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Breast Cancer Awareness Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What is breast cancer?
Please select the option that best describes breast cancer.
A type of cancer that forms in the cells of the breasts
A genetic disorder
A viral infection
2
Rate your knowledge about breast cancer on a scale from 1 to 10
Please rate your knowledge about breast cancer from 1 to 10, with 1 being very low and 10 being very high.
3
Who should you talk to about breast cancer?
Please provide the name or profession of the person you would talk to about breast cancer.
4
Do you perform regular breast self-examinations?
Please select yes or no.
Yes
No
5
Have you or someone you know been affected by breast cancer?
Please select yes or no.
Yes
No
6
What age should women start getting regular mammograms?
Please select the age at which women should start getting regular mammograms.
30
40
50
7
How often should women get mammograms?
Please select the frequency at which women should get mammograms.
Every year
Every 2 years
Every 5 years
8
What are some common symptoms of breast cancer?
Please list some common symptoms of breast cancer.
9
Are you aware of the risk factors associated with breast cancer?
Please select yes or no.
Yes
No
10
Do you know how to perform a breast self-examination?
Please select yes or no.
Yes
No
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