Breast Cancer Awareness Tool

Early detection saves lives. Let's start with a few details about you.

Personal Information

Full Name *

Symptoms

Do you notice any of the following in either breast?

Select all that apply

A lump or thickeningNipple discharge (fluid leaking)Skin dimpling or puckering (like orange peel texture)Nipple pulling inward (retraction)Redness or warmth on the breast skinBreast pain that does not go awayNone of the above

Prior Screening

Have you had a breast exam or mammogram in the last 2 years?

YesNoNot sure

Menstrual Status

What is your current menstrual status?

Still having regular periodsIrregular periodsPeriods stopped — naturally (menopause)Periods stopped due to surgery/treatmentNever had periods / other

Pregnancy & Breastfeeding

Are you currently pregnant or breastfeeding?

Yes, pregnantYes, breastfeedingNoNot sure