STUDY OF BRAIN TUMORS IN ADULTS

[Section G. Family history of cancer]{.underline}

Now I have a few questions about some of your
(\_\_\_\_\_\_\_\_\_\_\_\_'s) [blood]{.underline} relatives. I am only
interested in (your/his/her) relatives who are related by blood. Do not
include adopted or foster relatives. I will be asking about
(your/his/her) mother, father, sisters, brothers, and children.

G1. First, (are you/was he/she) adopted?

YES 1

NO 2 (G3)

DK 8

G2. Can you answer questions about the health of (your/his/her)
[blood]{.underline} relatives, that is (your/his/her) biological
parents, full brothers or sisters, or half-brothers or -sisters?

YES 1

NO 2 (G11e)

G3. (Were you/Was he/she) born a twin (or triplet)?

YES 1

NO 2 (G5)

DK 8 (G5)

G4. (Were you/Was he/she) born an identical or fraternal twin (or
triplet)?

IDENTICAL 1

FRATERNAL 2

DK 8

G5. In what year was (your/his/her) mother born?

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

YEAR

DK 98

G6. Is she alive now?

YES 1 (G8)

NO 2

DK 8 (G8)

G7. In what year or at what age did she die?

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| OR \|\_\_\_\|\_\_\_\|

YEAR AGE

DK 98

G8. In what year was (your/his/her) father born?

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

YEAR

DK 98

G9. Is he alive now?

YES 1 (G11)

NO 2

DK 8 (G11)

G10. In what year or at what age did he die?

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| OR \|\_\_\_\|\_\_\_\|

YEAR AGE

DK 98

G11. How many (RELATIONSHIP) (do you/does your \_\_\_\_\_\_\_\_\_\_)
have, both living and deceased? FOR [EACH]{.underline} RELATIONSHIP WITH
A NUMBER ENTERED IN THE BOX, GO TO Q.G12, ENTER THE FIRST NAMES, CIRCLE
THE RELATIONSHIP CODES AND ASK Q.G13 THROUGH G16, AS APPROPRIATE. THEN,
GO TO BOX G1.)

a\. full sisters \|\_\_\_\|\_\_\_\|

\#

NONE 00 (b)

DK 98 (b)

b\. full brothers \|\_\_\_\|\_\_\_\|

\#

NONE 00 (c)

DK 98 (c)

c\. half-sisters \|\_\_\_\|\_\_\_\|

\#

NONE 00 (d)

DK 98 (d)

d\. half-brothers \|\_\_\_\|\_\_\_\|

\#

NONE 00 (e)

DK 98 (e)

e\. daughters \|\_\_\_\|\_\_\_\|

\#

NONE 00 (f)

DK 98 (f)

f\. sons \|\_\_\_\|\_\_\_\|

\#

NONE 00 (BOX G1)

DK 98 (BOX G1)

**BOX G1**

**IF G2 = 1 AND [ALL]{.underline} RESPONSES TO G11a THROUGH f = 00 (S.
HAS NONE OF THE RELATIVES LISTED), SKIP TO G17 INTRO AND READ PHRASE FOR
MOTHER AND FATHER ONLY.**

**IF G2 = 2 AND G11e AND G11f = 00, SKIP TO NEXT SECTION.**

**OTHERWISE, AFTER COMPLETING G12-G16, GO TO G17 INTRO.**

(COMPLETE GRID FOR ALL RELATIVES IDENTIFIED IN G11 THEN GO TO G17
INTRO.)

+------------------+------------+------------+------------+------------+
| G12.             | G13.       | G14.       | G15.       | G16.       |
|                  |            |            |            |            |
| Could I please   | Which      | In what    | Is         | In what    |
| have the first   | parent (do | year was   | (he/she)   | year or at |
| name(s) of       | you/does   | (NAME)     | alive now? | what age   |
| (your/his/her)   | your       | born?      |            | did        |
| (RELATIONSHIP)?  | \          |            |            | (he/she)   |
|                  | _\_\_\_\_\ |            |            | die?       |
|                  | _\_\_\_\_) |            |            |            |
|                  | share with |            |            |            |
|                  | (NAME)?    |            |            |            |
+------------------+------------+------------+------------+------------+
| a.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (b)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (b)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| b.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (c)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (c)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| c.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (d)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (d)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| d.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (e)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (e)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| e\. NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (f)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (f)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+

+------------------+------------+------------+------------+------------+
| G12.             | G13.       | G14.       | G15.       | G16.       |
|                  |            |            |            |            |
| Could I please   | Which      | In what    | Is         | In what    |
| have the first   | parent (do | year was   | (he/she)   | year or at |
| name(s) of       | you/does   | (NAME)     | alive now? | what age   |
| (your/his/her)   | your       | born?      |            | did        |
| (RELATIONSHIP)?  | \          |            |            | (he/she)   |
|                  | _\_\_\_\_\ |            |            | die?       |
|                  | _\_\_\_\_) |            |            |            |
|                  | share with |            |            |            |
|                  | (NAME)?    |            |            |            |
+------------------+------------+------------+------------+------------+
| f.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (g)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (g)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| g.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (h)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (h)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| h.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (i)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (i)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| i.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (j)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (j)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| j\. NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (k)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (k)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+

+------------------+------------+------------+------------+------------+
| G12.             | G13.       | G14.       | G15.       | G16.       |
|                  |            |            |            |            |
| Could I please   | Which      | In what    | Is         | In what    |
| have the first   | parent (do | year was   | (he/she)   | year or at |
| name(s) of       | you/does   | (NAME)     | alive now? | what age   |
| (your/his/her)   | your       | born?      |            | did        |
| (RELATIONSHIP)?  | \          |            |            | (he/she)   |
|                  | _\_\_\_\_\ |            |            | die?       |
|                  | _\_\_\_\_) |            |            |            |
|                  | share with |            |            |            |
|                  | (NAME)?    |            |            |            |
+------------------+------------+------------+------------+------------+
| k.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (l)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (l)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| l.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . .. 1   | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (m)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (m)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| m.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (n)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (n)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| n.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (o)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (o)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| o.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (p)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (p)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+

+------------------+------------+------------+------------+------------+
| G12.             | G13.       | G14.       | G15.       | G16.       |
|                  |            |            |            |            |
| Could I please   | Which      | In what    | Is         | In what    |
| have the first   | parent (do | year was   | (he/she)   | year or at |
| name(s) of       | you/does   | (NAME)     | alive now? | what age   |
| (your/his/her)   | your       | born?      |            | did        |
| (RELATIONSHIP)?  | \          |            |            | (he/she)   |
|                  | _\_\_\_\_\ |            |            | die?       |
|                  | _\_\_\_\_) |            |            |            |
|                  | share with |            |            |            |
|                  | (NAME)?    |            |            |            |
+------------------+------------+------------+------------+------------+
| p.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (q)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (q)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| q.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (r)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (r)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| r.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (s)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (s)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| s.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (t)        | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            |            |            |
|                  | . . . . 2  | YEAR       | NO . . . . | YEAR       |
| FULL SISTER . .  |            |            | . . . . 2  |            |
| . . . 1 (G14)    | DK . . . . | OR         |            | OR         |
|                  | . . . . .  |            | DK . . . . |            |
| FULL BROTHER . . | . 8        | \|\_       | . . . 8    | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | (t)        | \_\|\_\_\| |
|                  |            |            |            |            |
| HALF-SISTER . .  |            | AGE        |            | AGE        |
| . . 3            |            |            |            |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+
| t.  NAME:        | MOTHER . . | \|\_\_     | YES . . .  | \|\_\_     |
|                  | . . . . 1  | \|\_\_\|\_ | . . . . 1  | \|\_\_\|\_ |
| > \_\_\_\_\_     |            | \_\|\_\_\| | (G17       | \_\|\_\_\| |
| \_\_\_\_\_\_\_\_ | FATHER . . |            | INTRO)     |            |
|                  | . . . . 2  | YEAR       |            | YEAR       |
| FULL SISTER . .  |            |            | NO . . . . |            |
| . . . 1 (G14)    | DK . . . . | OR         | . . . . .  | OR         |
|                  | . . . . .  |            | . 2        |            |
| FULL BROTHER . . | . 8        | \|\_       |            | \|\_       |
| 2 (G14)          |            | \_\|\_\_\| | DK . . . . | \_\|\_\_\| |
|                  |            |            | . . . 8    |            |
| HALF-SISTER . .  |            | AGE        | (G17       | AGE        |
| . . 3            |            |            | INTRO)     |            |
|                  |            | DK . . . . |            | DK . . . . |
| HALF-BROTHER . . |            | . . . . .  |            | . . . . .  |
| 4                |            | 98         |            | 98         |
|                  |            |            |            |            |
| DAUGHTER . . . . |            |            |            |            |
| . . 5 (G14)      |            |            |            |            |
|                  |            |            |            |            |
| SON . . . . . .  |            |            |            |            |
| . . . . . . . .6 |            |            |            |            |
| (G14)            |            |            |            |            |
+------------------+------------+------------+------------+------------+

**G17 INTRO**

## SHOW CARD G1

> Now I'm going to ask you about the list of conditions shown on this
> card. For each condition, I will ask whether any of the relatives you
> just told me about, including (your/his/her) mother and father, was
> ever told by a doctor that he or she had that condition.

(FOR MOTHER AND FATHER ONLY):

(your/his/her) mother and father . . .

(FOR CHILDREN ONLY):

(your/his/her) children . . .

(FOR OTHER RELATIVES INCLUDING PARENTS & CHILDREN):

(any of the relatives you have just told me about, including
(your/his/her) mother and father . . .

G17. Were any of these relatives ever told by a doctor that they
(had/were) (CONDITION)? (OBTAIN RESPONSES FOR ALL CONDITIONS. THEN, FOR
EACH "YES," GO TO THE APPROPRIATE GRID FOR G18 (a, b, c, d, e, f, or g)
AND ENTER THE NAMES AND RELATIONSHIPS FOR ALL OF THE BLOOD RELATIVES WHO
HAD THAT CONDITION. THEN, FOR EACH RELATIVE, ASK THE OTHER QUESTIONS IN
THE GRID.)

a.  a brain tumor?

YES 1

NO 2

DK 8

b.  Tumors of the nerves or spinal cord?

YES 1

NO 2

DK 8

c.  Neurofibromatosis?

YES 1

NO 2

DK 8

d.  Leukemia, lymphoma, multiple myeloma, or Hodgkin's disease?

YES 1

NO 2

DK 8

e.  Any other cancers or tumors? (EXCLUDE SQUAMOUS OR BASAL CELL SKIN
    CANCERS.)

YES 1

NO 2

DK 8

f.  Epilepsy or seizures?

YES 1

NO 2

DK 8

g.  Were any of these relatives mentally retarded?

YES 1

NO 2

DK 8

**BOX G2**

**IF [ALL]{.underline} RESPONSES TO G17a THROUGH h = 2 OR 8, SKIP TO
G24.**

###### BRAIN TUMORS:

+------------+---------------------------------+-----------------------+
| G18a.      | G19a.                           | ### G20a.             |
|            |                                 |                       |
| Which      | What type of brain tumor did    | How old was (he/she)  |
| relative   | (NAME) have? (CODE UP TO TWO)   |                       |
| had a      | (PROBE: Any others?)            | when it was           |
| brain      |                                 | diagnosed?            |
| tumor?     | #### SHOW CARD G2               |                       |
|            |                                 |                       |
| (ENTER     | A.  GLIOBLASTOMA 01             |                       |
| FIRST NAME |                                 |                       |
| AND        | B.  ASTROCYTOMA 02              |                       |
| RE         |                                 |                       |
| LATIONSHIP | C.  MEDULLOBLASTOMA 03          |                       |
| FOR ALL    |                                 |                       |
| WHO HAD    | D.  MENINGIOMA 04               |                       |
| CONDITION) |                                 |                       |
|            | E.  OLIGODENDROGLIOMA 05        |                       |
|            |                                 |                       |
|            | F.  EPENDYMOMA 06               |                       |
|            |                                 |                       |
|            | G.  GLIOMA 07                   |                       |
|            |                                 |                       |
|            | H.  NEUROMA 08                  |                       |
|            |                                 |                       |
|            | I.  SCHWANNOMA 09               |                       |
|            |                                 |                       |
|            | J.  PITUITARY GLAND TUMOR 10    |                       |
|            |                                 |                       |
|            | K.  OTHER TYPE (SPECIFY)        |                       |
|            |                                 |                       |
|            | > \_\_\_\_\_\_                  |                       |
|            | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                       |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                       |
+------------+---------------------------------+-----------------------+
| a\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+
| b\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+
| c\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+
| d\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+

A.  [NERVE AND SPINAL CORD TUMORS:]{.underline}

+------------+---------------------------------+-----------------------+
| G18b.      | G19b.                           | ### G20b.             |
|            |                                 |                       |
| Which      | What type did (NAME) have?      | How old was (he/she)  |
| relative   | (CODE UP TO TWO) (PROBE: Any    |                       |
| had nerve  | others?)                        | when it was           |
| or spinal  |                                 | diagnosed?            |
| cord       | #### SHOW CARD G3               |                       |
| tumors?    |                                 |                       |
|            | A.  NEUROFIBROMA 01             |                       |
| (ENTER     |                                 |                       |
| FIRST NAME | B.  NEUROMA 02                  |                       |
| AND        |                                 |                       |
| RE         | C.  MENINGIOMA 03               |                       |
| LATIONSHIP |                                 |                       |
| FOR ALL    | D.  SCHWANNOMA 04               |                       |
| WHO HAD    |                                 |                       |
| CONDITION) | E.  ASTROCYTOMA 05              |                       |
|            |                                 |                       |
|            | F.  EPENDYMOMA 06               |                       |
|            |                                 |                       |
|            | G.  OTHER TYPE (SPECIFY)        |                       |
|            |                                 |                       |
|            | > \_\_\_\_\_\_                  |                       |
|            | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                       |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                       |
+------------+---------------------------------+-----------------------+
| a\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+
| b\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+
| c\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+
| d\.        | 1ST TYPE REPORTED:              | \|\_\_\|\_\_\| OR     |
|            | \|\_\_\_\|\_\_\_\|              | \|\_\                 |
| \|\_       |                                 | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | 2ND TYPE REPORTED:              | OR DK . . 98          |
|            | \|\_\_\_\|\_\_\_\|              |                       |
| DK         |                                 | AGE YEAR              |
|            | 96 -- OTHER TYPE SPECIFIED:     |                       |
|            | \_\_\_\                         | \|\_\_\|\_\_\| OR     |
|            | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \|\_\                 |
|            |                                 | _\|\_\_\|\_\_\|\_\_\| |
|            | 98 -- HAD TUMOR, BUT DK TYPE.   | OR DK . . 98          |
|            |                                 |                       |
|            |                                 | AGE YEAR              |
+------------+---------------------------------+-----------------------+

B.  [NEUROFIBROMATOSIS:]{.underline}

+------------+---------------------------------+-----------------------+
| G18c.      | G19c.                           | ### G20c.             |
|            |                                 |                       |
| Which      | Did (NAME) have NF-type 1 or    | How old was (he/she)  |
| relative   | NF-type 2?                      |                       |
| had        |                                 | when it was           |
| neurofi    | #### SHOW CARD G4               | diagnosed?            |
| bromatosis |                                 |                       |
| (NF)?      | > [TYPE 1]{.underline}: (VON    |                       |
|            | > RECKLINGHAUSEN DISEASE OR     |                       |
| (ENTER     | > PERIPHERAL NEUROFIBROMATOSIS) |                       |
| FIRST NAME | >                               |                       |
| AND        | > [TYPE 2]{.underline}:         |                       |
| RE         | > (BILATERAL ACOUSTIC OR        |                       |
| LATIONSHIP | > CENTRAL NEUROFIBROMATOSIS)    |                       |
| FOR ALL    |                                 |                       |
| WHO HAD    |                                 |                       |
| CONDITION) |                                 |                       |
+------------+---------------------------------+-----------------------+
| a\.        | > TYPE 1 1                      | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > TYPE 2 2                      | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > BOTH 3                        |                       |
| DK         | >                               | AGE YEAR              |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| b\.        | > TYPE 1 1                      | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > TYPE 2 2                      | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > BOTH 3                        |                       |
| DK         | >                               | AGE YEAR              |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| c\.        | > TYPE 1 1                      | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > TYPE 2 2                      | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > BOTH 3                        |                       |
| DK         | >                               | AGE YEAR              |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| d\.        | > TYPE 1 1                      | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > TYPE 2 2                      | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > BOTH 3                        |                       |
| DK         | >                               | AGE YEAR              |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+

C.  [LEUKEMIA, LYMPHOMA, MULTIPLE MYELOMA, OR HODGKIN'S
    DISEASE]{.underline}

+------------+---------------------------------+-----------------------+
| G18d.      | G19d.                           | ### G20d.             |
|            |                                 |                       |
| Which      | > Which disease did (NAME)      | How old was (he/she)  |
| relative   | > have?                         |                       |
| had        |                                 | when it was           |
| leukemia,  | ##### SHOW CARD G5              | diagnosed?            |
| lymphoma,  |                                 |                       |
| multiple   |                                 |                       |
| myeloma,   |                                 |                       |
| or         |                                 |                       |
| Hodgkin's  |                                 |                       |
| disease?   |                                 |                       |
|            |                                 |                       |
| (ENTER     |                                 |                       |
| FIRST NAME |                                 |                       |
| AND        |                                 |                       |
| RE         |                                 |                       |
| LATIONSHIP |                                 |                       |
| FOR ALL    |                                 |                       |
| WHO HAD    |                                 |                       |
| CONDITION) |                                 |                       |
+------------+---------------------------------+-----------------------+
| a\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| b\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| c\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| d\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+

+------------+---------------------------------+-----------------------+
| G18d.      | G19d.                           | ### G20d.             |
|            |                                 |                       |
| Which      | > Which disease did (NAME)      | How old was (he/she)  |
| relative   | > have?                         |                       |
| had        |                                 | when it was           |
| leukemia,  | ##### SHOW CARD G5              | diagnosed?            |
| lymphoma,  |                                 |                       |
| multiple   |                                 |                       |
| myeloma,   |                                 |                       |
| or         |                                 |                       |
| Hodgkin's  |                                 |                       |
| disease?   |                                 |                       |
|            |                                 |                       |
| (ENTER     |                                 |                       |
| FIRST NAME |                                 |                       |
| AND        |                                 |                       |
| RE         |                                 |                       |
| LATIONSHIP |                                 |                       |
| FOR ALL    |                                 |                       |
| WHO HAD    |                                 |                       |
| CONDITION) |                                 |                       |
+------------+---------------------------------+-----------------------+
| e          | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| f\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| g\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+
| h\.        | > LEUKEMIA 1                    | \|\_\_\|\_\_\| OR     |
|            | >                               | \|\_\                 |
| \|\_       | > LYMPHOMA 2                    | _\|\_\_\|\_\_\|\_\_\| |
| \_\|\_\_\| | >                               | OR DK . .. 98         |
|            | > MULTIPLE MYELOMA 3            |                       |
| DK         | >                               | AGE YEAR              |
|            | > HODGKIN'S DISEASE 4           |                       |
|            | >                               |                       |
|            | > DK 8                          |                       |
+------------+---------------------------------+-----------------------+

###### ANY OTHER CANCERS

+-----------+-----------+-----------+-----------+-----------+-----------+
| G18e.     | G19e.     | G20e.     | G21e.     | G22e.     | G23e.     |
|           |           |           |           |           |           |
| Which     | What type | How old   | Did       | Where did | How old   |
| relative  | of cancer | was       | (you      | the       | was       |
| had other | did       | (he/she)  | r/his/her | cancer    | (he/she)  |
| cancers?  | (he/she)  | when it   | (         | start?    | when it   |
|           | have?     | was       | RELATIVE) | (What     | was       |
| (ENTER    | (For      | d         | ever have | type of   | d         |
| FIRST     | (NAME),   | iagnosed? | any other | cancer    | iagnosed? |
| NAME AND  | where did |           | cancer?   | did       |           |
| REL       | the       |           |           | (he/she)  |           |
| ATIONSHIP | cancer    |           |           | have?)    |           |
| FOR ALL   | start?)   |           |           |           |           |
| WHO HAD   |           |           |           |           |           |
| C         |           |           |           |           |           |
| ONDITION) |           |           |           |           |           |
+-----------+-----------+-----------+-----------+-----------+-----------+
| a\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (b)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (b)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| b\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (c)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (c)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| c\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (d)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (d)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| d\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (e)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (e)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| e\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (f)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (f)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+

+-----------+-----------+-----------+-----------+-----------+-----------+
| G18e.     | G19e.     | G20e.     | G21e.     | G22e.     | G23e.     |
|           |           |           |           |           |           |
| Which     | What type | How old   | Did       | Where did | How old   |
| relative  | of cancer | was       | (you      | the       | was       |
| had other | did       | (he/she)  | r/his/her | cancer    | (he/she)  |
| cancers?  | (he/she)  | when it   | (         | start?    | when it   |
|           | have?     | was       | RELATIVE) | (What     | was       |
| (ENTER    | (For      | d         | ever have | type of   | d         |
| FIRST     | (NAME),   | iagnosed? | any other | cancer    | iagnosed? |
| NAME AND  | where did |           | cancer?   | did       |           |
| REL       | the       |           |           | (he/she)  |           |
| ATIONSHIP | cancer    |           |           | have?)    |           |
| FOR ALL   | start?)   |           |           |           |           |
| WHO HAD   |           |           |           |           |           |
| C         |           |           |           |           |           |
| ONDITION) |           |           |           |           |           |
+-----------+-----------+-----------+-----------+-----------+-----------+
| f\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (g)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (g)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| g\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (h)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (h)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| h\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (i)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (i)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| i\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2 (j)  |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           |           | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | DK 8 (j)  | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           |           | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           |           |           |           |
|           | DK        | \|\_\     |           | DK        | \|\_\     |
|           |           | _\|\_\_\| |           |           | _\|\_\_\| |
|           |           |           |           |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+
| j\.       | S         | \|\_\_\|  | YES 1     | S         | \|\_\_\|  |
|           | ITE/TYPE: | \_\_\|\_\ |           | ITE/TYPE: | \_\_\|\_\ |
| \|\_\     |           | _\|\_\_\| | NO 2      |           | _\|\_\_\| |
| _\|\_\_\| | \|\_\     |           | (NEXT     | \|\_\     |           |
|           | _\|\_\_\| | YEAR      | CONDITION | _\|\_\_\| | YEAR      |
| DK        | \_\_\|\_\ |           | OR G24)   | \_\_\|\_\ |           |
|           | _\|\_\_\| | OR        |           | _\|\_\_\| | OR        |
|           |           |           | DK 8      |           |           |
|           | DK        | \|\_\     | (NEXT     | DK        | \|\_\     |
|           |           | _\|\_\_\| | CONDITION |           | _\|\_\_\| |
|           |           |           | OR G24)   |           |           |
|           |           | AGE       |           |           | AGE       |
|           |           |           |           |           |           |
|           |           | DK . . .  |           |           | DK . . .  |
|           |           | . . . .   |           |           | . . . .   |
|           |           | 98        |           |           | 98        |
+-----------+-----------+-----------+-----------+-----------+-----------+

[F. EPILEPSY]{.underline} [G. MENTAL RETARDATION]{.underline}

+-------------+-------------+-------------+-------------+-------------+
| G18f.       | G19.        |             | G18g.       | G19.        |
|             |             |             |             |             |
| Which       | What age    |             | Which       | Was it      |
| relative    | was         |             | relative    | Down's      |
| had         | (he/she)    |             | was         | Syndrome?   |
| epilepsy?   | when it was |             | mentally    |             |
|             | diagnosed?  |             | retarded?   |             |
| (ENTER      |             |             |             |             |
| FIRST NAME  |             |             | (ENTER      |             |
| AND         |             |             | FIRST NAME  |             |
| R           |             |             | AND         |             |
| ELATIONSHIP |             |             | R           |             |
| FOR ALL WHO |             |             | ELATIONSHIP |             |
| HAD         |             |             | FOR ALL WHO |             |
| CONDITION)  |             |             | HAD         |             |
|             |             |             | CONDITION)  |             |
+-------------+-------------+-------------+-------------+-------------+
| a\.         | \|\_        |             | a\.         | YES 1       |
|             | \_\|\_\_\|\ |             |             |             |
| \|\         | _\_\|\_\_\| |             | \|\         | NO 2        |
| _\_\|\_\_\| |             |             | _\_\|\_\_\| |             |
|             | YEAR        |             |             | DK 8        |
| DK          |             |             | DK          |             |
|             | OR          |             |             |             |
|             |             |             |             |             |
|             | \|\         |             |             |             |
|             | _\_\|\_\_\| |             |             |             |
|             |             |             |             |             |
|             | AGE         |             |             |             |
|             |             |             |             |             |
|             | DK . . . .  |             |             |             |
|             | . . . . .   |             |             |             |
|             | 98          |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| b\.         | \|\_        |             | b\.         | YES 1       |
|             | \_\|\_\_\|\ |             |             |             |
| \|\         | _\_\|\_\_\| |             | \|\         | NO 2        |
| _\_\|\_\_\| |             |             | _\_\|\_\_\| |             |
|             | YEAR        |             |             | DK 8        |
| DK          |             |             | DK          |             |
|             | OR          |             |             |             |
|             |             |             |             |             |
|             | \|\         |             |             |             |
|             | _\_\|\_\_\| |             |             |             |
|             |             |             |             |             |
|             | AGE         |             |             |             |
|             |             |             |             |             |
|             | DK . . . .  |             |             |             |
|             | . . . . .   |             |             |             |
|             | 98          |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| c\.         | \|\_        |             | c\.         | YES 1       |
|             | \_\|\_\_\|\ |             |             |             |
| \|\         | _\_\|\_\_\| |             | \|\         | NO 2        |
| _\_\|\_\_\| |             |             | _\_\|\_\_\| |             |
|             | YEAR        |             |             | DK 8        |
| DK          |             |             | DK          |             |
|             | OR          |             |             |             |
|             |             |             |             |             |
|             | \|\         |             |             |             |
|             | _\_\|\_\_\| |             |             |             |
|             |             |             |             |             |
|             | AGE         |             |             |             |
|             |             |             |             |             |
|             | DK . . . .  |             |             |             |
|             | . . . . .   |             |             |             |
|             | 98          |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| d\.         | \|\_        |             | d\.         | YES 1       |
|             | \_\|\_\_\|\ |             |             |             |
| \|\         | _\_\|\_\_\| |             | \|\         | NO 2        |
| _\_\|\_\_\| |             |             | _\_\|\_\_\| |             |
|             | YEAR        |             |             | DK 8        |
| DK          |             |             | DK          |             |
|             | OR          |             |             |             |
|             |             |             |             |             |
|             | \|\         |             |             |             |
|             | _\_\|\_\_\| |             |             |             |
|             |             |             |             |             |
|             | AGE         |             |             |             |
|             |             |             |             |             |
|             | DK . . . .  |             |             |             |
|             | . . . . .   |             |             |             |
|             | 98          |             |             |             |
+-------------+-------------+-------------+-------------+-------------+

+-----------------------------------+-----------------------------------+
| G24.                              | G25.                              |
|                                   |                                   |
| Were any other of (your/his/her)  | Which relative(s) had CANCER?     |
| blood relatives (GRANDPARENTS,    | (SPECIFY RELATIONSHIP TO          |
| AUNTS, UNCLES, COUSINS), besides  | PARTICIPANT.)                     |
| those we just discussed, ever     |                                   |
| diagnosed with...                 |                                   |
+-----------------------------------+-----------------------------------+
| a.  A tumor of the brain or       | a1.                               |
|     nervous system?               | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| YES 1                             | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
| NO 2 (b)                          | \|\_\_\|\_\_\| DK                 |
|                                   |                                   |
| DK 8 (b)                          | a2.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
|                                   |                                   |
|                                   | a3.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
+-----------------------------------+-----------------------------------+
| b.  Leukemia?                     | b1.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
| YES 1                             | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| NO 2 (c)                          |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
| DK 8 (c)                          |                                   |
|                                   | b2.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
|                                   |                                   |
|                                   | b3.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
+-----------------------------------+-----------------------------------+
| c.  Lymphoma?                     | c1.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
| YES 1                             | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| NO 2 (d)                          |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
| DK 8 (d)                          |                                   |
|                                   | c2.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
|                                   |                                   |
|                                   | c3.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
+-----------------------------------+-----------------------------------+
| d.  Colon Cancer?                 | d1.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
| YES 1                             | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| NO 2                              |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
| DK 8                              |                                   |
|                                   | d2.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
|                                   |                                   |
|                                   | d3.                               |
|                                   | \_\_\_\_\_\_\_\_\_\_\_            |
|                                   | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | \|\_\_\|\_\_\| DK                 |
+-----------------------------------+-----------------------------------+

BOX G3

INTERVIEWER:

WHO PROVIDED MOST OF THE RESPONSES IN THIS SECTION?

SUBJECT 1

PROXY 2

EQUALLY 3