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What is your age?
Less than 25
Greater than 25
More than 55
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At what age did your menstrual periods start?
7 to 11
12 to 13
Greater than 14
Unknown
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What was your age when you had your first baby?
Unknown
No Birth
Less than 20
20 to 24
25 to 29
Greater than 35
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Please indicate your ethnicity/ racial origin?
White
Black
Asian/Pacific
Hispanic
American Indian
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How many of your blood relatives have had breast cancer ?
Unknown
None
One
More than one
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Do you drink alcohol?
Yes
No
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Do you takes Birth control pills?
Yes
No
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Have u ever had radiation therapy?
Yes
No
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Are you healthy or what is your BMI range?
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No
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70%
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