Breast Cancer Risk Assessment and Prevention Program Form

The Breast Cancer Risk Assessment and Prevention Program at Roswell Park was developed to help women who are concerned about their risk of developing breast cancer.

Take this quiz to learn if you’re at increased risk.

YesNo
Does cancer run in your family?
Do you have a family history of ovarian cancer?
Did your mother, father, sister or brother have breast cancer?
Did at least two aunts, uncles, grandparents or first cousins have breast cancer?
Do you or does anyone in your family have a mutation in any of these genes: BRCA1, BRCA2, PTEN, TP53?
Have you had radiation treatment to your chest?
Have you ever had an abnormal breast biopsy?

If you answered “NO” to all - you’re at average risk.
If you answered “YES” to one or more of the above, RPCI’s team of breast cancer experts can help you learn more about your personal breast cancer risk.

Due to HIPAA regulations, Roswell Park will not be able identify itself to someone other than you who may answer the phone or in a voice message, unless you indicate otherwise.

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This question is to prevent automated spam submissions.
1 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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