IBCSG Long Term Follow-Up Recurrence Form (18-LTF-RC) Source Form: NCI FormBuilder:


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  1. 8/26/12
  2. 6/20/17
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June 20, 2017

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IBCSG Long Term Follow-Up Recurrence Form (18-LTF-RC)

Complete this form for patients with a proven recurrence. Use minus one (-1) to indicate that an answer is unknown unobtainable or not done

Header Module
Proven Recurrence/Metastasis Or Contralateral Invasive Breast Cancer
Hormone Receptor Analysis
day month year
Footer Module