Your Customized Breast Cancer Treatment Report
 

Printable Questionnaire

Print Questions

Following is a printed version of the questionnaire contained within My Breast Cancer Coach. If you answer these questions using the online questionnaire, you will receive a report outlining treatment options for your specific type of breast cancer. You may wish to talk to your doctor about these questions and then come back to the questionnaire to enter your answers and receive your treatment report.

  1. Do you have a copy of your pathology report?
    • Yes
    • No
  2. What stage is your cancer?
    • Stage 0
    • Stage 1
    • Stage 2
    • Stage 3
    • Stage 4
    • I don't know
  3. Am I a candidate for Oncotype DX, or other diagnostic tests?
  4. What is your hormone receptor status?
    • Hormone receptor positive
    • Hormone receptor negative
    • I don't know/I've never been tested
  5. What is your HER2 status?
    • HER2 positive (HER2+)
    • HER2 negative (HER2-)
    • I don't know/I've never been tested
  6. What is your lymph node status?
    • Lymph node positive
    • Lymph node negative
    • I don't know/I've never been tested
  7. Has your breast cancer metastasized?
    • Yes
    • No
    • I don't know/I've never been tested
 
 
 
 
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