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Protocol - Pre-existing Conditions Associated with Cancer

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Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Description:

This self-administered protocol asks respondents to indicate the year of diagnosis for clinician-diagnosed illnesses. The respondent is also asked to provide the year of first diagnosis.

Protocol:

1. Have you had any of these clinician-diagnosed illnesses?

Year of Diagnosis

mark here for Yes
Leave blank for NO;

Yes

Myocardial infarction (heart attack)

[_]

__ __ __ __

Angina pectoris

[_]

__ __ __ __

Confirmed angiography? [_] No [_] Yes

Coronary bypass, angioplasty, or stent

[_]

__ __ __ __

Transient ischemic attack (TIA)

[_]

__ __ __ __

Stroke (CVA)

[_]

__ __ __ __

Deep vein thrombosis/Pulmonary embolism

[_]

__ __ __ __

Melanoma

[_]

__ __ __ __

Basal cell skin cancer

[_]

__ __ __ __

Squamous cell skin cancer

[_]

__ __ __ __

Fibrocystic/other benign breast disease

[_]

__ __ __ __

Confirmed by breast biopsy? [_] No [_] Yes

Confirmed by aspiration? [_] No [_] Yes

Breast cancer

[_]

__ __ __ __

Other cancer

[_]

__ __ __ __

Specify site of other cancer: ______________________

Colon or rectal polyp (benign)

[_]

__ __ __ __

Ulcerative colitis/Crohn's

[_]

__ __ __ __

Gastric or duodenal ulcer

[_]

__ __ __ __

Barrett's Esophagus

[_]

__ __ __ __

Gallstones

[_]

__ __ __ __

Did you have symptoms? [_] No [_] Yes

How diagnosed? [_] X-ray or ultrasound [_] Other

Cholecystectomy

[_]

__ __ __ __

Diabetes mellitus

[_]

__ __ __ __

Elevated cholesterol

[_]

__ __ __ __

High blood pressure

[_]

__ __ __ __

Endometriosis−1st diagnosis

[_]

__ __ __ __

Confirmed by laparoscopy? [_] No [_] Yes

Uterine fibroids−1st diagnosis

[_]

__ __ __ __

Confirmed by pelvic exam? [_] No [_] Yes

Confirmed by ultrasound/hysterectomy? [_] No [_] Yes

Premenstrual syndrome (PMS)

[_]

__ __ __ __

Kidney stones

[_]

__ __ __ __

Multiple Sclerosis

[_]

__ __ __ __

Asthma, doctor diagnosed

[_]

__ __ __ __

Emphysema/Chronic Bronchitis, doctor diagnosis

[_]

__ __ __ __

Pneumonia, x-ray confirmed

[_]

__ __ __ __

Graves' Disease/Hyperthyroidism

[_]

__ __ __ __

Hypothyroidism

[_]

__ __ __ __

Thyroid nodule (benign)

[_]

__ __ __ __

Gout

[_]

__ __ __ __

SLE (systemic lupus)

[_]

__ __ __ __

Rheumatoid arthritis, doctor diagnosis

[_]

__ __ __ __

Other arthritis

[_]

__ __ __ __

Depression, clinician diagnosis

[_]

__ __ __ __

Other major illness or surgery

[_]

__ __ __ __

Please specify: Date:

Editor's Note: The Cancer Working Group (WG) slightly modified this question from the original protocol text. The original protocol obtains year of diagnosis by asking respondents to choose between three choices (Before June 1, 2003; June 2003 to May 2005; or after June 1, 2005). The Cancer WG removed the phrase "since June 2003" in order to allow collection of diagnoses that occurred prior to June 2003. The additional response options were deleted, and respondents are now asked to write in the four-digit year of diagnosis.

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

Specific Instructions:

None

Research Domain Information

Release Date:

December 30, 2009

Definition

Measure to assess history of clinician-diagnosed illnesses

Purpose

History of clinician-diagnosed illnesses is important to investigate because some pre-existing conditions are associated with cancer. These pre-existing conditions can cause or be associated with secondary conditions that may themselves cause cancer.

Selection Rationale

The Nurses' Health Study II was established in 1989. This is a validated and reliable protocol.

Language

English

Standards

StandardNameIDSource
Common Data Elements (CDE)Person Cancer Associated Pre-existing Condition Text2961255CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Pre-existing cancer conditions proto62573-1LOINC

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

U.S. Department of Health and Human Services. National Institutes of Health, The Nurses’ Health Study II, 2005 Long form, question 11 (source for question 1).

General References

None

Protocol ID:

70801

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX070801_Myocardial_Infarction_Heart_Attack_HistoryPX070801010100Have you had any of these clinician-diagnosed illnesses? Myocardial infarction (heart attack)?4N/A
PX070801_Myocardial_Infarction_Heart_Attack_YearPX070801010200Year of Diagnosis, Myocardial infarction (heart attack)?4N/A
PX070801_Angina_Pectoris_HistoryPX070801020100Have you had any of these clinician-diagnosed illnesses? Angina pectoris?4N/A
PX070801_Angina_Pectoris_YearPX070801020200Year of Diagnosis, Angina pectoris?4N/A
PX070801_Angina_Pectoris_Confirmed_AngiographyPX070801020300Confirmed angiography?4N/A
PX070801_Coronary_Bypass_HistoryPX070801030100Have you had any of these clinician-diagnosed illnesses? Coronary bypass, angioplasty, or stent?4N/A
PX070801_Coronary_Bypass_YearPX070801030200Year of Diagnosis, Coronary bypass, angioplasty, or stent?4N/A
PX070801_Transient_Ischemic_Attack_TIA_HistoryPX070801040100Have you had any of these clinician-diagnosed illnesses? Transient ischemic attack (TIA)?4N/A
PX070801_Transient_Ischemic_Attack_TIA_YearPX070801040200Year of Diagnosis, Transient ischemic attack (TIA)?4N/A
PX070801_Stroke_CVA_HistoryPX070801050100Have you had any of these clinician-diagnosed illnesses? Stroke (CVA)?4N/A
PX070801_Stroke_CVA_YearPX070801050200Year of Diagnosis, Stroke (CVA)?4N/A
PX070801_DVT_Thrombosis_PE_Embolism_HistoryPX070801060100Have you had any of these clinician-diagnosed illnesses? Deep vein thrombosis/Pulmonary embolism?4N/A
PX070801_DVT_Thrombosis_PE_Embolism_YearPX070801060200Year of Diagnosis, Deep vein thrombosis/Pulmonary embolism?4N/A
PX070801_Melanoma_HistoryPX070801070100Have you had any of these clinician-diagnosed illnesses? Melanoma?4N/A
PX070801_Melanoma_YearPX070801070200Year of Diagnosis, Melanoma?4N/A
PX070801_Basal_Cell_Skin_Cancer_HistoryPX070801080100Have you had any of these clinician-diagnosed illnesses? Basal cell skin cancer?4N/A
PX070801_Basal_Cell_Skin_Cancer_YearPX070801080200Year of Diagnosis, Basal cell skin cancer?4N/A
PX070801_Squamous_Cell_Skin_Cancer_HistoryPX070801090100Have you had any of these clinician-diagnosed illnesses? Squamous cell skin cancer?4N/A
PX070801_Squamous_Cell_Skin_Cancer_YearPX070801090200Year of Diagnosis, Squamous cell skin cancer?4N/A
PX070801_Fibrocystic_Benign_Breast_Disease_HistoryPX070801100100Have you had any of these clinician-diagnosed illnesses? Fibrocystic/other benign breast disease?4N/A
PX070801_Fibrocystic_Benign_Breast_Disease_YearPX070801100200Year of Diagnosis, Fibrocystic/other benign breast disease?4N/A
PX070801_Fibrocystic_Benign_Breast_Confirmed_BiopsyPX070801100300Confirmed by breast biopsy?4N/A
PX070801_Fibrocystic_Benign_Breast_Confirmed_AspirationPX070801100400Confirmed by aspiration?4N/A
PX070801_Breast_Cancer_HistoryPX070801110100Have you had any of these clinician-diagnosed illnesses? Breast cancer?4N/A
PX070801_Breast_Cancer_YearPX070801110200Year of Diagnosis, Breast cancer?4N/A
PX070801_Other_Cancer_HistoryPX070801120100Have you had any of these clinician-diagnosed illnesses? Other cancer?4N/A
PX070801_Other_Cancer_YearPX070801120200Year of Diagnosis, Other cancer?4N/A
PX070801_Other_Cancer_SitePX070801120300Specify site of other cancer.4N/A
PX070801_Colon_Rectal_Polyp_Benign_HistoryPX070801130100Have you had any of these clinician-diagnosed illnesses? Colon or rectal polyp (benign)?4N/A
PX070801_Colon_Rectal_Polyp_Benign_YearPX070801130200Year of Diagnosis, Colon or rectal polyp (benign)?4N/A
PX070801_Ulcerative_Colitis_Crohns_HistoryPX070801140100Have you had any of these clinician-diagnosed illnesses? Ulcerative colitis/Crohn's?4N/A
PX070801_Ulcerative_Colitis_Crohns_YearPX070801140200Year of Diagnosis, Ulcerative colitis/Crohn's?4N/A
PX070801_Gastric_Duodenal_Ulcer_HistoryPX070801150100Have you had any of these clinician-diagnosed illnesses? Gastric or duodenal ulcer?4N/A
PX070801_Gastric_Duodenal_Ulcer_YearPX070801150200Year of Diagnosis, Gastric or duodenal ulcer?4N/A
PX070801_Barretts_Esophagus_HistoryPX070801160100Have you had any of these clinician-diagnosed illnesses? Barrett's Esophagus?4N/A
PX070801_Barretts_Esophagus_YearPX070801160200Year of Diagnosis, Barrett's Esophagus?4N/A
PX070801_Gallstones_HistoryPX070801170100Have you had any of these clinician-diagnosed illnesses? Gallstones?4N/A
PX070801_Gallstones_YearPX070801170200Year of Diagnosis, Gallstones?4N/A
PX070801_Gallstones_SymptomsPX070801170300Did you have symptoms?4N/A
PX070801_Gallstones_DiagnosedPX070801170400How diagnosed?4N/A
PX070801_Cholecystectomy_HistoryPX070801180100Have you had any of these clinician-diagnosed illnesses? Cholecystectomy?4N/A
PX070801_Cholecystectomy_YearPX070801180200Year of Diagnosis, Cholecystectomy?4N/A
PX070801_Diabetes_Mellitus_HistoryPX070801190100Have you had any of these clinician-diagnosed illnesses? Diabetes mellitus?4N/A
PX070801_Diabetes_Mellitus_YearPX070801190200Year of Diagnosis, Diabetes mellitus?4N/A
PX070801_Elevated_Cholesterol_HistoryPX070801200100Have you had any of these clinician-diagnosed illnesses? Elevated cholesterol?4N/A
PX070801_Elevated_Cholesterol_YearPX070801200200Year of Diagnosis, Elevated cholesterol?4N/A
PX070801_High_Blood_Pressure_HBP_HistoryPX070801210100Have you had any of these clinician-diagnosed illnesses? High blood pressure?4N/A
PX070801_High_Blood_Pressure_HBP_YearPX070801210200Year of Diagnosis, High blood pressure?4N/A
PX070801_Endometriosis_HistoryPX070801220100Have you had any of these clinician-diagnosed illnesses? Endometriosis-1st diagnosis?4N/A
PX070801_Endometriosis_YearPX070801220200Year of Diagnosis, Endometriosis-1st diagnosis?4N/A
PX070801_Endometriosis_Confirmed_LaparoscopyPX070801220300Confirmed by laparoscopy?4N/A
PX070801_Uterine_Fibroids_HistoryPX070801230100Have you had any of these clinician-diagnosed illnesses? Uterine fibroids-1st diagnosis?4N/A
PX070801_Uterine_Fibroids_YearPX070801230200Year of Diagnosis, Uterine fibroids-1st diagnosis?4N/A
PX070801_Uterine_Fibroids_Confirmed_Pelvic_ExamPX070801230300Confirmed by pelvic exam?4N/A
PX070801_Uterine_Fibroids_Confirmed_Ultrasound_HysterectomyPX070801230400Confirmed by ultrasound/hysterectomy?4N/A
PX070801_Premenstrual_Syndrome_PMS_HistoryPX070801240100Have you had any of these clinician-diagnosed illnesses? Premenstrual syndrome (PMS)?4N/A
PX070801_Premenstrual_Syndrome_PMS_YearPX070801240200Year of Diagnosis, Premenstrual syndrome (PMS)?4N/A
PX070801_Kidney_Stones_HistoryPX070801250100Have you had any of these clinician-diagnosed illnesses? Kidney stones?4N/A
PX070801_Kidney_Stones_YearPX070801250200Year of Diagnosis, Kidney stones?4N/A
PX070801_Multiple_Sclerosis_HistoryPX070801260100Have you had any of these clinician-diagnosed illnesses? Multiple Sclerosis?4N/A
PX070801_Multiple_Sclerosis_YearPX070801260200Year of Diagnosis, Multiple Sclerosis?4N/A
PX070801_Asthma_HistoryPX070801270100Have you had any of these clinician-diagnosed illnesses? Asthma, doctor diagnosed?4N/A
PX070801_Asthma_YearPX070801270200Year of Diagnosis, Asthma, doctor diagnosed?4N/A
PX070801_Emphysema_Chronic_Bronchitis_HistoryPX070801280100Have you had any of these clinician-diagnosed illnesses? Emphysema/Chronic Bronchitis, doctor diagnosis?4N/A
PX070801_Emphysema_Chronic_Bronchitis_YearPX070801280200Year of Diagnosis, Emphysema/Chronic Bronchitis, doctor diagnosis?4N/A
PX070801_Pneumonia_HistoryPX070801290100Have you had any of these clinician-diagnosed illnesses? Pneumonia, x-ray confirmed?4N/A
PX070801_Pneumonia_YearPX070801290200Year of Diagnosis, Pneumonia, x-ray confirmed?4N/A
PX070801_Graves_Disease_Hyperthyroidism_HistoryPX070801300100Have you had any of these clinician-diagnosed illnesses? Graves' Disease/Hyperthyroidism4N/A
PX070801_Graves_Disease_Hyperthyroidism_YearPX070801300200Year of Diagnosis, Graves' Disease/Hyperthyroidism4N/A
PX070801_Hypothyroidism_HistoryPX070801310100Have you had any of these clinician-diagnosed illnesses? Hypothyroidism?4N/A
PX070801_Hypothyroidism_YearPX070801310200Year of Diagnosis, Hypothyroidism?4N/A
PX070801_Thyroid_Nodule_Benign_HistoryPX070801320100Have you had any of these clinician-diagnosed illnesses? Thyroid nodule (benign)?4N/A
PX070801_Thyroid_Nodule_Benign_YearPX070801320200Year of Diagnosis, Thyroid nodule (benign)?4N/A
PX070801_Gout_HistoryPX070801330100Have you had any of these clinician-diagnosed illnesses? Gout?4N/A
PX070801_Gout_YearPX070801330200Year of Diagnosis, Gout?4N/A
PX070801_SLE_Systemic_Lupus_HistoryPX070801340100Have you had any of these clinician-diagnosed illnesses? SLE (systemic lupus)?4N/A
PX070801_SLE_Systemic_Lupus_YearPX070801340200Year of Diagnosis, SLE (systemic lupus)?4N/A
PX070801_Rheumatoid_Arthritis_HistoryPX070801350100Have you had any of these clinician-diagnosed illnesses? Rheumatoid arthritis, doctor diagnosis?4N/A
PX070801_Rheumatoid_Arthritis_YearPX070801350200Year of Diagnosis, Rheumatoid arthritis, doctor diagnosis?4N/A
PX070801_Other_Arthritis_HistoryPX070801360100Have you had any of these clinician-diagnosed illnesses? Other arthritis?4N/A
PX070801_Other_Arthritis_YearPX070801360200Year of Diagnosis, Other arthritis?4N/A
PX070801_Depression_HistoryPX070801370100Have you had any of these clinician-diagnosed illnesses? Depression, clinician diagnosis?4N/A
PX070801_Depression_YearPX070801370200Year of Diagnosis, Depression, clinician diagnosis?4N/A
PX070801_Other_Major_Illness_Surgery_HistoryPX070801380100Have you had any of these clinician-diagnosed illnesses? Other major illness or surgery?4N/A
PX070801_Other_Major_Illness_Surgery_YearPX070801380200Year of Diagnosis, Other major illness or surgery?4N/A
PX070801_Other_Major_Illness_Surgery_DatePX070801380300Please specify Date.4N/A