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Lung cancer questionnaire 2026

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The document is a Lung Cancer Screening Questionnaire designed to identify candidates eligible for screening based on specific criteria, including age, smoking history, and risk factors. It outlines two categories of eligibility and provides a section for personal and family health history. The completed questionnaire can be submitted via email or brought to a health fair for review by a healthcare professional.

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Click ‘Get Form’ to open the lung cancer questionnaire in the editor.
Begin by entering your name and date of birth in the designated fields at the top of the form.
Indicate your smoking status by selecting 'Current Smoker' or 'Former/quit' and provide additional details such as packs per day or years since quitting.
Proceed to Category 1 Eligibility. Answer each question with a 'YES' or 'NO' by clicking the appropriate box.
Continue to Category 2 Eligibility and check all high-risk factors that apply, including family history and personal health conditions.
Once completed, you can easily email the form to Nancy Judd or print it for review at your health fair.

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What are the hidden signs of lung cancer?

The only recommended screening test for lung cancer is low-dose computed tomography (also called a low-dose CT scan, or LDCT). Lung cancer screening is recommended only for adults who are at high risk for developing the disease because of their smoking history and age.

What is the 5 finger test for lung cancer?

In this test, the person places their two index fingers together, nail to nail, forming a heart shape. There should be a small, diamond-shaped window between the cuticles of the fingers. In people with finger clubbing, the fingers will lie flat against each other and no window is visible.

What is a simple finger trick to check if you have lung cancer?

2010 Pallares-Sanmartin et al used the interphalangeal depth ratio as the diagnostic standard and demonstrated that the Schamroth sign had a sensitivity of 77-87%, specificity of 90%, positive likelihood ratio of 8, and negative likelihood ratio of 0.2.

What is the gold standard for lung cancer screening?

Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over if they have two or more of the following unexplained symptoms, or if they have ever smoked and have one or more of the following unexplained symptoms: Cough. Fatigue. Shortness of breath.

How accurate is the Schamroth test?

The most common symptoms of lung cancer are: Chest pain that is often worse with deep breathing, coughing, or laughing. Hoarseness. Loss of appetite. Unexplained weight loss. Shortness of breath. Feeling tired or weak. Infections such as bronchitis and pneumonia that dont go away or keep coming back. New onset of wheezing.

lung cancer screening questionnaire pdf

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What do your fingers look like if you have lung cancer?

Simple test for lesser known lung cancer symptom. If you press your fingers together, is there a tiny diamond-shaped hole? If there isnt, then this could mean you have clubbed fingers, a lesser known symptom of lung cancer.