General information*
- linkId: General-Information-Clinical
What is the patient's medical record number? *
- linkId: NA-Clinical
What is the patient's last name? *
- linkId: LastName-Clinical
Demographic factors*
- linkId: Demographics
Indicate the sex of the patient at birth: *
- linkId: Sex
- Answers: AdministrativeGender
In what year was the patient born? *
- linkId: YearOfBirth
- Max Length: 4
Clinical factors*
- linkId: Clinical-Factors
Indicate the patient's body height *
-
Flags:
- linkId: Height
Indicate the patient's weight. *
-
Flags:
- linkId: Weight
Indicate the laterality of breast cancer *
- linkId: LATERAL
- Answers: Laterality of breast cancer ValueSet
Indicate if this is the first breast cancer *
- linkId: FIRSTBC
- Answers: Yes, No and Unknown Valueset
Indicate if this is a new cancer on contralateral or ipsilateral breast *
- linkId: NewBC
- Enable When: todo
- Answers: Laterality of new cancer ValueSet
Tumor factors*
- linkId: Tumor-Factors
Is the date of histological diagnosis known? *
- linkId: HistologicalDateKnown
Indicate the initial date of histological diagnosis: *
- linkId: HistologicalDiagnosisDate
- Enable When: todo
Indicate the histologic type of the tumor (select all that apply) *
- linkId: HISTOTYPE
- Answers: Histological type of the tumor ValueSet
Indicate if the patient carries a germline mutation predisposing breast cancer *
- linkId: MUTBC
- Answers: Germline Mutation ValueSet
Indicate the grade of the invasive component of tumor *
- linkId: GRADEINV
- Answers: Grading of tumor ValueSet
Indicate the tumor grade of DCIS component of tumor *
- linkId: GRADEDCIS
- Answers: Grading of tumor ValueSet
Indicate the clinical tumor stage (per AJCC 8th Ed.): *
- linkId: TNMCT_BREAST
- Answers: TNM Primary Tumor ValueSet
Indicate the clinical nodal stage (per AJCC 8th Ed.): *
- linkId: TNMCN_BREAST
- Answers: TNM Regional Nodes ValueSet
Indicate the clinical distant metastasis (per AJCC 8th Ed.): *
- linkId: TNMCM_BREAST
- Answers: TNM Distant Metastases ValueSet
Indicate if the estrogen receptor status is positive: *
- linkId: ERSTATUS
- Answers: Estrogen receptor status ValueSet
Indicate if the progesterone receptor status is positive: *
- linkId: PRSTATUS
- Answers: Progesterone receptor status ValueSet
Indicate if the HER2 receptor status is positive: *
- linkId: HER2STATUS
- Answers: HER2 receptor status ValueSet
Indicate if a molecular profiling tool was used. If so, which one? *
- linkId: MolecularProfiling
- Answers: Molecular profiling
Indicate the mammaprint score on a scale of 0.000 to 1.000 *
- linkId: Mammaprint
- Enable When: todo
Indicate the oncotype score on a scale of 0 to 100 *
- linkId: Oncotype
- Enable When: todo
Indicate the endopredict score on a scale of 1.1 to 6.2 *
- linkId: Endopredict
- Enable When: todo
Treatment variables*
- linkId: Treatment-Variables
Indicate if a multidisciplinary meeting was conducted *
- linkId: MultMeet
- Answers: Yes, No and Unknown Valueset
Which treatments did the multidisciplinary team recommend (select all that apply)? *
- linkId: MultRecTreatments
- Enable When: todo
- Answers: Recommended treatment types ValueSet