Step 1 of 9

Basic Information

Age

Gender

Step 2 of 9

Lifestyle Factors

Smoking / tobacco use Counts cigarettes, beedis, hookah, and chewing tobacco or gutka.

Alcohol consumption Roughly how often you drink any alcohol — beer, wine, or spirits.

Step 3 of 9

Family History

Has a close blood relative had any of these cancers? Close relative means a parent, brother or sister, or child.

Breast Cancer Colorectal Cancer (colon or rectum) Lung Cancer Prostate Cancer None of the above

Step 4 of 9

Medical History

Do you have any of these conditions? Tick any a doctor has told you that you have. Diabetes (high blood sugar) Hypertension (high blood pressure) Obesity (significantly overweight) None of the above

Step 5 of 9

Environmental Exposure

Have you had long-term exposure to any of these? Repeated or workplace exposure over time — not a one-off. Radiation (frequent X-rays/CT scans, radiotherapy, or work with radiation) Industrial chemicals (e.g. benzene, dyes, solvents, pesticides at work) Asbestos (old roofing/insulation, shipyard or construction work) None of the above

Step 6 of 9

Physical Activity

Physical Activity Level

Step 7 of 9

Current Symptoms

Are you experiencing any of these symptoms? Unexplained Fatigue Unexplained Weight Loss Persistent Pain None of the above

Step 8 of 9

Screening History

Which screening tests have you had in the last year? Routine check-up tests done when you had no symptoms. Mammogram (breast X-ray) Colonoscopy (camera test of the colon) Pap smear (cervical screening test) None of the above

Cancer Risk Assessment