Introduction

The nonprofit organization, Facing Our Risk of Cancer Empowered (FORCE) is working with the Autistic Self Advocacy Network (ASAN) to learn about people’s needs for information, support and services related to breast health, breast cancer risk and screening. The information will be used to create materials for autistic people to learn more about breast cancer risk and screening. FORCE is funded by the Centers for Disease Control and Prevention (CDC) for this survey and for the materials that we will create. FORCE will not share your personal information with the CDC or anyone else. There are two parts to this survey.

  • Part 1: The questions below are Part 1 of our survey. They should take you about 5 minutes to complete. Your answers will help us determine if you are eligible to complete Part 2 of our survey.
  • Part 2: Part 2 is a longer survey to share your experiences and needs related to breast health, breast cancer risk and screening.
You may want to consider the following information before taking this eligibility survey:
  • If you are autistic and have breasts, you may qualify for Part 2 of our survey.
  • If you are eligible, we will contact you by email with directions on how to complete the Part 2 survey.
  • If you are eligible and decide to complete the full survey, it should take about 30 minutes.
  • The Part 2 survey can be completed online. Or, if you prefer, you can talk with someone by phone or zoom to answer the rest of the questions.
  • You may stop at any time if you decide that you no longer wish to complete the questions below.
  • Your information will be kept private and will not be shared with anyone outside of the FORCE project team.
If you need a definition or description of the terms used in this survey, you may visit the glossary at this link.

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* 1. Are you autistic, or has a doctor or health expert told you that you are on the autism spectrum?

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* 2. What is your age?

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* 3. What is your gender?

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* 4. Are you transgender?

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* 5. Has a doctor or relative ever spoken to you about your risk for breast cancer?

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* 6. Have you ever had a test to check for breast cancer (for example, a mammogram, breast ultrasound, breast MRI, breast exam by a doctor or nurse, or breast biopsy?)

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* 7. Have you ever been treated for breast cancer?

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* 8. What is your name and what is the best email address to contact you? (We will use your email to send you follow up information to complete Part 2 of the survey if you are eligible. We will not use your information for any other purpose.)

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* 9. If you are eligible for our full survey, how would you prefer to complete it?

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