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Question Index: Family History


Questions

Year(s) Asked on Long Forms

(Click on year to view PDF of questionnaire.)
Mother's year of birth x
Mother still living? x x
Mother's age at death x x x
Cause of mother's death: trauma or disease? x x
Mother have MI? x x
Mother have breast cancer? x
Mother's age at first occurrence of breast cancer or MI x x
Father's year of birth x
Father still alive? x x x
Father's year of death x x
Cause of father's death: trauma or disease? x
Father have MI? x x
Father's age at first MI x x
Family history of disease including:
- Colon or rectal cancer x x x x x
- Breast cancer x x x x x
- Melanoma x   x x x
- Other cancer x
- Diabetes x x x
- MI x
- Stroke x
- Uterine Cancer x
- Prostate Cancer x
- Pancreatic Cancer x x
- Ovarian Cancer x x x
- Hypertension x
- Dementia prior to age 70 x
- Alcoholism x
- Parkinson's Disease x
- Down's Syndrome x
- Lung Cancer x
- Glaucoma x
Do you have any sisters? How many? x
How many sisters have had breast cancer? x
Father's occupation when participant was 16 years old x
Mother's occupation when participant was 16 years old x
How many biological brothers & sisters do you have? (incl deceased, not incl 1/2 bros) x
Has any sibling or parent had Parkinson's disease? x
Any immediate family members with Down's syndrome? x

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