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FAMILY HISTORY OF CANCER QUESTIONNAIRE Name Date Please circle Y to those that apply to YOU and/or YOUR FAMILY (on both your mother OR fathers side). Please notate your relationship to the individual
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How to fill out family history of cancer
How to fill out family history of cancer
01
Start by gathering information about your immediate family members such as parents, siblings, and children.
02
Make a list of any known cases of cancer in your family, along with the type of cancer and the age at diagnosis.
03
If possible, gather more detailed information about each case including the date of diagnosis, the treatment received, and the outcome.
04
Use online tools or software to create a family tree and include the information you have collected.
05
Talk to your extended family members such as aunts, uncles, and cousins to gather additional information about any cancer cases in the family.
06
Consult with healthcare professionals or genetic counselors to understand the significance of the family history and its potential implications for your own health.
07
Keep the family history record updated as new information becomes available or as you discover new cases of cancer in the family.
Who needs family history of cancer?
01
Individuals who have a family history of cancer are encouraged to gather and document the information.
02
People who have a personal history of cancer also need to know their family history as it may help in understanding their own risk factors and potential genetic predispositions.
03
Healthcare professionals, including doctors and genetic counselors, rely on family history information to assess an individual's risk of developing cancer and to provide appropriate screening and prevention recommendations.
04
Certain individuals who have a high-risk family history of cancer may be candidates for genetic testing, which can help identify specific gene mutations associated with increased cancer risk.
05
Researchers and scientists studying the genetic basis of cancer rely on family history data to make advancements in understanding the disease and developing new treatments.
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What is family history of cancer?
Family history of cancer refers to the record of cancer occurrences within a person's family, including the types of cancer and the ages at which they were diagnosed.
Who is required to file family history of cancer?
Individuals with a personal or family history of cancer are required to report their family history of cancer.
How to fill out family history of cancer?
Family history of cancer can be filled out by accessing the necessary forms from a healthcare provider or genetic counselor, and providing accurate information about family members and their cancer history.
What is the purpose of family history of cancer?
The purpose of family history of cancer is to assess an individual's risk of developing cancer and to determine if further screening or preventive measures are necessary.
What information must be reported on family history of cancer?
Information that must be reported on family history of cancer includes the types of cancer that family members have been diagnosed with, their ages at diagnosis, and any genetic mutations that may be present.
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