QUESTIONNAIRES RESEARCH SURVEY

TITLE: LACTATION AND INCIDENCE OF BREAST

CANCER AMONG MALAYSIAN WOMEN
This questionnaire is designed to solicit your
review and analysis of history of lactation and
incidence of breast cancer. Please spare a few
minutes of your valuable time to answer this
simple research survey.
1. Age in years
35 40
41 45
46 50
51 55
56 60
61 65
66 70

2. Ethnicity
Malay
Chinese
Indian

3. Education
No formal
Elementary
Secondary
SPM
Diploma
Degree
Master Degree or above

4. Family history of breast cancer
Yes state who:
..
No















5. Menopausal status
Pre-menopausal
Post-menopausal, natural
(Age: ..)
Post-menopausal, artificial
(Age: ..)

6. Hormonal contraceptives
Yes (Duration : )
No

7. Hormonal replacement therapy
Yes (Duration : )
No

8. Age at menarche (years)
9 10
11 12
13 14
15 16
17

9. Parity
1
2
3
4
5
6 and above



10. Age at first live birth
< 20
20 24
25 29
30

11. Age at first lactation
< 20
20 24
25 29
30
Never lactated

12. Reason for not breastfeeding
Lack of milk
Nipple inverted
Lack of knowledge
Complication after delivery
Other (State the reason:
.)

13. Age when breast cancer being
diagnosed
35 40
41 45
46 50
51 55
56 60
61 65
66 70
71 75

14. Number of children breastfed
1
2
3
4




15. Mean duration of breastfeeding per
child
1 months
2 months
2 6 months
7 12 months
12 18 months
17 24 months
24 months

16. Duration of exclusive breastfeeding
< 2 months
2 6 months
7 12 months
13 18 months
19 24 months

17. Lifetime duration of breastfeeding
(months)
24
25 48
49 72
73 96
> 96

18. Medication to suppress lactation
Pills for 1 -2 days only
Pills for > 2 days
Injection
No

Thanks for participating in this survey.