1. Do you or an immediate family member (mother, sister, daughter) have a history of breast cancer?
∠Yes
∠No
2. Have you noticed a change in the size or shape of your breast(s)?
∠Yes
∠No
3. Havve you experienced bleeding or discharge from your nipples?
∠Yes
∠No
4. Do you have thickening or lump(s) in your breast(s) or surrounding tissues?
∠Yes
∠No
5. Have you experienced inversion of the nipples?
∠Yes
∠No
6. Have you experienced a change in the color or feel of the skin of the breast or nipple?
∠Yes
∠No
7. Do you have an ulceration on any of the breast?
∠Yes
∠No
8. Have you experienced pain in the breast(s) or surrounding area?
∠Yes
∠No
9. Did you begin menarche (your menstrual period) before 12 or experience menopause after 55?
∠Yes
∠No
Now that you have completed the survey, if you answered yes to any of the nine questions, then you should make an appointment with us for a thorough examination. If you answered no to all of the nine survey questions, keep this survey handy for review every 6-12 months.
Cancer Risks
Avoiding certain risk factors and behaviors may help decrease your risk for developing cancer. Remember:
• Avoid cigarette and cigar smoke.
• Avoid overexposure to the sun.
• Eat a balanced diet low in fat and high in fiber.
• Exercise regularly.
• Avoid alcohol.
• Maintain a healthy weight.
• Avoid exposure to toxic chemicals.
Breast Cancer Screening
Cancer screening can result in early detection, diagnosis, and treatment. Early detection and diagnosis of breast cancer can lead to a more favorable prognosis when treatment is received early in the disease course. Ask us to develop a breast cancer screening plan individualized to meet your needs based on your family history and health status.
A mammogram can help detect breast cancer when it's very small, often several years before a woman or her doctor would be able to feel it. The American Cancer Society recommends an annual mammogram beginning at age 40.
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