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Protocol - Cancer: Personal and Family History

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Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Description:

This protocol is used to assess if the respondent and his or her biological parents, siblings, and children have had cancer. This protocol also obtains information about vital status, age, type of cancer, age at first diagnosis, and any additional cancer diagnoses.

Protocol:

1. Please answer the following questions about you and your "blood" relatives. Do not include adopted, half and step relatives. Please mark all that apply for each person.

       

Alive

Current age or age at death

First cancer diagnosis

Age at first cancer diagnosis

Second or other cancer diagnoses

Relative

M

a

l

e

F

e

m

a

l

e

Y

e

s

N

o

<

5

0

5

0

-

6

4

6

5

+

N

e

v

e

r

 

h

a

d

 

c

a

n

c

e

r

B

r

e

a

s

t

O

v

a

r

y

E

n

d

o

m

e

t

r

i

u

m

C

e

r

v

i

x

L

y

m

p

h

o

m

a

M

e

l

a

n

o

m

a

C

o

l

o

n

/

R

e

c

t

u

m

L

u

n

g

P

r

o

s

t

a

t

e

P

a

n

c

r

e

a

s

T

h

y

r

o

i

d

O

t

h

e

r

<

5

0

5

0

-

6

4

6

5

+

B

r

e

a

s

t

O

v

a

r

y

E

n

d

o

m

e

t

r

i

u

m

C

o

l

o

n

/

R

e

c

t

u

m

M

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l

a

n

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m

a

P

r

o

s

t

a

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O

t

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r

 

c

a

n

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r

Self

Mother

Father

Sibling #1

Sibling #2

Sibling #3

Sibling #4

Sibling #5

Sibling #6

Sibling #7

Sibling #8

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

Child #7

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

Specific Instructions:

None

Research Domain Information

Release Date:

December 30, 2009

Definition

Measure to assess if respondent and his or her biological parents, siblings, and children have had cancer

Purpose

Personal and family history is used to assess the presence and age of onset of cancer in all first-degree, biological relatives. A positive family history of cancer in a first-degree relative (parent, siblings, or children) is a cancer-specific risk factor.

Selection Rationale

This protocol was selected because it obtains information about personal and family history of cancer in first-degree relatives in a single table. It also obtains vital status and the age at first cancer diagnosis, both of which are critical to assessing cancer risk.

Language

English

Standards

StandardNameIDSource
Common Data Elements (CDE)Person Personal And Family Cancer History Text2961265CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Cancer pers family hx proto62569-9LOINC

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

State of California, The California Teachers Study, Follow Up Survey 4, 2005–2006, page 7, question 32 (source for question 1).

General References

None

Protocol ID:

70601

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX070601_Sibling_Second_Cancer_Diagnosis_4PX070601070700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_5PX070601080100Gender?4N/A
PX070601_Sibling_Alive_5PX070601080200Alive?4N/A
PX070601_Sibling_Age_5PX070601080300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_5PX070601080400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_5PX070601080500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_5PX070601080600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_5PX070601080700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_6PX070601090100Gender?4N/A
PX070601_Sibling_Alive_6PX070601090200Alive?4N/A
PX070601_Sibling_Age_6PX070601090300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_6PX070601090400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_6PX070601090500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_6PX070601090600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_6PX070601090700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_7PX070601100100Gender?4N/A
PX070601_Sibling_Alive_7PX070601100200Alive?4N/A
PX070601_Sibling_Age_7PX070601100300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_7PX070601100400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_7PX070601100500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_7PX070601100600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_7PX070601100700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_8PX070601110100Gender?4N/A
PX070601_Sibling_Alive_8PX070601110200Alive?4N/A
PX070601_Sibling_Age_8PX070601110300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_8PX070601110400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_8PX070601110500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_8PX070601110600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_8PX070601110700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_1PX070601120100Gender?4N/A
PX070601_Child_Alive_1PX070601120200Alive?4N/A
PX070601_Child_Age_1PX070601120300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_1PX070601120400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_1PX070601120500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_1PX070601120600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_1PX070601120700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_2PX070601130100Gender?4N/A
PX070601_Child_Alive_2PX070601130200Alive?4N/A
PX070601_Child_Age_2PX070601130300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_2PX070601130400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_2PX070601130500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_2PX070601130600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_2PX070601130700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_3PX070601140100Gender?4N/A
PX070601_Child_Alive_3PX070601140200Alive?4N/A
PX070601_Child_Age_3PX070601140300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_3PX070601140400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_3PX070601140500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_3PX070601140600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_3PX070601140700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_4PX070601150100Gender?4N/A
PX070601_Child_Alive_4PX070601150200Alive?4N/A
PX070601_Child_Age_4PX070601150300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_4PX070601150400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_4PX070601150500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_4PX070601150600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_4PX070601150700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_5PX070601160100Gender?4N/A
PX070601_Child_Alive_5PX070601160200Alive?4N/A
PX070601_Child_Age_5PX070601160300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_5PX070601160400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_5PX070601160500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_5PX070601160600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_5PX070601160700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_6PX070601170100Gender?4N/A
PX070601_Child_Alive_6PX070601170200Alive?4N/A
PX070601_Child_Age_6PX070601170300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_6PX070601170400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_6PX070601170500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_6PX070601170600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_6PX070601170700Second or other cancer diagnoses?4N/A
PX070601_Child_Gender_7PX070601180100Gender?4N/A
PX070601_Child_Alive_7PX070601180200Alive?4N/A
PX070601_Child_Age_7PX070601180300Current age or age at death?4N/A
PX070601_Child_Ever_Cancer_Diagnosis_7PX070601180400Never had cancer?4N/A
PX070601_Child_First_Cancer_Diagnosis_7PX070601180500First cancer diagnosis?4N/A
PX070601_Child_First_Cancer_Diagnosis_Age_7PX070601180600Current age or age at death?4N/A
PX070601_Child_Second_Cancer_Diagnosis_7PX070601180700Second or other cancer diagnoses?4N/A
PX070601_Self_GenderPX070601010100Gender?4N/A
PX070601_Self_AlivePX070601010200Alive?4N/A
PX070601_Self_AgePX070601010300Current age or age at death?4N/A
PX070601_Self_Ever_Cancer_DiagnosisPX070601010400Never had cancer?4N/A
PX070601_Self_First_Cancer_DiagnosisPX070601010500First cancer diagnosis?4N/A
PX070601_Self_First_Cancer_Diagnosis_AgePX070601010600Current age or age at death?4N/A
PX070601_Self_Second_Cancer_DiagnosisPX070601010700Second or other cancer diagnoses?4N/A
PX070601_Mother_GenderPX070601020100Gender?4N/A
PX070601_Mother_AlivePX070601020200Alive?4N/A
PX070601_Mother_AgePX070601020300Current age or age at death?4N/A
PX070601_Mother_Ever_Cancer_DiagnosisPX070601020400Never had cancer?4N/A
PX070601_Mother_First_Cancer_DiagnosisPX070601020500First cancer diagnosis?4N/A
PX070601_Mother_First_Cancer_Diagnosis_AgePX070601020600Current age or age at death?4N/A
PX070601_Mother_Second_Cancer_DiagnosisPX070601020700Second or other cancer diagnoses?4N/A
PX070601_Father_GenderPX070601030100Gender?4N/A
PX070601_Father_AlivePX070601030200Alive?4N/A
PX070601_Father_AgePX070601030300Current age or age at death?4N/A
PX070601_Father_Ever_Cancer_DiagnosisPX070601030400Never had cancer?4N/A
PX070601_Father_First_Cancer_DiagnosisPX070601030500First cancer diagnosis?4N/A
PX070601_Father_First_Cancer_Diagnosis_AgePX070601030600Current age or age at death?4N/A
PX070601_Father_Second_Cancer_DiagnosisPX070601030700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_1PX070601040100Gender?4N/A
PX070601_Sibling_Alive_1PX070601040200Alive?4N/A
PX070601_Sibling_Age_1PX070601040300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_1PX070601040400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_1PX070601040500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_1PX070601040600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_1PX070601040700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_2PX070601050100Gender?4N/A
PX070601_Sibling_Alive_2PX070601050200Alive?4N/A
PX070601_Sibling_Age_2PX070601050300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_2PX070601050400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_2PX070601050500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_2PX070601050600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_2PX070601050700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_3PX070601060100Gender?4N/A
PX070601_Sibling_Alive_3PX070601060200Alive?4N/A
PX070601_Sibling_Age_3PX070601060300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_3PX070601060400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_3PX070601060500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_3PX070601060600Current age or age at death?4N/A
PX070601_Sibling_Second_Cancer_Diagnosis_3PX070601060700Second or other cancer diagnoses?4N/A
PX070601_Sibling_Gender_4PX070601070100Gender?4N/A
PX070601_Sibling_Alive_4PX070601070200Alive?4N/A
PX070601_Sibling_Age_4PX070601070300Current age or age at death?4N/A
PX070601_Sibling_Ever_Cancer_Diagnosis_4PX070601070400Never had cancer?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_4PX070601070500First cancer diagnosis?4N/A
PX070601_Sibling_First_Cancer_Diagnosis_Age_4PX070601070600Current age or age at death?4N/A