NasoCRA: Nasopharyngeal Cancer Risk Assessment

What is your gender/sex?
Male
Female
What is your age?
1 - 20 years old
21 - 40 years old
41 - 50 years old
51 - 70 years old
71 years old and older
What is your ethnicity (race)?
Malay
Chinese
Indian
Iban
Bidayuh
Lun Dayeh (Orang Ulu)
Kadazan-Dusun
Others
Do you smoke cigarette/cigar/pipe/e-cigarette?
Yes, more than 5 sticks/times per day
Yes, between 1 - 5 sticks/times per day
Yes, less than 4 sticks/times per week
Yes, occasionally (1 - 3 sticks/times per month)
Yes, but rarely (once or twice per year)
No, not at all
How often do you consume salted preserved food (salted fish and vegetables)?
At least once per week
Once or twice per month
Once or twice per year
Never
Do you work and/or live in an environment that exposes you to chemicals like formaldehyde, formalin or harmful gases?
Yes
No
Do you have an immediate family member and/or close relative suffering from nose and throat cancer??
Yes, both my parents.
Yes, one of my parents.
Yes, one of my grandparents.
Yes, one of my brothers/sisters
Yes, one of my uncles/aunties
None in my family or among my relatives.
How often do you experience symptoms of common cold or flu, such as sore throat, cough, and running nose?
At least once every month
3 to 5 times in a year
Less than 2 times in a year
Do you experience ear pain that is not due to ear infection?
Yes, very often
Yes, but not so often
No, I never have such experience
Do you ever notice blood in your sputum and/or nasal discharge?
Yes, every time I sneeze or spit
Only sometimes when I sneeze or spit
Not at all
Do you have any unusual swelling or lump(s) underneath your chin or any area around your neck?
Yes
No
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