Surgery Form (Form 24-C) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder:


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January 9, 2015

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Breast Cancer NCT00659373 Treatment - Surgery Form (Form 24-C) - 2074148v3.0

SURGERY FORM (Form 24-C) Instructions: This form is to be completed and submitted one month after final surgery. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable, or not done.

Ccrr Module For Surgery Form (form 24-c)
This form is being completed for
Type (LTM = less than mastectomy)
Was sentinel node biopsy performed?
Was axillary dissection performed?

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