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a close family member had lung cancer, tubercolusis or emphysema? Yes No If yes, who? If you are a woman, have you passed menopause (change of life)? Yes If yes, at what age? No No

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Page 1: a close family member had lung cancer, tubercolusis or emphysema? Yes No If yes, who? If you are a woman, have you passed menopause (change of life)? Yes If yes, at what age? No No
Page 2: a close family member had lung cancer, tubercolusis or emphysema? Yes No If yes, who? If you are a woman, have you passed menopause (change of life)? Yes If yes, at what age? No No
Page 3: a close family member had lung cancer, tubercolusis or emphysema? Yes No If yes, who? If you are a woman, have you passed menopause (change of life)? Yes If yes, at what age? No No
Page 4: a close family member had lung cancer, tubercolusis or emphysema? Yes No If yes, who? If you are a woman, have you passed menopause (change of life)? Yes If yes, at what age? No No

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