[EDITORIAL NOTE]{.underline}: This extended family history questionnaire
is in three sections. It is centered on the SUBJECT, who had a childhood
cancer. In Section I, the father or mother of SUBJECT or another
relative gives demographic information about SUBJECT and SUBJECT's
siblings as well as a pregnancy history of SUBJECT or SUBJECT's spouse.

**CHILDHOOD MEDULLOBLASTOMA STUDY**

**[SECTION I]{.underline}. FAMILY HISTORY QUESTIONNAIRE**

**Confidential Information Not To Be Coded**

  ------------ ------------------------ ----------------------------------
               IDENTIFICATION PAGE      SUBJECT ID NO.
                                        \|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

  ------------ ------------------------ ----------------------------------

\[THIS PAGE TO BE REMOVED AFTER INTERVIEW IS COMPLETE\]

SUBJECT NAME:

Address:

Social Security Number (SSN):

Phone Number: (\_\_\_\_\_\_\_\_) \_\_\_\_\_\_\_\_ -
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ----------------------------------- -----------------------------------
  [MOTHER]{.underline}                [FATHER]{.underline}

                                      

  Name:                               Name:

                                      

  \[RECORD ADDRESS AND PHONE NUMBER   \[RECORD ADDRESS AND PHONE NUMBER
  IF DIFFERENT FROM THE SUBJECT,      IF DIFFERENT FROM THE SUBJECT,
  OTHERWISE WRITE \"SAME\"\]          OTHERWISE WRITE \"SAME\"\]

                                      

  Address:                            Address:

  Work Phone:                         Work Phone:

                                      

  Home Phone:                         Home Phone:

  SSN:                                SSN:
  ----------------------------------- -----------------------------------

**CHILDHOOD MEDULLOBLASTOMA STUDY**

**FAMILY HISTORY QUESTIONNAIRE**

SUBJECT\'S FIRST NAME: SUBJECT\'S ID \|\_\_\_\_\_\_\_\_\_\_\_\_\_\|

1\. DATE OF INTERVIEW: \|\_\_\|\_\_\| - \|\_\_\|\_\_\| - \|\_\_\|\_\_\|

DA MO YR

2\. TIME INTERVIEW BEGAN: \|\_\_\|\_\_\| : \|\_\_\|\_\_\| AM PM

TIME INTERVIEW ENDED: \|\_\_\|\_\_\| : \|\_\_\|\_\_\| AM PM

3\. RESPONDENT\'S RELATIONSHIP TO SUBJECT. (CIRCLE ALL THAT APPLY)

Mother 1

Father 2

Other (SPECIFY) 6

Other (SPECIFY) 7

4\. SUBJECT\'S VITAL STATUS: Living 1

Deceased 2

5\. SUBJECT\'S SEX: M               F

GENERAL INTRODUCTION:

Thank you for participating in this study. Today I would like to ask you
about (NAME)\'s family, his/her health history, his/her blood relatives
and their ages, and the health history of the relatives. If there are
any questions that you are unable to answer, I will make a note of them
and ask you to consult with other family members to obtain the correct
answer.

DEMOGRAPHICS

First I would like to ask you a few questions about (NAME)\'s background
and health.

1\. What is (NAME)\'s date of birth?

\|\_\_\|\_\_\| - \|\_\_\|\_\_\| - 19 \|\_\_\|\_\_\|

MONTH DAY YEAR

2\. Where was he/she born?

CITY/TOWN STATE

OR

FOREIGN COUNTRY

3\. Is (NAME) adopted?

Yes 1

No 2 (4)

3a. Was (NAME) adopted by a relative who knows the family history?

Yes 1

No 2 (BOX S1)

+---------------+------------------------------------------------------+
|               | BOX S1                                               |
|               |                                                      |
|               | IF 3a = NO (2), THEN ASK QUESTIONS 4-8, 28-39 AND    |
|               | TERMINATE THE INTERVIEW                              |
+---------------+------------------------------------------------------+

4\. Was (SUBJECT) a single or multiple birth?

SINGLE 1

MULTIPLE 2 (SPECIFY 1ST OF

(SPECIFY) 2, ETC.)

5\. Did (NAME) ever have any birth defects or genetic syndromes?
(SPECIFY DETAILS)

YES 1

NO 2 (6)

IF YES, SPECIFY

5a. \|\_\_\|\_\_\|

5b. \|\_\_\|\_\_\|

5c. \|\_\_\|\_\_\|

5d. \|\_\_\|\_\_\|

6\. How much did (SUBJECT) weigh at birth?

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

LB OZ

7\. What type of delivery did he have? SHOW CARD H

Normal, head first 1

Breech, bottom first 2

One foot first 3

One arm first 4

C-section 5

8\. Which of the following, if any, were used during delivery? SHOW CARD
I

Suction 1

Vacuum 2

Forceps 3

C-section 4

Other 5

None 6

siblings

Now I would like to ask you some questions about (NAME)\'s full and half
biological siblings, whether living or deceased, starting with the
oldest. Please give me the first names of all (NAME)\'s siblings. Please
do not include adopted siblings.

> WRITE THE FIRST NAME AND CIRCLE THE SEX OF EACH FULL OR HALF SIBLING
> AT TOP OF EACH COLUMN. ASK THE QUESTIONS FOR EACH SIBLING BEFORE GOING
> ON TO NEXT COLUMN. IF NONE, GO TO QUESTION 28.

+---------------------------+---------+---------+---------+---------+
| 9\. (Starting with the    | NAME    | NAME    | NAME    | NAME    |
| oldest)                   |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
| CONFIRM: That\'s a        | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
| sister? Or that\'s a      | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
| brother?                  | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           |         |         |         |         |
| MALE                      | 1       | 1       | 1       | 1       |
|                           |         |         |         |         |
| FEMALE                    | 2       | 2       | 2       | 2       |
+---------------------------+---------+---------+---------+---------+
| 10\. What is (SIBLING)\'s | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
| date of birth? CODE MONTH | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
| AND YEAR                  | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
|                           | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
|                           |         |         |         |         |
|                           | M Y     | M Y     | M Y     | M Y     |
+---------------------------+---------+---------+---------+---------+
| 11\. What is the          | 1       | 1       | 1       | 1       |
| relationship of this      |         |         |         |         |
| child to (NAME)? SHOW     | 2       | 2       | 2       | 2       |
| CARD G                    |         |         |         |         |
|                           | 3       | 3       | 3       | 3       |
| FULL SIBLING; SAME        |         |         |         |         |
| MOTHER,                   |         |         |         |         |
|                           |         |         |         |         |
| SAME FATHER               |         |         |         |         |
|                           |         |         |         |         |
| HALF SIBLING; BY MOTHER   |         |         |         |         |
|                           |         |         |         |         |
| HALF SIBLING; BY FATHER   |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| 12\. How much did         | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
| (SIBLING) weigh at birth? | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
|                           | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
|                           | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
|                           |         |         |         |         |
|                           | LB OZ   | LB OZ   | LB OZ   | LB OZ   |
+---------------------------+---------+---------+---------+---------+
| 13\. What type of         | 1       | 1       | 1       | 1       |
| delivery did he/she have? |         |         |         |         |
| SHOW CARD H               | 2       | 2       | 2       | 2       |
|                           |         |         |         |         |
| NORMAL, HEAD FIRST        | 3       | 3       | 3       | 3       |
|                           |         |         |         |         |
| BREECH, BOTTOM FIRST      | 4       | 4       | 4       | 4       |
|                           |         |         |         |         |
| ONE FOOT FIRST            | 5 (15)  | 5 (15)  | 5 (15)  | 5 (15)  |
|                           |         |         |         |         |
| ONE ARM FIRST             | 9       | 9       | 9       | 9       |
|                           |         |         |         |         |
| C-SECTION                 |         |         |         |         |
|                           |         |         |         |         |
| DON\'T KNOW               |         |         |         |         |
+---------------------------+---------+---------+---------+---------+

+---------------------------+---------+---------+---------+---------+
|                           | NAME    | NAME    | NAME    | NAME    |
|                           |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
+---------------------------+---------+---------+---------+---------+
| 14\. Which of the         | 1       | 1       | 1       | 1       |
| following, if any, were   |         |         |         |         |
| used during delivery?     | 2       | 2       | 2       | 2       |
| SHOW CARD I               |         |         |         |         |
|                           | 3       | 3       | 3       | 3       |
| SUCTION                   |         |         |         |         |
|                           | 4       | 4       | 4       | 4       |
| Vacuum                    |         |         |         |         |
|                           | 5       | 5       | 5       | 5       |
| Forceps                   |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
| C-section                 | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
| Other (SPECIFY)           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           |         |         |         |         |
| None                      | 6       | 6       | 6       | 6       |
|                           |         |         |         |         |
| Don\'t know               | 9       | 9       | 9       | 9       |
+---------------------------+---------+---------+---------+---------+
| 15. Did (SIBLING) ever    | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
|     have any birth        | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
|     defects or            |         |         |         |         |
|     malformations at      | NONE =  | NONE =  | NONE =  | NONE =  |
|     birth?                | 00      | 00      | 00      | 00      |
|                           |         |         |         |         |
| > NONE 1                  | \_\_\_  | \_\_\_  | \_\_\_  | \_\_\_  |
| >                         | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
| > YES (SPECIFY) 2         | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
+---------------------------+---------+---------+---------+---------+
| 16\. Did (SIBLING) have   | 1       | 1       | 1       | 1       |
| any illness during        |         |         |         |         |
| childhood requiring       | \_\     | \_\     | \_\     | \_\     |
| hospitalization for at    | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
| least one night?          | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
| Yes (SPECIFY)             |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
| No                        | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           |         |         |         |         |
|                           | 2       | 2       | 2       | 2       |
+---------------------------+---------+---------+---------+---------+
| 17\. Was (SIBLING) ever   | 1       | 1       | 1       | 1       |
| diagnosed as having       |         |         |         |         |
| cancer?                   | 2 (21)  | 2 (21)  | 2 (21)  | 2 (21)  |
|                           |         |         |         |         |
| Yes                       |         |         |         |         |
|                           |         |         |         |         |
| No                        |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| 18\. Looking at SHOW CARD | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
| J on page S8, tell me     | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
| what type of cancer did   |         |         |         |         |
| the physician state       | \_\     | \_\     | \_\     | \_\     |
| he/she had?               | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
+---------------------------+---------+---------+---------+---------+
| 19\. At what age was the  | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
| cancer diagnosed? What    | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
| year was that?            |         |         |         |         |
|                           | AGE IN  | AGE IN  | AGE IN  | AGE IN  |
|                           | YRS.    | YRS.    | YRS.    | YRS.    |
|                           |         |         |         |         |
|                           | 19      | 19      | 19      | 19      |
|                           | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
|                           | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
|                           |         |         |         |         |
|                           | YEAR    | YEAR    | YEAR    | YEAR    |
+---------------------------+---------+---------+---------+---------+
| 20\. How was the child    | 1       | 1       | 1       | 1       |
| treated? Did he/she have: |         |         |         |         |
|                           | 2       | 2       | 2       | 2       |
| a\. surgery?              |         |         |         |         |
|                           | 1       | 1       | 1       | 1       |
| Yes                       |         |         |         |         |
|                           | 2       | 2       | 2       | 2       |
| No                        |         |         |         |         |
|                           | 1       | 1       | 1       | 1       |
| b\. chemotherapy?         |         |         |         |         |
|                           | 2       | 2       | 2       | 2       |
| Yes                       |         |         |         |         |
|                           |         |         |         |         |
| No                        |         |         |         |         |
|                           |         |         |         |         |
| c\. radiation?            |         |         |         |         |
|                           |         |         |         |         |
| Yes                       |         |         |         |         |
|                           |         |         |         |         |
| No                        |         |         |         |         |
+---------------------------+---------+---------+---------+---------+

+---------------------------+---------+---------+---------+---------+
|                           | NAME    | NAME    | NAME    | NAME    |
|                           |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
+---------------------------+---------+---------+---------+---------+
| 21\. Did (SIBLING) ever   | 1       | 1       | 1       | 1       |
| have a benign tumor?      |         |         |         |         |
|                           | 2 (25)  | 2 (25)  | 2 (25)  | 2 (25)  |
| Yes                       |         |         |         |         |
|                           |         |         |         |         |
| No                        |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| 22\. Looking at SHOW CARD | 1       | 1       | 1       | 1       |
| K, please tell me what    |         |         |         |         |
| kind of benign tumor it   | 2       | 2       | 2       | 2       |
| was.                      |         |         |         |         |
|                           | 3       | 3       | 3       | 3       |
| Adenomas colorectal       |         |         |         |         |
|                           | 4       | 4       | 4       | 4       |
| Ovarian fibroma           |         |         |         |         |
|                           | 5       | 5       | 5       | 5       |
| Cardiac fibroma           |         |         |         |         |
|                           | 6       | 6       | 6       | 6       |
| Jaw cysts                 |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
| Meningioma                | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
| Other (SPECIFY)           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           |         |         |         |         |
|                           | \_\     | \_\     | \_\     | \_\     |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
|                           | \_\_\_\ | \_\_\_\ | \_\_\_\ | \_\_\_\ |
|                           | _\_\_\_ | _\_\_\_ | _\_\_\_ | _\_\_\_ |
+---------------------------+---------+---------+---------+---------+
| 23\. How old was          | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
| (SIBLING) when the benign | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
| tumor was diagnosed?      |         |         |         |         |
|                           | AGE IN  | AGE IN  | AGE IN  | AGE IN  |
|                           | YRS.    | YRS.    | YRS.    | YRS.    |
+---------------------------+---------+---------+---------+---------+
| 24\. How was the tumor    | 1       | 1       | 1       | 1       |
| treated, by surgery or by |         |         |         |         |
| observation only?         | 2       | 2       | 2       | 2       |
|                           |         |         |         |         |
| Observation               |         |         |         |         |
|                           |         |         |         |         |
| Surgery                   |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| 25\. Is (SIBLING) still   | 1 (NEXT | 1 (NEXT | 1 (NEXT | 1 (NEXT |
| living?                   |         |         |         |         |
|                           | SIB.)   | SIB.)   | SIB.)   | SIB.)   |
| Yes                       |         |         |         |         |
|                           | 2       | 2       | 2       | 2       |
| No                        |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| 26\. In what year did     | 19      | 19      | 19      | 19      |
| he/she die?               | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
|                           | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
|                           |         |         |         |         |
|                           | YEAR    | YEAR    | YEAR    | YEAR    |
+---------------------------+---------+---------+---------+---------+
| 27\. What was the cause   | \|\_\_\ | \|\_\_\ | \|\_\_\ | \|\_\_\ |
| of death? SHOW CARD L ON  | |\_\_\| | |\_\_\| | |\_\_\| | |\_\_\| |
| PAGE S8                   |         |         |         |         |
|                           |         |         |         |         |
| > GO TO NEXT SIBLING      |         |         |         |         |
+---------------------------+---------+---------+---------+---------+

PREGNANCY HISTORY OF THE SUBJECT

This section asks about the pregnancies of the subject (those of female
subjects and of the partners of male subjects).

28\. Has (NAME) ever (been pregnant/fathered a pregnancy)?

Yes 1

+--------------------------------------------+---+---------------------+
| No 2                                       |  | (NEXT SECTION       |
|                                            |   |                     |
| DON\'T KNOW 9                              |   | RECORD END TIME)    |
+--------------------------------------------+---+---------------------+

29\. How many times has (NAME) (been pregnant/fathered a pregnancy)?

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

\#

+---------------------------+-------------+-------------+-------------+
|                           | 1ST PREG.   | 2ND PREG.   | 3RD PREG.   |
+---------------------------+-------------+-------------+-------------+
| 30\. Beginning with the   | 0           | 0           | 0           |
| first pregnancy, please   |             |             |             |
| tell me the outcome of    | 1           | 1           | 1           |
| each one. SHOW CARD D     |             |             |             |
|                           | 2           | 2           | 2           |
| Currently pregnant        |             |             |             |
|                           | 3           | 3           | 3           |
| Birth of full-term child  |             |             |             |
|                           | 4           | 4           | 4           |
| Birth of premature child  |             |             |             |
|                           | 5           | 5           | 5           |
| Stillbirth, after 28      |             |             |             |
| weeks of pregnancy        | 6           | 6           | 6           |
|                           |             |             |             |
| Miscarriage, before 28    | 7           | 7           | 7           |
| weeks                     |             |             |             |
|                           | 9           | 9           | 9           |
| of pregnancy              |             |             |             |
|                           |             |             |             |
| Elective abortion         |             |             |             |
|                           |             |             |             |
| Ectopic pregnancy (tubal  |             |             |             |
|                           |             |             |             |
| pregnancy)                |             |             |             |
|                           |             |             |             |
| Baby who died shortly     |             |             |             |
| after                     |             |             |             |
|                           |             |             |             |
| birth                     |             |             |             |
|                           |             |             |             |
| Unknown outcome           |             |             |             |
+---------------------------+-------------+-------------+-------------+
| ASK THE FOLLOWING         | 1           | 1           | 1           |
| QUESTIONS FOR ANY         |             |             |             |
| LIVE-BORN CHILDREN.       | 2           | 2           | 2           |
|                           |             |             |             |
| 31\. Is this child male   |             |             |             |
| or female?                |             |             |             |
|                           |             |             |             |
| Male                      |             |             |             |
|                           |             |             |             |
| Female                    |             |             |             |
+---------------------------+-------------+-------------+-------------+
| 32\. What was the date of | \|\_\_\|\_\ | \|\_\_\|\_\ | \|\_\_\|\_\ |
| birth of this baby?       | _\|-\|\_\_\ | _\|-\|\_\_\ | _\|-\|\_\_\ |
|                           | |\_\_\|-\|\ | |\_\_\|-\|\ | |\_\_\|-\|\ |
|                           | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
|                           |             |             |             |
|                           | MM DD YY    | MM DD YY    | MM DD YY    |
+---------------------------+-------------+-------------+-------------+
| 33\. Was the child born   | 1           | 1           | 1           |
| with any birth defects?   |             |             |             |
|                           | 2 (35)      | 2 (35)      | 2 (35)      |
| Yes                       |             |             |             |
|                           | 9 (35)      | 9 (35)      | 9 (35)      |
| No                        |             |             |             |
|                           |             |             |             |
| DON\'T KNOW               |             |             |             |
+---------------------------+-------------+-------------+-------------+

+---------------------------+-------------+-------------+-------------+
| 34\. If yes, please       | a\.         | a\.         | a\.         |
| specify.                  | \|\         | \|\         | \|\         |
|                           | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
|                           | \_\_\_\_\   | \_\_\_\_\   | \_\_\_\_\   |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           |             |             |             |
|                           |  \_\_\_\_\_ |  \_\_\_\_\_ |  \_\_\_\_\_ |
|                           | \_\_\_\_\_\ | \_\_\_\_\_\ | \_\_\_\_\_\ |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           | b\.         | b\.         | b\.         |
|                           | \|\         | \|\         | \|\         |
|                           | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
|                           | \_\_\_\_\   | \_\_\_\_\   | \_\_\_\_\   |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           |             |             |             |
|                           |  \_\_\_\_\_ |  \_\_\_\_\_ |  \_\_\_\_\_ |
|                           | \_\_\_\_\_\ | \_\_\_\_\_\ | \_\_\_\_\_\ |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           | c\.         | c\.         | c\.         |
|                           | \|\         | \|\         | \|\         |
|                           | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
|                           | \_\_\_\_\   | \_\_\_\_\   | \_\_\_\_\   |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           |             |             |             |
|                           |  \_\_\_\_\_ |  \_\_\_\_\_ |  \_\_\_\_\_ |
|                           | \_\_\_\_\_\ | \_\_\_\_\_\ | \_\_\_\_\_\ |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           | d\.         | d\.         | d\.         |
|                           | \|\         | \|\         | \|\         |
|                           | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
|                           | \_\_\_\_\   | \_\_\_\_\   | \_\_\_\_\   |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
|                           |             |             |             |
|                           |             |             |             |
|                           |  \_\_\_\_\_ |  \_\_\_\_\_ |  \_\_\_\_\_ |
|                           | \_\_\_\_\_\ | \_\_\_\_\_\ | \_\_\_\_\_\ |
|                           | _\_\_\_\_\_ | _\_\_\_\_\_ | _\_\_\_\_\_ |
+---------------------------+-------------+-------------+-------------+
| 35\. Did the child ever   | 1           | 1           | 1           |
| have cancer?              |             |             |             |
|                           | 2 (38)      | 2 (38)      | 2 (38)      |
| Yes                       |             |             |             |
|                           | 9 (38)      | 9 (38)      | 9 (38)      |
| No                        |             |             |             |
|                           |             |             |             |
| DON\'T KNOW               |             |             |             |
+---------------------------+-------------+-------------+-------------+
| 36\. If yes, which type   | \|\         | \|\         | \|\         |
| of cancer?\               | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
| SHOW CARD J ON PAGE S8    |             |             |             |
+---------------------------+-------------+-------------+-------------+
| 37\. In what year was     | \|\_        | \|\_        | \|\_        |
| this cancer diagnosed?    | \_\|\_\_\|\ | \_\|\_\_\|\ | \_\|\_\_\|\ |
| \[CODE AS YYYY\]          | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
|                           |             |             |             |
|                           | YEAR        | YEAR        | YEAR        |
+---------------------------+-------------+-------------+-------------+
| 38\. Is the child still   | 1 [(NEXT    | 1 [(NEXT    | 1 [(NEXT    |
| living?                   | SEC.)]{     | SEC.)]{     | SEC.)]{     |
|                           | .smallcaps} | .smallcaps} | .smallcaps} |
| Yes                       |             |             |             |
|                           | 2           | 2           | 2           |
| No                        |             |             |             |
|                           | 9 [(NEXT    | 9 [(NEXT    | 9 [(NEXT    |
| DON\'T KNOW               | SEC.)]{     | SEC.)]{     | SEC.)]{     |
|                           | .smallcaps} | .smallcaps} | .smallcaps} |
+---------------------------+-------------+-------------+-------------+
| 39\. If no, please state  | \|\         | \|\         | \|\         |
| the cause of death. SHOW  | _\_\|\_\_\| | _\_\|\_\_\| | _\_\|\_\_\| |
| CARD L ON PAGE S8         |             |             |             |
+---------------------------+-------------+-------------+-------------+

This concludes this section.

**[SHOW CARD J]{.underline}: TYPE OF CANCER**

1.  Leukemia

2.  Lung

3.  Liver

4.  Pancreas

5.  Spleen

6.  Breast

7.  Ovaries

8.  Prostate

9.  Colon or digestive tract

10. Stomach

11. Skin

12. Brain

13. Other type of cancer, specify (do not code)

14. Not defined but widespread cancer of unknown type

**[SHOW CARD L]{.underline}: CAUSE OF DEATH**

1.  Cancer, specify type

2.  Accident

3.  Heart disease/attack

4.  Stroke (clot of blood in brain)

5.  Natural causes (old age)

6.  Infection

7.  Spina bifida-related complications

8.  Renal failure

9.  Other, specify