BREAST HEALTH SURVEY
                              University Medical Center    
                              University at Stony Brook
                                   Part II of II

16. Have any males in your family had breast cancer?  ]Yes   ]No
17. Have you ever had any other cancer?  ]Yes   ]No  
       If yes, what type(s)?  ___________________________________________________________________________________________
18. Has any member of your household (family or non-family) had other cancer? ]Yes   ]No
       If yes, what type(s)?  __________________________________________________________________________________________
19. Have you ever had a mammogram?  ]Yes   ]No
       If yes, what was the date of your last mammogram (month/year)?  __________________                              
20. Have you ever had a breast biopsy?  Yes   No
       If yes, what were the results?  Benign growth   Malignancy   Don’t know
21. How old were you at your first menstruation?  __________                                                      
22. Have you ever been pregnant?  Yes   No
23. How old were you at your first pregnancy?  __________                                                        
24. How many times have you given birth?  __________                                                              
25. Did you breast-feed any of your children?  Yes   No
        If yes, for approximately how many total months?  __________                                                
26. Have you ever used birth control pills?  Yes   No
        If yes, for how many years?  __________                                                                            
27. Have you reached menopause?  Yes   No
28. Reason for menopause?  Natural   Surgical   Other
29. Have you ever used menopausal hormones, such as estrogen replacement therapy?  ]Yes   ]No
        If yes, for how many years?  __________                                                                            
30. How would you characterize your current home environment?  Select one or more of the following categories that best describes
    those surroundings:

        Heavy industrial: you live within a mile of a factory, large plant, refinery, disposal or waste treatment plant, or
        similar facility.

        Light industrial: you live within a mile of a smaller
        plant, or a facility such as a car service center or hospital.

        Commercial: you live within 200 yards of a mall, shopping center,
        or the like.

        You live within a mile of an airport.

        You live within a mile of a golf course.

        You live within a mile of a landfill.

        You live within a mile of a railroad track.

        You live within 15 miles of a nuclear reactor.

        Surburban:  You live in a neighborhood or subdivision comprising
        homes or apartment buildings.

        Rural:  You live on a farm or in a rustic setting that is not
        typically suburban.

        THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE

                Please send your response, via e-mail to:

                        P…@SURG.SOM.SUNYSB.EDU

              If you cannot return via e-mail, please send to:

             Lorraine Pace, Breast Cancer Education Specialist
                              SUNY @ Stony Brook
                                 HSC T19 020
                        Stony Brook, New York 11794-8191

(Karen C Allen) writes:

KA>Does anyone know the name of the ayurveda newsgroup.  I am trying to
get it on our server

Karen, alt.health.ayurveda should do the trick. jim