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Have you ever had breast, ovarian, prostate, pancreatic, endometrial (uterine) or colorectal cancer? Have you ever had breast, ovarian, prostate, pancreatic, endometrial (uterine) or colorectal cancer? YES NO UNSURE

Does anyone in your family have a history of any of the following cancers? (check all that apply) Does anyone in your family have a history of any of the following cancers? (check all that apply) Breast Cancer Two different breast cancers in one family member Three or more breast cancers in family members on the same side of the family Ovarian cancer Male breast cancer Triple negative breast cancer Ashkenazi Jewish ancestry with breast cancer Pancreatic cancer in a first-degree relative (parents, siblings or children) Metastatic or high-risk prostate cancer in a first-degree relative Colon cancer before age 50 in a first-degree relative Uterine (endometrial) cancer before age 50 in a first-degree relative Three or more colon and/or uterine cancers on the same side of the family A positive genetic test result for a hereditary cancer gene mutation like BRCA1/2