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Colorectal Cancer Risk Assessment

 

Colorectal Cancer Risk Assessment

Women can answer the following questions to get a sense of their
likelihood of having or developing cancer colon (large intestine) or rectum.

Do you eat a diet that is low in fiber?
Yes
No
Do you eat a diet that is high in fat? Yes No
Are you over age 50? Yes No
Have you ever been diagnosed with colorectal polyps? Yes No
Do you have an immediate family member (parent, child, or sibling) who has had colorectal polyps or colorectal cancer? Yes No
Have you ever been diagnosed with IBD (inflammatory bowel disease in the form of ulcerative colitis or
Crohn’s disease)?
Yes No
Have you ever had breast, uterine, or ovarian cancer? Yes No

On average, do you consume the equivalent of more than one alcoholic beverage per day?

Yes No
Are you overweight? Yes No
Is your lifestyle inactive? Yes No

Have you ever smoked?

Yes No
Have you had screening for colorectal cancer, according to your age recommendations? Yes No
Are you African American or of Eastern-European Jewish descent? Yes No
Have you noticed blood in your stool recently? Yes No

Have you noticed a disruption of your bowel habits that lasts for more than a few days?

Yes No

Have you had pain, bloating, or cramping in your abdomen?

Yes No

Have you had weight loss, or tiredness and weakness that you cannot explain?

Yes No
Have you ever been diagnosed with a colorectal cancer that has previously been removed? Yes No


The more often you answered “Yes” to the above questions, the greater your risk for developing or having colorectal cancer.  If you answered “Yes” to questions above, consider discussing colorectal cancer with one of our Women’s Center healthcare providers.

Print this page and bring it with you, filled out, to your appointment.