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| 1. Has any member of your close family (parents, grandparents) been affected with cancer? |
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| 2. Have you been drinking more than one peg (60 ml) of alcohol almost daily since the last seven to 10 years? |
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| 3. Have you been smoking about a packet of (10) cigarettes almost daily since the last seven to 10 years? |
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| 4. Have you been chewing paan, tobacco, supari etc almost daily since the last seven to 10 years? |
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| 5. Do you eat excessively salty/fried/oily/commercially prepared foods/ sauces/ jams/ spicy foods/pickles etc daily? |
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| 6. If fair skinned, do you frequently expose your skin to sunlight for long hours and suffer sunburn? |
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| 7. At your workplace and the like, are you frequently exposed to chemicals, fumes, radiation etc almost daily since the last seven to 10 years? |
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