This questionnaire aims to standardize the breast health information being collected at mammography clinics across Hawaiʻi and the US Affiliated Pacific Islands (USAPI). Many imaging sites are collecting inadequate information to accurately determine a woman’s risk of developing breast cancer in the future using the current breast cancer risk models. Standardizing the questions across the state and USAPI allows for researchers and doctors to better calculate breast cancer risk as well as develop a risk model more appropriate for the region’s unique population.

Beginning in September 2023, participating mammography clinics on Oahu, Hawaiʻi island, and Guam will be offering the questionnare to women participating in screening.

Breast Health Questionnaire

See below to see the Breast Health Questionnaire that we’ve developed.

This questionnaire is intended to capture risk data needed for risk modeling for women in Hawaiʻi and the USAPI. It builds from existing risk models such as such as the Breast Cancer Risk Assessment Tool (BCRAT), the Tyrer-Cuzick Risk Model, and the Breast Cancer Surveillance Consortium (BCSC) Risk Calculator (V2).

About The Study

Please see the fact sheet below about this HIPIMR study:


Why are these questions being asked?

Risk of breast cancer increases with age. In Hawaiʻi, 72% of breast cancer diagnoses were in women 55 years or older (Cancer at a Glance 2014-2018). The American College of Radiology (ACR) recommends that annual screening begins for most women at age 40.

From Cancer at a Glance 2014-2018, graph shows that the highest number of breast cancer diagnoses between 2014-2018 were in women ages 65-72 in Hawaiʻi.

Breast cancer diagnoses and mortality rates are higher among certain racial and ethnic groups. The Hawaiʻi Tumor Registry found that, in Hawaiʻi, Native Hawaiians and Japanese have the highest incidence of breast cancer (Cancer at a Glance 2014-2018).

According to the American Cancer Society, having a blood relative with breast cancer greatly increases a person’s risk of getting it themselves. Specifically, having at least one first-degree relative (mother, sister, or daughter) with breast cancer almost doubles the risk and having multiple first-degree relatives increases the risk even more.

Depending on the hormones being administered, menopausal hormone therapy may increase or decrease a woman’s risk of developing certain cancers [1, 2]. The effect of the hormone therapy can change after prolonged use (5+ years) and declines soon after discontinuing the treatment [3].

The risk of breast cancer is greater for women who started having periods before the age of 12 compared to women who had their first period at age 15 or later [4].

The later a women begins menopause, the higher her chance of breast cancer [4]. For every 5 years difference in the start of menopause, the risk for breast cancer increases by about 17% [5].

Studies have found that women who give birth to their first child after the age of 30 have a greater risk of breast cancer compared to women who had their first full-term pregnancy at a younger age [4].

Studies find that breast cancer risk can be significantly associated with height and weight. Body mass index (BMI) is calculated using height and weight and is used to define obesity (BMI of 30 or greater). Weight gain, obesity, and higher height and weight are all associated with an increased risk of breast cancer, including for racial/ethnic groups living in Hawaiʻi and California [6].

  1. Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. JAMA 2004; 291(14):1701–1712. [PubMed]
  2. Chlebowski RT, Anderson G, Pettinger M, et al. Estrogen plus progestin and breast cancer detection by means of mammography and breast biopsy. Archives of Internal Medicine 2008; 168(4):370–377. [PubMed]
  3. Chlebowski RT, Kuller LH, Prentice RL, et al. Breast cancer after use of estrogen plus progestin in postmenopausal women. New England Journal of Medicine 2009; 360(6):573–587. [PubMed]
  4. Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer. Epidemiol Rev. 1993;15(1):36-47. [PubMed]
  5. Hsieh CC, Trichopoulos D, Katsouyanni K, Yuasa S. Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study. Int J Cancer. 1990 Nov 15;46(5):796-800. [PubMed]
  6. White KK, Park SY, Kolonel LN, Henderson BE, Wilkens LR. Body size and breast cancer risk: the Multiethnic Cohort. Int J Cancer. 2012 Sep 1;131(5):E705-16. [PubMed]