Question

In order to determine your risk we need additional information related to the colon/uterine/stomach cancer in your family history.

(Please check all that apply)

• You have three or more relatives with any of the following cancers: colon or rectal, uterine, ovarian, stomach, ureter/renal, pelvis, biliary tract, small bowel, pancreas, and/or brain.
• You have at least two relatives with any of the following cancers: colon or rectal, uterine, ovarian, stomach, ureter/renal, pelvis, biliary tract, small bowel, pancreas, and/or brain AND at least one them was diagnosed under the age of 50.
• You have a parent, sibling, or child diagnosed with colon or uterine/endometrial cancer at or under the age of 50.
• You have a parent, sibling, or child diagnosed with colon or uterine/endometrial cancer and any of the following cancers: ovarian, stomach, ureter/renal, pelvis, biliary tract, small bowel, pancreas, and/or brain.
• None of the above apply.