University of Cincinnati Breast Cancer Registry of Greater Cincinnati
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How to Enroll

The Breast Cancer Registry of Greater Cincinnati (BCRGC) is a local program designed to obtain information from and about women and men diagnosed with breast cancer.

The Registry is voluntary. Participants enroll by signing a consent form and completing a questionnaire about their breast cancer diagnosis, treatment and reoccurrence; family history of breast cancer; environmental and occupational exposures; residential history, etc. All the information is confidential and protected by UC’s strict standards for protecting confidentiality and the rights of people who participate in registries and research studies (Privacy Policy). The Registry is not a clinical trial. There are no treatments or testing of drugs. Any woman or man ever diagnosed with breast cancer is eligible to enroll in the Registry. The purpose of the Registry is to support research about the causes of breast cancer, a crucial first step in prevention.

Read more about the Breast Cancer Registry of Greater Cincinnati >

 

Enrollment Process

  1. Print two copies of the Consent & Enrollment Form. Retain one copy for your records.

        Download Female Consent & Enrollment Form >        Download Male Consent & Enrollment Form >

  2. Read the consent form carefully. If you have questions, please contact us at 513.558.0559 or write to straugvl@ucmail.uc.edu

  3. If you have read the consent form and have no questions, sign and date the consent form.

  4. Read through the questionnaire and then complete the form. If you have questions, write to straugvl@ucmail.uc.edu

  5. Address an envelope to:
    Dr. Susan Pinney
    Breast Cancer Registry of Greater Cincinnati
    Department of Environmental Health
    University of Cincinnati
    PO Box 670056
    Cincinnati, Ohio 45267-0056
  6. Write your return address in the upper left corner of the envelop and affix a First Class stamp to the envelope.

  7. Insert the signed consent form and completed questionnaire in the addressed envelope.

  8. Mail the stamped envelope with the signed and dated consent form and the completed questionnaire.

  9. File the blank copies of the consent form and questionnaire for your personal reference.

 

Thank You for Enrolling and Helping to Find the Causes of Breast Cancer!


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