Questionnaire - Page 1(b) of 9
(1077 maximum possible questions)		 Last updated: Sep 22, 2008

THE ANALYST TM
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This section pertains to your family history of Cancer.
96.  Melanoma (a dangerous form of skin cancer) in close family members?
None / don't know
Probably, in one parent or sibling
Probably, in two or more parents or siblings
Yes, in one parent or sibling
Yes, in more than one parent or sibling
97.  Cancer of the colon / rectum in close family members?
None / don't know
Probably, in parent(s) or sibling(s)
Yes, in one parent or sibling
Yes, in more than one parent or sibling
98.  Has there been a history of Kidney cancer in your family?
Don't know
No
Yes, in a distant relative
Yes, in one parent or sibling
Yes, in more than one parent or sibling
99.  If your mother ever had breast cancer, at approximately what age did she get it?
Never / don't know
Over 60
51-60
41-50
40 or younger
100.  Not counting your mother, has there been breast cancer in any other close family member?
None / don't know
Perhaps, in one family member
Perhaps, in more than one family member
Yes, in one family member
Yes, in more than one family member
101.  Has your mother or a sister had cervical cancer?
Don't know
No
Birth mother has had it
Sister(s) has had it
Both mother and sister(s) have had cervical cancer

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GLOSSARY

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Close Family Members:  For medical purposes this would include your parents, grandparents, and nonadopted siblings (brothers and sisters). In some cases it could include your children as well.

Colon:  The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

Melanoma:  A life-threatening type of skin cancer that occurs in the cells (melanocytes) that produce melanin, the pigment found in skin, hair, and the iris of the eyes.