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Table 3 Questionnaire for choosing mastectomy in patients who were eligible for BCS

From: Non-doctoral factors influencing the surgical choice of Chinese patients with breast cancer who were eligible for breast-conserving surgery

Your age ( ) years
Your menstrual status Premenopausal ( )
Postmenopausal ( )
Your address Urban ( ); rural ( )
Within Nanjing ( ); outside Nanjing ( )
Your family income per year > $1500 ( )
≤ $1500 ( )
Your insurance status General medicare insurance ( )
No or low-level medicare insurance ( )
Level of education Bachelor’s degree or above ( )
Other ( )
Main reason for choosing mastectomy Concern about cancer recurrence ( )
Reluctance to undergo radiotherapy ( )
Concern about residual cancer ( )
Other reasons ( )
  1. Please fill in your age and mark up “√” in the bracket after the option that you consider appropriate