Submit every 6 months from date of randomization for the first 5 years; yearly thereafter, and when a protocol event occurs. Fax Form F to 412-622-2111

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Patient Initials
Item
Patient Initials (Last First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
CombinedInstitutionName
Item
Institution/Affiliate
text
ResponsiblePersonLastName
Item
Person Completing Form, Last Name
text
ResponsiblePersonFirstName
Item
Person Completing Form, First Name
text
ResponsiblePersonPhoneNumber
Item
Person Completing Form, Phone
text
Date Form Completed
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Data amended
Item
Are data amended
boolean
C0680532 (UMLS CUI-1)
Item Group
Patient characteristics
C0815172 (UMLS CUI-1)
Item
Tumor Laterality
text
C25284 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C25185 (NCI Thesaurus Property)
C2985714 (UMLS CUI-1)
Code List
Tumor Laterality
CL Item
Left (Left)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
CL Item
Right (Right)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
Item
Histologic Type (from diagnostic core needle biopsy - Mark predominant tumor type if more than one applies.)
text
C3262 (NCI Thesaurus ObjectClass)
C12971 (NCI Thesaurus ObjectClass-2)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
C25372 (NCI Thesaurus ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
C0449574 (UMLS CUI-1)
Code List
Histologic Type (from diagnostic core needle biopsy - Mark predominant tumor type if more than one applies.)
CL Item
Ductal (Ductal)
C25732 (NCI Thesaurus)
C1512083 (UMLS CUI-1)
CL Item
Other Specify (Other)
C1299220 (UMLS CUI-1)
CL Item
Lobular (90% or more) (Lobular)
C0205417 (UMLS CUI-1)
Histologic Type, other
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
Item
Receptor Status, ER (from diagnostic core needle biopsy)
text
C3262 (NCI Thesaurus ValueDomain)
C17069 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain-2)
C25554 (NCI Thesaurus Property)
C1516974 (UMLS CUI-1)
Code List
Receptor Status, ER (from diagnostic core needle biopsy)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Receptor Status, PgR
text
C25284 (NCI Thesaurus ValueDomain)
C17075 (NCI Thesaurus ObjectClass)
C0678257 (NCI Metathesaurus Property)
C0034833 (UMLS CUI-1)
Code List
Receptor Status, PgR
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Histologic Grade (from diagnostic core needle biopsy Use combined histologic grade SBR/Elston classification.)
text
C3262 (NCI Thesaurus ObjectClass)
C12971 (NCI Thesaurus ObjectClass-2)
C25526 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25526 (NCI Thesaurus ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS CUI-1)
Code List
Histologic Grade (from diagnostic core needle biopsy Use combined histologic grade SBR/Elston classification.)
CL Item
Well Differentiated (Grade I (low))
C0205615 (UMLS CUI-1)
CL Item
Moderately Differentiated (Grade II (intermediate))
C0205616 (UMLS CUI-1)
CL Item
Poorly Differentiated (Grade III (high))
C0205617 (UMLS CUI-1)
Item
HER-2/neu status (if yes from core needle biopsy - )
text
C25284 (NCI Thesaurus ValueDomain)
C17756 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C0069515 (UMLS CUI-1)
Code List
HER-2/neu status (if yes from core needle biopsy - )
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS CUI-1)
CL Item
unknown (Unknown)
C0439673 (UMLS CUI-1)
Family history cardiac death
Item
Does the patient have any first degree relatives who died from heart disease before the age of 55 ("First degree relatives" include parents, children, brothers and sisters.)
boolean
C38147 (NCI Thesaurus ValueDomain)
C28554 (NCI Thesaurus Property)
C2931 (NCI Thesaurus Property-2)
C21481 (NCI Thesaurus ObjectClass)
C2825161 (UMLS CUI-1)
Prior medication
Item
Did the patient take medications for any of the following medical conditions in the 12 months prior to study entry
boolean
C459 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus Property)
C25639 (NCI Thesaurus Property-2)
C25261 (NCI Thesaurus Property-3)
C25457 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C0013227 (UMLS CUI-1)
Item
Medical Condition
integer
C25284 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25457 (NCI Thesaurus Property-2)
C0012634 (UMLS CUI-1)
Code List
Medical Condition
CL Item
Hypertension (1)
C0020538 (UMLS CUI-1)
CL Item
Angina pectoris (2)
C0002962 (UMLS CUI-1)
CL Item
Myocardial Infarction (3)
C0027051 (UMLS CUI-1)
CL Item
Congestive Heart Failure (4)
C0018802 (UMLS CUI-1)
CL Item
Atrial Fibrillation (5)
C0004238 (UMLS CUI-1)
CL Item
Ventricular Arrhythmia (6)
C0085612 (UMLS CUI-1)
CL Item
Diabetes (7)
C0011849 (UMLS CUI-1)
CL Item
Elevated Fasting Lipid Profile (8)
C0020473 (UMLS CUI-1)

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