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Rapid Genetic Testing for Newly Diagnosed Breast Cancer Patients Phase II Study Screening Form

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Thank you for your interest in the Rapid Genetic Testing for Newly Diagnosed Breast Cancer Patients Phase II Study or Rapid Genetic Testing 2 Study for short.

This research study provides rapid genetic testing for 9 genes associated with increased risk of breast cancer and other cancers to women newly diagnosed with breast cancer. The 9 genes tested through the study are BRCA1, BRCA2, CDH1, PALB2, PTEN, STK11, TP53, ATM, or CHEK2.

Participation involves providing a saliva sample for genetic testing by Invitae (a genetic testing company located in the United States). Results will be made available to the genetic counsellor at Women's College Hospital 5-12 days after receipt of your saliva sample at the Invitae laboratory. When the results are available, the genetic counsellor will call you to give you your results. You will also be asked to complete 4 questionnaires over two years (one questionnaire at the time of enrollment and three follow-up questionnaires).

If you are interested in participating in the study, please complete the screening questions below to determine if you are eligible to participate.

The option "" can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?

Are you a woman who was recently diagnosed with your first invasive breast cancer (Stage I or higher)?

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Have you had surgery for the treatment of your recently diagnosed breast cancer? (This does not include the biopsy you may have had to confirm the diagnosis of breast cancer).

Yes No

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Are you between the ages of 18 and 70 (inclusive)?

Yes No

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Have you received genetic testing for any of the following genes: BRCA1, BRCA2, CDH1, PALB2, PTEN, STK11, TP53, ATM, and CHEK2?

Yes No

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Please indicate if any of the following statements are true for you (select all that apply):

You were diagnosed with breast cancer at age 50 or under

You are of Ashkenazi Jewish ethnicity

You were diagnosed with a triple negative breast cancer

You have a family history of breast cancer and/or ovarian cancer (This means you have a sibling, parent, child, aunt, uncle, or grandparent diagnosed with breast cancer before age 50 or diagnosed with ovarian cancer at any age or diagnosed with male breast cancer at any age)

You were diagnosed with bilateral breast cancer (breast cancer in both breasts)

None of the above

It looks like you are eligible to participate in the Rapid Genetic Testing II Study. If you would like to learn more about the study, please provide your contact information and a copy of your breast cancer pathology report so that the study team may contact you to further explain the study. Please note, you may submit this form without providing your pathology report, but the study team will require a copy of your biopsy results for confirmation prior to participation. Alternatively, you may contact the study team directly by emailing the study team (by clicking here) or calling (416) 351-3770.

Based on your responses, you are not eligible to participate in the Rapid Genetic Testing II Study. If you feel there has been an error, please contact the study team by emailing the study team (by clicking here) or calling (416) 351-3770.

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Phone Number

Comments for the study team

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By submitting this form you give permission to the study team to contact you using the information provided. This information may be stored by the study team whether or not you participate in or are eligible to participate in the Rapid Genetic Testing II Study.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.