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.
