Form:	Canary: PASS Retrospective Family Cancer History v2.0

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 422)
* 422	EDRN Site ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 1349)
* 1349	Have any of the participant´s living and deceased first degree blood relatives been diagnosed with cancer [other than basal/squamous cell skin cancer]? (Have any of your living and deceased first degree blood relatives (biological parents, siblings, children) been diagnosed with cancer [other than basal/squamous cell skin cancer]? [Not including half-siblings, step-siblings, step-parents, or step-children]. (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3143)
	Unknown/refused (9)
* 3143	Number of relative´s cancers to record: (Go To: 3202)
	Permissible Values (value): 1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	7 (7)
	8 (8)
	9 (9)
	10 (10)
* 3202	Line number or identifier 3 (system-generated): (Go To: 1351)
* 1351	Relative type (mother, brother, etc) (Go To: 1311)
	Permissible Values (value): Brother (1)
	Sister (2)
	Son (3)
	Daughter (4)
	Father (5)
	Mother (6)
	Refused (88)
	Unknown (99)
* 1311	First primary cancer: (Go To: 1430)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Cervix (5)
	Colon (6)
	Endometrium (22)
	Esophagus (7)
	Fallopian tube (45)
	Gall bladder (40)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Leukemia (11)
	Liver (10)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Mesothelioma (42)
	Multiple myeloma (44)
	Ovary (14)
	Pancreas (15)
	Primary peritoneal cancer (46)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Testis (24)
	Thyroid (20)
	Uterus (21)
	Vagina (26)
	Other, specify: (97) (Go To: 1310)
	Refused (88)
	Unknown (99)
* 1310	Cancer type/Location (Other, specify) (Go To: 1430)
1430	Relative´s age when diagnosed (Go To: 1317)
1317	Subsequent primary cancer(s): (Go To: 3272)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Cervix (5)
	Colon (6)
	Endometrium (22)
	Esophagus (7)
	Fallopian tube (45)
	Gall bladder (40)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Leukemia (11)
	Liver (10)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Mesothelioma (42)
	Multiple myeloma (44)
	Ovary (14)
	Pancreas (15)
	Primary peritoneal cancer (46)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Testis (24)
	Thyroid (20)
	Uterus (21)
	Vagina (26)
	None (0)
	Other (95)
	Refused (88)
	Unknown (99)
3272	Loop-specific comments 5: (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)