Page 175 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

BI-27 If female, when was her last mammogram? (A mammogram is an x-ray of each breast to
check for breast cancer.) Check ONE. Will be reported for females age 40 and over.

□ 98. Not applicable – individual is not female or individual is under age 40
□ 1. Within the past year (anytime less than 12 months ago)
□ 2. Within the past 2 years (more than 1 year ago but less than 2 years ago)
□ 3. Within the past 3 years (more than 2 years ago but less than 3 years ago)
□ 4. Within the past 5 years (more than 3 years ago but less than 5 years ago)

□ 5. 5 or more years ago
□ 6. Has never had a mammogram
□ 99. Don't know

BI-28 Has this person received screening for colorectal cancer? Check ALL that apply. Will be
reported for adults age 50 to 74.

□ 98. Not applicable – individual is under age 50 or 75 and over
□ 1. Colonoscopy within the past 10 years
□ 2. Flexible sigmoidoscopy within the past 5 years
□ 3. Testing for colorectal cancer with stool sample, using a Fecal Occult Blood Test (FOBT) or
Fecal Immunochemical Test (FIT) in the past year.

□ 4. Has never had screening for colorectal cancer or screening was more than 10 years ago
□ 99. Don't know

BI-29 If this person has a seizure disorder, how often do seizures occur? Check ONE.

□ 98. Not applicable – individual does not have a seizure disorder
□ 1. Seizures are controlled
□ 2. Less frequently than once a month
□ 3. At least once a month, though not once a week
□ 4. At least once a week
□ 99. Don’t know

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