Yes No
1.
I am a woman
2.
I am more than 50 years of age.
3.
I have had cancer or a precancerous condition.
4.
I have a family history of breast cancer.
5.
I began my periods before age 12.
6.
I reached menopause after age 55.
7.
I never had a child or had my first child after age 30.
8.
I weigh 40% more than my ideal weight.
9.
I drink alcohol.
10.
More than 30% of my daily calories come from fat.
11.
I am using or have used hormone replacement therapy.
