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    Breast Cancer Risk Assessment

    Breast cancer is the most commonly diagnosed cancer in women (other than skin cancer). The American Cancer Society reports the breast cancer death rate is declining, probably due to earlier detection and improved treatment. This short assessment will help you determine if you have major risk factors for breast cancer. It is not a complete assessment of all risks. For a complete evaluation of your risks, see your health care provider

    African-American Asian Caucasian Hispanic Other
    lbs.
    Feet Inches
    Yes No
    Yes No
    Yes No
    Mother Daughter Sister Aunt (mother’s or father’s sister) Grandmother No family history of breast cancer.
    Yes No
    Yes No
    Yes No

    This assessment is not intended to replace the evaluation of a health care professional.