NasoCRA: Nasopharyngeal Cancer Risk Assessment

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

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

Do you have an immediate family member and/or close relative suffering from nose and throat cancer??

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

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