Get the free Hereditary Cancer Risk Assessment Program - mycancercenter.com

Bergen Oncology Health Questionnaire Date completed: Patient Name: Gender: Male Female Referring Physician: Other Physicians: Date of Birth: Age: Race/Ethnicity: Family Physician: (if different from

How to fill out hereditary cancer risk assessment

How to fill out hereditary cancer risk assessment:

1. Obtain the hereditary cancer risk assessment form from a healthcare provider or genetic counselor.
2. Fill in your personal information, including your name, date of birth, and contact information.
3. Provide details about your family history of cancer. Include information about any relatives who have had cancer, their age at diagnosis, and the type of cancer they had.
4. Indicate whether any of your relatives have undergone genetic testing for cancer-related gene mutations and if they have tested positive or negative.
5. Answer questions about your personal medical history, including any previous cancer diagnoses or precancerous conditions you have had.
6. Provide information about your lifestyle factors that could impact your cancer risk, such as smoking, alcohol consumption, and physical activity levels.
7. If you have had any genetic testing done, include the test results and any relevant genetic mutations that were identified.
8. Once you have completed the form, review it for accuracy and make sure all necessary information has been provided.
9. Submit the completed hereditary cancer risk assessment form to your healthcare provider or genetic counselor for evaluation and further discussion.

Who needs hereditary cancer risk assessment:

1. Individuals with a family history of cancer, especially if they have relatives who were diagnosed at a young age or had multiple types of cancer.
2. People with a personal history of cancer, particularly if it occurred at a young age or is a rare type of cancer.
3. Individuals belonging to certain ethnic or racial groups that have a higher prevalence of specific hereditary cancer gene mutations.
4. Those with a family history of genetic conditions associated with increased cancer risk, such as hereditary breast and ovarian cancer syndrome or Lynch syndrome.
5. People who have been diagnosed with precancerous conditions, such as atypical hyperplasia or adenomatous polyps.
6. Individuals with a history of exposure to known cancer-causing agents, such as radiation therapy or certain chemicals.
7. Anyone who is interested in understanding their personal risk of developing hereditary cancers and wants to explore options for prevention or early detection strategies.

Note: It is always recommended to consult with a healthcare provider or genetic counselor to determine if a hereditary cancer risk assessment is appropriate for your specific situation. They can provide personalized guidance and help interpret the results of the assessment.

For pdfFiller’s FAQs

What is hereditary cancer risk assessment?

Hereditary cancer risk assessment is a process that evaluates an individual's likelihood of developing cancer based on their family history and genetic factors.

Who is required to file hereditary cancer risk assessment?

Individuals with a family history of cancer or genetic predisposition to cancer are required to file hereditary cancer risk assessment.

How to fill out hereditary cancer risk assessment?

Hereditary cancer risk assessment can be filled out by providing information about family history of cancer, genetic testing results, and personal medical history.

What is the purpose of hereditary cancer risk assessment?

The purpose of hereditary cancer risk assessment is to identify individuals who may benefit from early detection and prevention strategies for cancer.

What information must be reported on hereditary cancer risk assessment?

Information such as family history of cancer, genetic testing results, and personal medical history must be reported on hereditary cancer risk assessment.

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