutes of Health**

> NOTE: This questionnaire is administered by telephone interview to
> breast cancer cases who participate in the Genetics Studies as a
> follow-up to a mailed survey instrument previously completed by the
> subject. Information collected during this interview is used to
> augment and verify information obtained by the previous survey
> instrument.

+--------+---------------------------------------------------+---+----+
| # G    |                                                   |   |    |
| enetic |                                                   |   |    |
| s Stud |                                                   |   |    |
| y Data |                                                   |   |    |
|  Retri |                                                   |   |    |
| eval - |                                                   |   |    |
|  FCRDC |                                                   |   |    |
+--------+---------------------------------------------------+---+----+
| The    |                                                   |   |    |
| first  |                                                   |   |    |
| que    |                                                   |   |    |
| stions |                                                   |   |    |
| are    |                                                   |   |    |
| about  |                                                   |   |    |
| your   |                                                   |   |    |
| family |                                                   |   |    |
| hi     |                                                   |   |    |
| story, |                                                   |   |    |
| beg    |                                                   |   |    |
| inning |                                                   |   |    |
| with   |                                                   |   |    |
| your   |                                                   |   |    |
| [biolo |                                                   |   |    |
| gical] |                                                   |   |    |
| {.unde |                                                   |   |    |
| rline} |                                                   |   |    |
| pa     |                                                   |   |    |
| rents. |                                                   |   |    |
+--------+---------------------------------------------------+---+----+
|        | **BOX A**                                         |   |    |
|        |                                                   |   |    |
|        | **IF TECH WAS ADOPTED:**                          |   |    |
|        |                                                   |   |    |
|        | Does not know biological family history 1         |   |    |
|        | **\[SKIP TO TOP OF PAGE 8\]**                     |   |    |
|        |                                                   |   |    |
|        | Knows biological family history 2 **\[GO TO       |   |    |
|        | Q1\]**                                            |   |    |
+--------+---------------------------------------------------+---+----+

**Q1.** For each parent, please tell me the year of birth, year of death
*(if deceased),* and whether or not\
he or she was ever diagnosed with cancer.

For each parent diagnosed with cancer, please list all primary sites
*(excluding metastases and\
non-melanoma skin cancer)* and provide the age at diagnosis for each
cancer listed.

+-----+---------+---------+--------+---------------+------+---------+
| *   | **b.    | **c.    | **e.   | **f. List     | **g. | **h.    |
| *a. | Year of | A       | Dia    | Primary site  | Age  | ICD9**  |
| Pa  | Birth** | live?** | gnosed | (exclude      | at   |         |
| ren |         |         | with   | metastases    | Dia  | **\[TO  |
| t** |         |         | can    | and\          | gnos | BE      |
|     |         |         | cer?** | non-melanoma  | is** | CO      |
|     |         |         |        | skin          |      | DED\]** |
|     |         |         |        | cancer)**     |      |         |
+-----+---------+---------+--------+---------------+------+---------+
| Fat | \_\_    | Alive   | Yes 1  | \_\_\_\_\_    | \_\_ | \_\_    |
| her | \_\_    | 1\      |        | \_\_\_\_\_\_\ | \_\_ | \_\_    |
| 1   | \_\_    | D       | No 2   | _\_\_\_\_\_\_ |      | \_\_    |
|     | \_\_    | eceased |        |               | DK 8 | \_\_    |
|     |         | 2       | DK 8   |               |      |         |
|     |         |         |        |               |      |         |
|     |         | DK 8    |        |               |      |         |
+-----+---------+---------+--------+---------------+------+---------+
|     | DK 8    | **d.    |        | *             | \_\_ | \_\_    |
|     |         | Year    |        | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|     |         | of\     |        | \_\_\_\_\_\_\ |      | \_\_    |
|     |         | Death** |        | _\_\_\_\_\_** | DK 8 | \_\_    |
|     |         |         |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         |         |        |               |      |         |
|     |         | DK 8    |        |               |      |         |
+-----+---------+---------+--------+---------------+------+---------+
|     |         |         |        | *             | \_\_ | \_\_    |
|     |         |         |        | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|     |         |         |        | \_\_\_\_\_\_\ |      | \_\_    |
|     |         |         |        | _\_\_\_\_\_** | DK 8 | \_\_    |
+-----+---------+---------+--------+---------------+------+---------+
| Mot | \_\_    | Alive   | Yes 1  | \_\_\_\_\_    | \_\_ | \_\_    |
| her | \_\_    | 1\      |        | \_\_\_\_\_\_\ | \_\_ | \_\_    |
| 2   | \_\_    | D       | No 2   | _\_\_\_\_\_\_ |      | \_\_    |
|     | \_\_    | eceased |        |               | DK 8 | \_\_    |
|     |         | 2       | DK 8   |               |      |         |
|     |         |         |        |               |      |         |
|     |         | DK 8    |        |               |      |         |
+-----+---------+---------+--------+---------------+------+---------+
|     | DK 8    | **d.    |        | *             | \_\_ | \_\_    |
|     |         | Year    |        | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|     |         | of\     |        | \_\_\_\_\_\_\ |      | \_\_    |
|     |         | Death** |        | _\_\_\_\_\_** | DK 8 | \_\_    |
|     |         |         |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         | \_\_    |        |               |      |         |
|     |         |         |        |               |      |         |
|     |         | DK 8    |        |               |      |         |
+-----+---------+---------+--------+---------------+------+---------+
|     |         |         |        | *             | \_\_ | \_\_    |
|     |         |         |        | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|     |         |         |        | \_\_\_\_\_\_\ |      | \_\_    |
|     |         |         |        | _\_\_\_\_\_** | DK 8 | \_\_    |
+-----+---------+---------+--------+---------------+------+---------+

+-----------------------------------------------------------+----------+
| **Q2.** Next, I\'d like to ask you about your             | > **BOX  |
| [blood-related]{.underline} siblings. This would include  | > B**    |
| half-brothers or half-sisters, but NOT step-siblings.     | >        |
| Beginning with the oldest, please tell me the gender,     | > **IF   |
| year of birth, year of death *(if deceased)* for each     | > ONLY   |
| sibling, and whether or not he or she was ever diagnosed  | > CHILD, |
| with cancer.                                              | > CIRCLE |
|                                                           | > \'1\'  |
| For each sibling diagnosed with cancer, please list all   | > AND    |
| primary sites *(excluding metastases and non-melanoma     | > SKIP   |
| skin cancer)* and provide the age at diagnosis for each   | > TO     |
| cancer listed.                                            | > Q3**   |
|                                                           | >        |
|                                                           | > **     |
|                                                           | ........ |
|                                                           | .....1** |
+-----------------------------------------------------------+----------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| * | *   | **c. | **e.  | **f.  | **h.  | **i. List   | **j. | **k. |
| * | *b. | Full | Year  | Ali   | Diag  | Primary     | Age  | IC   |
| a | Sex | or   | of    | ve?** | nosed | site        | at   | D9** |
| . | of  | half | Bi    |       | with  | (exclude    | Dia  |      |
| # | sib | s    | rth** |       | canc  | metastases  | gnos | **   |
| * | lin | ibli |       |       | er?** | and\        | is** | \[TO |
| * | g** | ng** |       |       |       | n           |      | BE   |
|   |     |      |       |       |       | on-melanoma |      | C    |
|   |     |      |       |       |       | skin        |      | ODED |
|   |     |      |       |       |       | cancer)**   |      | \]** |
+---+-----+------+-------+-------+-------+-------------+------+------+
| 1 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | DK 8 |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 2 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 3 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| * | *   | **c. | **e.  | **f.  | **h.  | **i. List   | **j. | **k. |
| * | *b. | Full | Year  | Ali   | Diag  | Primary     | Age  | IC   |
| a | Sex | or   | of    | ve?** | nosed | site        | at   | D9** |
| . | of  | half | Bi    |       | with  | (exclude    | Dia  |      |
| # | sib | s    | rth** |       | canc  | metastases  | gnos | **   |
| * | lin | ibli |       |       | er?** | and\        | is** | \[TO |
| * | g** | ng** |       |       |       | n           |      | BE   |
|   |     |      |       |       |       | on-melanoma |      | C    |
|   |     |      |       |       |       | skin        |      | ODED |
|   |     |      |       |       |       | cancer)**   |      | \]** |
+---+-----+------+-------+-------+-------+-------------+------+------+
| 4 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 5 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 6 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 7 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| * | *   | **c. | **e.  | **f.  | **h.  | **i. List   | **j. | **k. |
| * | *b. | Full | Year  | Ali   | Diag  | Primary     | Age  | IC   |
| a | Sex | or   | of    | ve?** | nosed | site        | at   | D9** |
| . | of  | half | Bi    |       | with  | (exclude    | Dia  |      |
| # | sib | s    | rth** |       | canc  | metastases  | gnos | **   |
| * | lin | ibli |       |       | er?** | and\        | is** | \[TO |
| * | g** | ng** |       |       |       | n           |      | BE   |
|   |     |      |       |       |       | on-melanoma |      | C    |
|   |     |      |       |       |       | skin        |      | ODED |
|   |     |      |       |       |       | cancer)**   |      | \]** |
+---+-----+------+-------+-------+-------+-------------+------+------+
| 8 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 9 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
|   | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 1 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
| 0 | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

+---+-----+------+-------+-------+-------+-------------+------+------+
| 1 | M   | Full | \_\_  | Alive | Yes 1 | \           | \_\_ | \_\_ |
| 1 | ale | 1    | \_\_  | 1     |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   | 1   |      | \_\_  |       | No 2  | \_\_\_\_\_\ |      | \_\_ |
|   |     | Half | \_\_  | Dec   |       | _\_\_\_\_\_ | DK 8 | \_\_ |
|   | Fem | 2    |       | eased | DK 8  |             |      |      |
|   | ale |      |       | 2     |       |             |      |      |
|   | 2   | DK 8 |       |       |       |             |      |      |
|   |     |      |       | DK 8  |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     | **d. | DK 8  | **g.  |       | **\_\       | \_\_ | \_\_ |
|   |     | If   |       | Year  |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     | h    |       | of\   |       | \_\_\_\_\_\ |      | \_\_ |
|   |     | alf, |       | De    |       | _\_\_\_\_** | DK 8 | \_\_ |
|   |     | s    |       | ath** |       |             |      |      |
|   |     | hare |       |       |       |             |      |      |
|   |     | same |       | \_\_  |       |             |      |      |
|   |     | . .  |       | \_\_  |       |             |      |      |
|   |     | .**  |       | \_\_  |       |             |      |      |
|   |     |      |       | \_\_  |       |             |      |      |
|   |     | Mo   |       |       |       |             |      |      |
|   |     | ther |       | DK 8  |       |             |      |      |
|   |     | 1    |       |       |       |             |      |      |
|   |     |      |       |       |       |             |      |      |
|   |     | Fa   |       |       |       |             |      |      |
|   |     | ther |       |       |       |             |      |      |
|   |     | 2 DK |       |       |       |             |      |      |
|   |     | 8    |       |       |       |             |      |      |
+---+-----+------+-------+-------+-------+-------------+------+------+
|   |     |      |       |       |       | **\_\       | \_\_ | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_\_ | \_\_ | \_\_ |
|   |     |      |       |       |       | \_\_\_\_\_\ |      | \_\_ |
|   |     |      |       |       |       | _\_\_\_\_** | DK 8 | \_\_ |
+---+-----+------+-------+-------+-------+-------------+------+------+

**Q3.** Next, I\'d like to ask you about your
[blood-related]{.underline} grandparents. For each grandparent, please
tell me the year of birth, year of death *(if deceased)*, and whether or
not he or she was ever diagnosed with cancer.

For each grandparent diagnosed with cancer, please list all primary
sites *(excluding metastases and non-melanoma skin cancer)* and provide
the age at diagnosis for each cancer listed.

+-------+---------+---------+-------+---------------+------+---------+
| **a.  | **b.    | **c.    | **e.  | **f. List     | **g. | **h.    |
| Gr    | Year    | A       | Diag  | Primary site  | Age  | ICD9**  |
| and-\ | of\     | live?** | nosed | (exclude      | at   |         |
| par   | Birth** |         | with  | metastases    | Dia  | **\[TO  |
| ent** |         |         | canc  | and\          | gnos | BE      |
|       |         |         | er?** | non-melanoma  | is** | CO      |
|       |         |         |       | skin          |      | DED\]** |
|       |         |         |       | cancer)**     |      |         |
+-------+---------+---------+-------+---------------+------+---------+
| Mat   | \_\_    | Alive   | Yes 1 | \_\_\_\_\_    | \_\_ | \_\_    |
| ernal | \_\_    | 1\      |       | \_\_\_\_\_\_\ | \_\_ | \_\_    |
| Gr    | \_\_    | D       | No 2  | _\_\_\_\_\_\_ |      | \_\_    |
| andfa | \_\_    | eceased |       |               | DK 8 | \_\_    |
| ther\ |         | 2       | DK 8  |               |      |         |
| 1     |         |         |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       | DK 8    | **d.    |       | *             | \_\_ | \_\_    |
|       |         | Year    |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         | of\     |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         | Death** |       | _\_\_\_\_\_** | DK 8 | \_\_    |
|       |         |         |       |               |      |         |
|       |         | **\     |       |               |      |         |
|       |         | **\_\_  |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_\   |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       |         |         |       | *             | \_\_ | \_\_    |
|       |         |         |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         |         |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         |         |       | _\_\_\_\_\_** | DK 8 | \_\_    |
+-------+---------+---------+-------+---------------+------+---------+
| Mat   | \_\_    | Alive   | Yes 1 | \_\_\_\_\_    | \_\_ | \_\_    |
| ernal | \_\_    | 1\      |       | \_\_\_\_\_\_\ | \_\_ | \_\_    |
| Gr    | \_\_    | D       | No 2  | _\_\_\_\_\_\_ |      | \_\_    |
| andmo | \_\_    | eceased |       |               | DK 8 | \_\_    |
| ther\ |         | 2       | DK 8  |               |      |         |
| 2     |         |         |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       | DK 8    | **d.    |       | *             | \_\_ | \_\_    |
|       |         | Year    |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         | of\     |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         | Death** |       | _\_\_\_\_\_** | DK 8 | \_\_    |
|       |         |         |       |               |      |         |
|       |         | **\     |       |               |      |         |
|       |         | **\_\_  |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_\   |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       |         |         |       | *             | \_\_ | \_\_    |
|       |         |         |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         |         |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         |         |       | _\_\_\_\_\_** | DK 8 | \_\_    |
+-------+---------+---------+-------+---------------+------+---------+
| Pat   | \_\_    | Alive   | Yes 1 | \_\_\_\_\_    | \_\_ | \_\_    |
| ernal | \_\_    | 1\      |       | \_\_\_\_\_\_\ | \_\_ | \_\_    |
| Gr    | \_\_    | D       | No 2  | _\_\_\_\_\_\_ |      | \_\_    |
| andfa | \_\_    | eceased |       |               | DK 8 | \_\_    |
| ther\ |         | 2       | DK 8  |               |      |         |
| 3     |         |         |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       | DK 8    | **d.    |       | *             | \_\_ | \_\_    |
|       |         | Year    |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         | of\     |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         | Death** |       | _\_\_\_\_\_** | DK 8 | \_\_    |
|       |         |         |       |               |      |         |
|       |         | **\     |       |               |      |         |
|       |         | **\_\_  |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_\   |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       |         |         |       | *             | \_\_ | \_\_    |
|       |         |         |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         |         |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         |         |       | _\_\_\_\_\_** | DK 8 | \_\_    |
+-------+---------+---------+-------+---------------+------+---------+
| Pat   | \_\_    | Alive   | Yes 1 | \_\_\_\_\_    | \_\_ | \_\_    |
| ernal | \_\_    | 1\      |       | \_\_\_\_\_\_\ | \_\_ | \_\_    |
| Gr    | \_\_    | D       | No 2  | _\_\_\_\_\_\_ |      | \_\_    |
| andmo | \_\_    | eceased |       |               | DK 8 | \_\_    |
| ther\ |         | 2\      | DK 8  |               |      |         |
| 4     |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       | DK 8    | **d.    |       | *             | \_\_ | \_\_    |
|       |         | Year    |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         | of\     |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         | Death** |       | _\_\_\_\_\_** | DK 8 | \_\_    |
|       |         |         |       |               |      |         |
|       |         | **\     |       |               |      |         |
|       |         | **\_\_  |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_    |       |               |      |         |
|       |         | \_\_\   |       |               |      |         |
|       |         | DK 8    |       |               |      |         |
+-------+---------+---------+-------+---------------+------+---------+
|       |         |         |       | *             | \_\_ | \_\_    |
|       |         |         |       | *\_\_\_\_\_\_ | \_\_ | \_\_    |
|       |         |         |       | \_\_\_\_\_\_\ |      | \_\_    |
|       |         |         |       | _\_\_\_\_\_** | DK 8 | \_\_    |
+-------+---------+---------+-------+---------------+------+---------+

Now I\'d like to ask you about your [parents\'
siblings]{.underline}**.**

+---+----------------------+---+--------------------------------+----+
| * | How many             |   |                                |    |
| * | blood-related        |   |                                |    |
| Q | [                    |   |                                |    |
| 4 | sisters]{.underline} |   |                                |    |
| . | did your MOTHER      |   |                                |    |
| * | have?                |   |                                |    |
| * |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | \_\_ \_\_ **\[IF     | * | How many of these MATERNAL     |    |
|   | NONE, SKIP TO Q5\]** | * | aunts were diagnosed with      |    |
|   |                      | Q | **[breast]{.underline}**       |    |
|   | \# of Blood-Related  | 4 | cancer?                        |    |
|   | Sisters              | a |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | DK 8                 |   | \_\_ \_\_ \# of Maternal Aunts |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      | * | How many of these MATERNAL     |    |
|   |                      | * | aunts were diagnosed with      |    |
|   |                      | Q | **[ovarian]{.underline}**      |    |
|   |                      | 4 | cancer?                        |    |
|   |                      | b |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | \_\_ \_\_ \# of Maternal Aunts |    |
|   |                      |   |                                |    |
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
| * | How many             |   |                                |    |
| * | blood-related        |   |                                |    |
| Q | [b                   |   |                                |    |
| 5 | rothers]{.underline} |   |                                |    |
| . | did your MOTHER      |   |                                |    |
| * | have?                |   |                                |    |
| * |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | \_\_ \_\_ **\[IF     | * | How many of these MATERNAL     |    |
|   | NONE, SKIP TO Q6\]** | * | uncles were diagnosed with     |    |
|   |                      | Q | **[prostate]{.underline}**     |    |
|   | \# of Blood-Related  | 5 | cancer?                        |    |
|   | Brothers             | a |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | DK 8                 |   | \_\_ \_\_ \# of Maternal       |    |
|   |                      |   | Uncles                         |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      | * | How many of these MATERNAL     |    |
|   |                      | * | uncles were diagnosed with     |    |
|   |                      | Q | **[testicular]{.underline}**   |    |
|   |                      | 5 | cancer?                        |    |
|   |                      | b |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | \_\_ \_\_ \# of Maternal       |    |
|   |                      |   | Uncles                         |    |
|   |                      |   |                                |    |
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
| * | How many             |   |                                |    |
| * | blood-related        |   |                                |    |
| Q | [                    |   |                                |    |
| 6 | sisters]{.underline} |   |                                |    |
| . | did your FATHER      |   |                                |    |
| * | have?                |   |                                |    |
| * |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | \_\_ \_\_ **\[IF     | * | How many of these PATERNAL     |    |
|   | NONE, SKIP TO Q7\]** | * | aunts were diagnosed with      |    |
|   |                      | Q | **[breast]{.underline}**       |    |
|   | \# of Blood-Related  | 6 | cancer?                        |    |
|   | Sisters              | a |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | DK 8                 |   | \_\_ \_\_ \# of Paternal Aunts |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      | * | How many of these PATERNAL     |    |
|   |                      | * | aunts were diagnosed with      |    |
|   |                      | Q | **[ovarian]{.underline}**      |    |
|   |                      | 6 | cancer?                        |    |
|   |                      | b |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | \_\_ \_\_ \# of Paternal Aunts |    |
|   |                      |   |                                |    |
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
| * | How many             |   |                                |    |
| * | blood-related        |   |                                |    |
| Q | [b                   |   |                                |    |
| 7 | rothers]{.underline} |   |                                |    |
| . | did your FATHER      |   |                                |    |
| * | have?                |   |                                |    |
| * |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | \_\_ \_\_ **\[IF     | * | How many of these PATERNAL     |    |
|   | NONE, SKIP TO Q9\]** | * | uncles were diagnosed with     |    |
|   |                      | Q | **[prostate]{.underline}**     |    |
|   | \# of Blood-Related  | 7 | cancer?                        |    |
|   | Brothers             | a |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   | DK 8                 |   | \_\_ \_\_ \# of Paternal       |    |
|   |                      |   | Uncles                         |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+
|   |                      | * | How many of these PATERNAL     |    |
|   |                      | * | uncles were diagnosed with     |    |
|   |                      | Q | **[testicular]{.underline}**   |    |
|   |                      | 7 | cancer?                        |    |
|   |                      | b |                                |    |
|   |                      | . |                                |    |
|   |                      | * |                                |    |
|   |                      | * |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   |                                |    |
+---+----------------------+---+--------------------------------+----+
|   |                      |   | \_\_ \_\_ \# of Paternal       |    |
|   |                      |   | Uncles                         |    |
|   |                      |   |                                |    |
|   |                      |   | DK 8                           |    |
+---+----------------------+---+--------------------------------+----+

+----------------------------------+----------------------------------+---+
| The next questions are about     | > **BOX C**                      |   |
| [your]{.underline} biological    |                                  |   |
| children. These questions        | **No live-born children \[IF     |   |
| pertain only to those children   | LINE NEXT TO \"NO LIVE- BORN     |   |
| who were born alive.             | CHILDREN\" IS CHECKED, CIRCLE    |   |
|                                  | \'1\' FOR YES; IF LINE IS BLANK, |   |
| \_\_\_\_ **NO LIVE-BORN          | CIRCLE \'2\' FOR NO\]**          |   |
| CHILDREN,**                      |                                  |   |
|                                  | > **Yes 1 \[SKIP TO Q9\]**       |   |
| **SKIP TO Q9**                   | >                                |   |
|                                  | > **No 2 \[CONTINUE WITH Q8\]**  |   |
+----------------------------------+----------------------------------+---+

**Q8.** For each [live-born]{.underline} child, please tell me the sex,
year of birth, year of death *(if deceased)* and whether or not the
child was ever diagnosed with cancer.

For each [live-born]{.underline} child diagnosed with cancer, please
list all primary sites *(excluding metastases and non-melanoma skin
cancer)* and provide the age at diagnosis for each cancer listed.

+---+------+--------+--------+-------+--------------+------+--------+
| * | **b. | **c.   | **d.   | **f.  | **g. List    | **h. | **i.   |
| * | Sex  | Year   | Al     | Diag  | Primary site | Age  | ICD9** |
| a | of   | of     | ive?** | nosed | (exclude     | at   |        |
| . | chi  | B      |        | with  | metastases   | Dia  | **\[TO |
| \ | ld** | irth** |        | canc  | and\         | gnos | BE     |
| # |      |        |        | er?** | non-melanoma | is** | COD    |
| * |      |        |        |       | skin         |      | ED\]** |
| * |      |        |        |       | cancer)**    |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 1 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2      | DK 8  |              |      |        |
|   | 2    |        |        |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 2 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2      | DK 8  |              |      |        |
|   | 2    |        |        |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 3 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2      | DK 8  |              |      |        |
|   | 2    |        |        |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 4 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 5 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+

+---+------+--------+--------+-------+--------------+------+--------+
| * | **b. | **c.   | **d.   | **f.  | **g. List    | **h. | **i.   |
| * | Sex  | Year   | Al     | Diag  | Primary site | Age  | ICD9** |
| a | of   | of     | ive?** | nosed | (exclude     | at   |        |
| . | chi  | B      |        | with  | metastases   | Dia  | **\[TO |
| \ | ld** | irth** |        | canc  | and\         | gnos | BE     |
| # |      |        |        | er?** | non-melanoma | is** | COD    |
| * |      |        |        |       | skin         |      | ED\]** |
| * |      |        |        |       | cancer)**    |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 6 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 7 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 8 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 9 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
| 1 | Male | \_\_   | Alive  | Yes 1 | \_\_\_\_\_\_ | \_\_ | \_\_   |
| 0 | 1    | \_\_   | 1\     |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      | \_\_   | De     | No 2  | \_\_\_\_\_\_ |      | \_\_   |
|   | Fe   | \_\_   | ceased |       |              | DK 8 | \_\_   |
|   | male |        | 2\     | DK 8  |              |      |        |
|   | 2    |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+
|   |      |        | **e.   |       | **\_         | \_\_ | \_\_   |
|   |      |        | Year   |       | \_\_\_\_\_\_ | \_\_ | \_\_   |
|   |      |        | of\    |       | \_\_\_\_\_\_ |      | \_\_   |
|   |      |        | D      |       | \_\_\_\_\_** | DK 8 | \_\_   |
|   |      |        | eath** |       |              |      |        |
|   |      |        |        |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_   |       |              |      |        |
|   |      |        | \_\_\  |       |              |      |        |
|   |      |        | DK 8   |       |              |      |        |
+---+------+--------+--------+-------+--------------+------+--------+

Due to the fact that cancer rates are somewhat higher for certain
religious groups, we would like to ask you about your religious
background.

+----+-----------------------------------------------------------+-----+
| ** | Into what religion(s) were [you]{.underline} born . . . ? |     |
| Q9 | ***(Circle all that apply)***                             |     |
| a. |                                                           |     |
| ** |                                                           |     |
+----+-----------------------------------------------------------+-----+
|    |                                                           |     |
+----+-----------------------------------------------------------+-----+
|    | Jewish 1                                                  |     |
|    |                                                           |     |
|    | Catholic 2                                                |     |
|    |                                                           |     |
|    | Protestant 3                                              |     |
|    |                                                           |     |
|    | Other: 4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   |     |
|    | *(please specify)*                                        |     |
|    |                                                           |     |
|    | NONE 5                                                    |     |
|    |                                                           |     |
|    | DON\'T KNOW 8                                             |     |
+----+-----------------------------------------------------------+-----+

+----+-----------------------------------------------------------+-----+
| ** | In what religion were [you]{.underline} raised . . . ?    |     |
| Q9 |                                                           |     |
| b. |                                                           |     |
| ** |                                                           |     |
+----+-----------------------------------------------------------+-----+
|    |                                                           |     |
+----+-----------------------------------------------------------+-----+
|    | Jewish 1                                                  |     |
|    |                                                           |     |
|    | Catholic 2                                                |     |
|    |                                                           |     |
|    | Protestant 3                                              |     |
|    |                                                           |     |
|    | Other: 4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   |     |
|    | *(please specify)*                                        |     |
|    |                                                           |     |
|    | NONE 5                                                    |     |
|    |                                                           |     |
|    | DON\'T KNOW 8                                             |     |
+----+-----------------------------------------------------------+-----+

The next questions are about your medical history. When answering these
questions, please think about the time period up to one year before you
were diagnosed with breast cancer. According to our records you were
first diagnosed with breast cancer in \_\_\_\_\_, which means you would
have been about \_\_\_\_ years old.

+---+----------------------+---+----------------------------------+---+
| * | [Up until one        |   |                                  |   |
| * | year]{.underline}    |   |                                  |   |
| Q | before you were      |   |                                  |   |
| 1 | diagnosed with       |   |                                  |   |
| 0 | BREAST cancer, what  |   |                                  |   |
| . | was\                 |   |                                  |   |
| * | your usual adult     |   |                                  |   |
| * | weight without       |   |                                  |   |
|   | clothes?             |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | \_\_ \_\_ \_\_       |   |                                  |   |
|   | Pounds               |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | DK 8                 |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
| * | How old were you     |   |                                  |   |
| * | when you first       |   |                                  |   |
| Q | started having       |   |                                  |   |
| 1 | menstrual periods?   |   |                                  |   |
| 1 |                      |   |                                  |   |
| . |                      |   |                                  |   |
| * |                      |   |                                  |   |
| * |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | \_\_ \_\_ Age        |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | DK 8                 |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
| * | [Up until one        |   |                                  |   |
| * | year]{.underline}    |   |                                  |   |
| Q | before you were      |   |                                  |   |
| 1 | diagnosed with       |   |                                  |   |
| 2 | BREAST cancer, did   |   |                                  |   |
| . | you ever\            |   |                                  |   |
| * | take birth control   |   |                                  |   |
| * | pills or oral        |   |                                  |   |
|   | contraceptives on a  |   |                                  |   |
|   | regular basis?       |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | Yes 1                | * | What was the total number of     |   |
|   |                      | * | years you took oral              |   |
|   | No 2 **\[SKIP TO     | Q | contraceptives or birth control  |   |
|   | Q14\]** 1            | 1 | pills up until one year before   |   |
|   |                      | 3 | you were diagnosed with breast   |   |
|   | DK 8 **\[SKIP TO     | . | cancer?                          |   |
|   | Q14\]**              | * |                                  |   |
|   |                      | * |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   | \_\_ \_\_ Years                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   | DK 8                             |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
| * | [Up until one        |   |                                  |   |
| * | year]{.underline}    |   |                                  |   |
| Q | before you were      |   |                                  |   |
| 1 | diagnosed with       |   |                                  |   |
| 4 | BREAST cancer, did   |   |                                  |   |
| . | you ever take oral   |   |                                  |   |
| * | or other estrogens   |   |                                  |   |
| * | for any reason(s)    |   |                                  |   |
|   | other than as        |   |                                  |   |
|   | contraceptives?      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | Yes 1                | * | [Up until one year]{.underline}  |   |
|   |                      | * | before you were diagnosed with   |   |
|   | No 2 **\[SKIP TO     | Q | BREAST cancer, what was the      |   |
|   | Q16\]** 1            | 1 | total number of years you took   |   |
|   |                      | 5 | oral or other estrogens for      |   |
|   | DK 8 **\[SKIP TO     | . | that/those reason(s)?            |   |
|   | Q16\]**              | * |                                  |   |
|   |                      | * |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   | \_\_ \_\_ Years                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   | DK 8                             |   |
+---+----------------------+---+----------------------------------+---+

+---+----------------------+---+----------------------------------+---+
| * | [Up until one        |   |                                  |   |
| * | year]{.underline}    |   |                                  |   |
| Q | before you were      |   |                                  |   |
| 1 | diagnosed with       |   |                                  |   |
| 6 | BREAST cancer, did   |   |                                  |   |
| . | you ever try to      |   |                                  |   |
| * | become pregnant for  |   |                                  |   |
| * | more than two years  |   |                                  |   |
|   | without success?     |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   | Yes 1                | * | What was the cause? Was it . .   |   |
|   |                      | * | .\                               |   |
|   | No 2 **\[SKIP TO     | Q | **\[READ LIST AND MARK ALL THAT  |   |
|   | Q18\]** 1            | 1 | APPLY\]**                        |   |
|   |                      | 7 |                                  |   |
|   | DK 8 **\[SKIP TO     | . |                                  |   |
|   | Q18\]**              | * |                                  |   |
|   |                      | * |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   | An ovulatory/hormonal problem 1  |   |
|   |                      |   |                                  |   |
|   |                      |   | Tubal obstruction or scarring 1  |   |
|   |                      |   |                                  |   |
|   |                      |   | Male infertility 1               |   |
|   |                      |   |                                  |   |
|   |                      |   | Endometriosis 1                  |   |
|   |                      |   |                                  |   |
|   |                      |   | Any other reason 1               |   |
|   |                      |   |                                  |   |
|   |                      |   | \_\_\_\_\_                       |   |
|   |                      |   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |
|   |                      |   | *(please specify)*               |   |
|   |                      |   |                                  |   |
|   |                      |   | Cause not investigated 1         |   |
|   |                      |   |                                  |   |
|   |                      |   | Cause not found 1                |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+
|   |                      |   |                                  |   |
+---+----------------------+---+----------------------------------+---+

+---+------------+---+----+---+----------------------------------+---+
| * | [Up until  |   |    |   |                                  |   |
| * | one        |   |    |   |                                  |   |
| Q | year]{.    |   |    |   |                                  |   |
| 1 | underline} |   |    |   |                                  |   |
| 8 | before you |   |    |   |                                  |   |
| . | were       |   |    |   |                                  |   |
| * | diagnosed  |   |    |   |                                  |   |
| * | with       |   |    |   |                                  |   |
|   | BREAST     |   |    |   |                                  |   |
|   | cancer,    |   |    |   |                                  |   |
|   | how many   |   |    |   |                                  |   |
|   | times were |   |    |   |                                  |   |
|   | you        |   |    |   |                                  |   |
|   | pregnant?  |   |    |   |                                  |   |
|   | **\[IF     |   |    |   |                                  |   |
|   | NEVER      |   |    |   |                                  |   |
|   | PREGNANT,  |   |    |   |                                  |   |
|   | ENTER      |   |    |   |                                  |   |
|   | \'00\' AND |   |    |   |                                  |   |
|   | SKIP TO**  |   |    |   |                                  |   |
|   | **Q20\]**  |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   | \_\_ \_\_  |   |    | * | How many of these pregnancies    |   |
|   | \# of      |   |    | * | resulted in a miscarriage?       |   |
|   | p          |   |    | Q | **\[IF NONE, ENTER \'00\' \]**   |   |
|   | regnancies |   |    | 1 |                                  |   |
|   |            |   |    | 9 |                                  |   |
|   |            |   |    | . |                                  |   |
|   |            |   |    | * |                                  |   |
|   |            |   |    | * |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   | \_\_ \_\_ \# of miscarriages     |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
| * | [Up until  |   |    |   |                                  |   |
| * | one        |   |    |   |                                  |   |
| Q | year]{.    |   |    |   |                                  |   |
| 2 | underline} |   |    |   |                                  |   |
| 0 | before you |   |    |   |                                  |   |
| . | were       |   |    |   |                                  |   |
| * | diagnosed  |   |    |   |                                  |   |
| * | with       |   |    |   |                                  |   |
|   | BREAST     |   |    |   |                                  |   |
|   | cancer,    |   |    |   |                                  |   |
|   | did you    |   |    |   |                                  |   |
|   | ever have  |   |    |   |                                  |   |
|   | a breast   |   |    |   |                                  |   |
|   | biopsy or  |   |    |   |                                  |   |
|   | aspiration |   |    |   |                                  |   |
|   | (needle    |   |    |   |                                  |   |
|   | inserted   |   |    |   |                                  |   |
|   | to remove  |   |    |   |                                  |   |
|   | fluid)?    |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   | No 1       |   |    |   |                                  |   |
|   | **\[SKIP   |   |    |   |                                  |   |
|   | TO END OF  |   |    |   |                                  |   |
|   | INT        |   |    |   |                                  |   |
|   | ERVIEW\]** |   |    |   |                                  |   |
|   |            |   |    |   |                                  |   |
|   | Yes,       |   |    |   |                                  |   |
|   | BIOPSY     |   |    |   |                                  |   |
|   | ONLY 2     |   |    |   |                                  |   |
|   |            |   |    |   |                                  |   |
|   | Yes,       |   |    |   |                                  |   |
|   | BIOPSY AND |   |    |   |                                  |   |
|   | ASPIRATION |   |    |   |                                  |   |
|   | 3          |   |    |   |                                  |   |
|   |            |   |    |   |                                  |   |
|   | Yes,       |   |    |   |                                  |   |
|   | ASPIRATION |   |    |   |                                  |   |
|   | ONLY 4     |   |    |   |                                  |   |
|   |            |   |    |   |                                  |   |
|   | DK 8       |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            | * | H  |   |                                  |   |
|   |            | * | ow |   |                                  |   |
|   |            | Q | o  |   |                                  |   |
|   |            | 2 | ld |   |                                  |   |
|   |            | 1 | we |   |                                  |   |
|   |            | . | re |   |                                  |   |
|   |            | * | y  |   |                                  |   |
|   |            | * | ou |   |                                  |   |
|   |            |   | wh |   |                                  |   |
|   |            |   | en |   |                                  |   |
|   |            |   | y  |   |                                  |   |
|   |            |   | ou |   |                                  |   |
|   |            |   | h  |   |                                  |   |
|   |            |   | ad |   |                                  |   |
|   |            |   | yo |   |                                  |   |
|   |            |   | ur |   |                                  |   |
|   |            |   | f  |   |                                  |   |
|   |            |   | ir |   |                                  |   |
|   |            |   | st |   |                                  |   |
|   |            |   | br |   |                                  |   |
|   |            |   | ea |   |                                  |   |
|   |            |   | st |   |                                  |   |
|   |            |   | bi |   |                                  |   |
|   |            |   | op |   |                                  |   |
|   |            |   | sy |   |                                  |   |
|   |            |   | or |   |                                  |   |
|   |            |   | a  |   |                                  |   |
|   |            |   | sp |   |                                  |   |
|   |            |   | ir |   |                                  |   |
|   |            |   | at |   |                                  |   |
|   |            |   | io |   |                                  |   |
|   |            |   | n? |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   | \_ |   |                                  |   |
|   |            |   | \_ |   |                                  |   |
|   |            |   | \_ |   |                                  |   |
|   |            |   | \_ |   |                                  |   |
|   |            |   | A  |   |                                  |   |
|   |            |   | ge |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   | DK |   |                                  |   |
|   |            |   | 8  |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            | * | [  |   |                                  |   |
|   |            | * | Up |   |                                  |   |
|   |            | Q | u  |   |                                  |   |
|   |            | 2 | nt |   |                                  |   |
|   |            | 2 | il |   |                                  |   |
|   |            | . | o  |   |                                  |   |
|   |            | * | ne |   |                                  |   |
|   |            | * | y  |   |                                  |   |
|   |            |   | ea |   |                                  |   |
|   |            |   | r] |   |                                  |   |
|   |            |   | {. |   |                                  |   |
|   |            |   | un |   |                                  |   |
|   |            |   | de |   |                                  |   |
|   |            |   | rl |   |                                  |   |
|   |            |   | in |   |                                  |   |
|   |            |   | e} |   |                                  |   |
|   |            |   | be |   |                                  |   |
|   |            |   | fo |   |                                  |   |
|   |            |   | re |   |                                  |   |
|   |            |   | y  |   |                                  |   |
|   |            |   | ou |   |                                  |   |
|   |            |   | we |   |                                  |   |
|   |            |   | re |   |                                  |   |
|   |            |   | d  |   |                                  |   |
|   |            |   | ia |   |                                  |   |
|   |            |   | gn |   |                                  |   |
|   |            |   | os |   |                                  |   |
|   |            |   | ed |   |                                  |   |
|   |            |   | wi |   |                                  |   |
|   |            |   | th |   |                                  |   |
|   |            |   | BR |   |                                  |   |
|   |            |   | EA |   |                                  |   |
|   |            |   | ST |   |                                  |   |
|   |            |   | c  |   |                                  |   |
|   |            |   | an |   |                                  |   |
|   |            |   | ce |   |                                  |   |
|   |            |   | r, |   |                                  |   |
|   |            |   | h  |   |                                  |   |
|   |            |   | ow |   |                                  |   |
|   |            |   | ma |   |                                  |   |
|   |            |   | ny |   |                                  |   |
|   |            |   | br |   |                                  |   |
|   |            |   | ea |   |                                  |   |
|   |            |   | st |   |                                  |   |
|   |            |   | bi |   |                                  |   |
|   |            |   | op |   |                                  |   |
|   |            |   | si |   |                                  |   |
|   |            |   | es |   |                                  |   |
|   |            |   | an |   |                                  |   |
|   |            |   | d/ |   |                                  |   |
|   |            |   | or |   |                                  |   |
|   |            |   | a  |   |                                  |   |
|   |            |   | sp |   |                                  |   |
|   |            |   | ir |   |                                  |   |
|   |            |   | at |   |                                  |   |
|   |            |   | io |   |                                  |   |
|   |            |   | ns |   |                                  |   |
|   |            |   | d  |   |                                  |   |
|   |            |   | id |   |                                  |   |
|   |            |   | y  |   |                                  |   |
|   |            |   | ou |   |                                  |   |
|   |            |   | ha |   |                                  |   |
|   |            |   | ve |   |                                  |   |
|   |            |   | th |   |                                  |   |
|   |            |   | at |   |                                  |   |
|   |            |   | D  |   |                                  |   |
|   |            |   | ID |   |                                  |   |
|   |            |   | N  |   |                                  |   |
|   |            |   | OT |   |                                  |   |
|   |            |   | re |   |                                  |   |
|   |            |   | su |   |                                  |   |
|   |            |   | lt |   |                                  |   |
|   |            |   | in |   |                                  |   |
|   |            |   | a  |   |                                  |   |
|   |            |   | d  |   |                                  |   |
|   |            |   | ia |   |                                  |   |
|   |            |   | gn |   |                                  |   |
|   |            |   | os |   |                                  |   |
|   |            |   | is |   |                                  |   |
|   |            |   | of |   |                                  |   |
|   |            |   | br |   |                                  |   |
|   |            |   | ea |   |                                  |   |
|   |            |   | st |   |                                  |   |
|   |            |   | c  |   |                                  |   |
|   |            |   | an |   |                                  |   |
|   |            |   | ce |   |                                  |   |
|   |            |   | r? |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   |    |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   | \_ |   |                                  |   |
|   |            |   | \_ |   |                                  |   |
|   |            |   | \_ |   |                                  |   |
|   |            |   | \_ |   |                                  |   |
|   |            |   | \# |   |                                  |   |
|   |            |   | of |   |                                  |   |
|   |            |   | o  |   |                                  |   |
|   |            |   | th |   |                                  |   |
|   |            |   | er |   |                                  |   |
|   |            |   | bi |   |                                  |   |
|   |            |   | op |   |                                  |   |
|   |            |   | si |   |                                  |   |
|   |            |   | es |   |                                  |   |
|   |            |   | /a |   |                                  |   |
|   |            |   | sp |   |                                  |   |
|   |            |   | ir |   |                                  |   |
|   |            |   | at |   |                                  |   |
|   |            |   | io |   |                                  |   |
|   |            |   | ns |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+
|   |            |   | DK |   |                                  |   |
|   |            |   | 8  |   |                                  |   |
+---+------------+---+----+---+----------------------------------+---+

+---+------------+---+--------------------------------------------+---+
|   |            | * | [Up until one year]{.underline} before you |   |
|   |            | * | were diagnosed with BREAST cancer, how     |   |
|   |            | Q | many of those biopsies or aspirations led  |   |
|   |            | 2 | to the diagnosis of . . . **\[NAME EACH    |   |
|   |            | 3 | CONDITION\]**                              |   |
|   |            | . |                                            |   |
|   |            | * |                                            |   |
|   |            | * |                                            |   |
+---+------------+---+--------------------------------------------+---+
|   |            |   |                                            |   |
+---+------------+---+--------------------------------------------+---+
|   |            |   | > \# of Biopsies                           |   |
|   |            |   | >                                          |   |
|   |            |   | > or Aspirations                           |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Cyst                             |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Fibrocystic disease              |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Fibroadenoma                     |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Hyperplasia                      |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Atypical hyperplasia             |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Lobular carcinoma in situ        |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Ductal carcinoma in situ         |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ Other *(SPECIFY TYPE)*           |   |
|   |            |   | :\_\_\_\_\_\_\_\_\_                        |   |
|   |            |   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ No abnormality                   |   |
|   |            |   |                                            |   |
|   |            |   | \_\_ \_\_ DON\'T KNOW                      |   |
+---+------------+---+--------------------------------------------+---+
|   |            |   |                                            |   |
+---+------------+---+--------------------------------------------+---+

**END OF INTERVIEW:** Thank you very much for participating in this
study.