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BREAST TRAUMA SURVEY by WILLIAM D. PAUL PhD. FOUNDER OF THE (IWBA) INTERNATIONAL WOMEN'S BOXING ASSOCIATION.
SURVEY INTRODUCTION: Thank you for taking the time to complete this Breast Trauma Survey which will take between 5 and 10 minutes depending on the completeness of your responses. Your valuable response will assist in determining the association between breast trauma and breast cancer. In the United States, breast cancer is the most common form of cancer involving females. It is the second most common cause of cancer related death in women, and the main cause of death in women ages 40 to 59. Approximately one-half of breast cancer cases can be explained by known risk factors, such as age at menarche, first live birth, menopause, and proliferative breast disease. An additional 10 percent are associated with a positive family history. The lifetime probability of developing breast cancer is one in six overall (one in eight for invasive disease). Breast cancer kills. In order to show yet another risk factor for developing breast cancer, this survey is underway to gain beneficial information which you can assist with.
Again, thank you for your valuable time.
NOTICE OF PRIVACY AND DISCLAIMER: The below Breast Trauma Survey is not intended for personal medical treatment. The information obtained will be analyzed to determine if there is an association between breast trauma and breast cancer. This survey is to be taken anonymously. No identifiable information regarding any one individual will be available, accessible or released to any third party.
For additional information, please send an e-mail
or call (334) 552-1119
1. What is your age?
2. What is your Gender?
3. What is your race?
African American or Black
American Indian or Alaska Native
4. What is your Ethnicity?
Not Hispanic or Latino
Hispanic or Latino
Ethnicity not known
5. Do you or did you participate in sports?
No (Go to Question 7)
6. What sport(s) did you participate in?
Track and Field
7. Did you ever suffer trauma to your breast(s)?Trauma means any physical blow to the upper chest area.
No (Go to Number 13)
8. Which breast(s) suffered trauma?
9. Estimate the number of times there was trauma to the RIGHT breast.
10. Estimate the number of times there was trauma to the LEFT breast.
11. In what manner did you suffer trauma to the breast(s)? Fall
Trauma relating to Military involvement
Motor Vehicle Accident
Direct blow to the breast
12. Please explain how the trauma to the breast(s) occurred.
13. Do you perform monthly self-breast examinations?
I do, but not monthly.
14. If you have performed a self-breast examination, have you discovered any areas on your examination of concern?
15. If you have discovered an area or area(s) of concern on your self-breast examination, which breast was involved?
16. Have you had a mammogram for the detection of or screening for breast cancer?
No (Go to Number 19)
17. If you have had a mammogram, how old were you when you had your first mammogram?
<18 years old
18 - 25 years old
26 - 30 years old
31 - 35 years old
36 - 40 years old
41 - 45 years old
46 - 50 years old
51 - 55 years old
56 - 60 years old
61 - 65 years old
65 < years old
18. Please estimate the number of mammograms have you had in the past?
19. Have you had a mammogram that you considered to be particularly traumatic and/ or painful?
20. Have you ever had an abnormal mammogram?This would be any mammogram where you were asked to get additional follow-up due to some finding on the mammogram.
21. If you have had an abnormal mammogram, please briefly explain the finding.
22. Have you had a Breast Ultrasound done?
No (Go to Number 25)
23. If an Ultrasound was done, what were the results?
24. If an ultrasound was done and was abnormal, please briefly explain the results.
25. Have you been evaluated for the breast cancer gene BRCA1 or BRCA2?
No (Go to Number 28)
26. If you have been evaluated for the breast cancer genes BRCA1 or BRCA2, what were the results?
Abnormal - The gene is present.
Normal - The gene was not present.
27. If you have been found in the past to have breast cancer, was the cancer found to Estrogen / Progesterone (ER/PR) receptor positive?
I do not know if this was checked.
It was checked but I do not know the results.
28. Do you have a family history of breast cancer?
29. If a biopsy or resection of a breast mass was done, what was the outcome (if known)?
30. Have you taken Estrogen replacement therapy in the past?
31. Have you ever had exposure to ionizing radiation?
32. Were you questioned by your doctor(s) regarding breast trauma at any time during the evaluation or diagnosis of possible breast cancer or treatment of your breast cancer?
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