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Are you male or female?
Male
Female
What is your age?
<20
20-30
30-40
40-50
50-60
60+
Are you of Ashkenazi Jewish Heritage?
Yes
No
Has anyone in your family been diagnosed with cancer of any type?
Yes
No
Has anyone in your family been identified (now or in the past) with a BRCA1 or BRCA2 mutation?
Yes
No
How many family members do you know of?
1-10
How many were diagnosed before the age of 50?
1-10
What type of cancers were they diagnosed with?
Breast
Colon
Pancreatic
Prostate
Stomach
Other
Were any of them men?
Yes
No
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