Pancreatic Cancer Screening for At-risk Individuals

Inclusion Criteria:

• Inclusion criteria 1-3 are indications for pancreatic cancer screening as defined bythe CAPS3 guidelines or updated national pancreatic cancer screening guidelines.Patients who do not meet these guidelines but are undergoing pancreatic cancerscreening at the discretion of their treating physician at participating studycenters will also be included in the study. Based upon the indication for screening,patients will be categorized as either meeting CAPS3 screening criteria, or notmeeting CAPS3 screening criteria.

1. Familial Pancreatic cancer kindred. This is defined as family history ofpancreas cancer that meet the criteria listed below.

2. If at least two affected relatives who are First degree relatives (FDR) toeach other, of whom at least one is an FDR to the individual consideredfor surveillance

3. If at least three affected relatives on the same side of the family, ofwhom at least one is an FDR to the individual considered for surveillance

4. If at least two affected relatives on the same side of the family, of whomat least one is an FDR to the individual considered for surveillanceScreening is usually initialed at age 50 years or 10 years younger thanthe youngest family member with pancreatic cancer

5. Patients with genetic susceptibility to pancreas cancer

6. Patients with Peutz-Jeghers syndrome diagnosed with using clinicalcriteria or with a deleterious mutation in liver kinaseB1/Serine/threonine kinase 11 (LKB1/STK11). Screening is usually initiatedat age 40 years or later.

7. Patients with Familial Atypical Multiple Mole Melanoma Syndrome (FAMMMsyndrome), diagnosed using clinical criteria or CDKN2A p16 mutation.

Screening is usually initiated at age 45 years or 10 years younger than the youngest family member with pancreatic cancer.

1. Hereditary Breast and Ovarian Cancer syndrome: diagnosed using clinical criteria ordeleterious Breast Cancer gene 1 (BRCA1), Breast Cancer gene 2 (BRCA2), Partner andLocalizer of BRCA2 (PALB2). The usual indication for screening is:

• BRCA1 mutation and at least one affected first-degree relative with pancreaticcancer

• BRCA 2 mutation and at least one affected first-degree relative, or at leasttwo relatives of any degree with pancreatic cancer

• PALB2 mutation and at least one affected first-degree relative with pancreaticcancer Screening is usually initiated at age 45 or 10 years younger than theyoungest family member with pancreatic cancer; or per updated nationalscreening guidelines

2. Lynch syndrome or Ataxia Telangiectasia Mutated (ATM) mutations with at least oneaffected first-degree relative (FDR). Lynch syndrome could be diagnosed either byusing clinical criteria or Mutator L homolog 1 (MLH1), Mutator S homolog 2 (MSH2),Mutator S homolog 6 (MSH6), Postmeiotic Segregation Increased, S. Cerevisiae, 2 (PMS2) or EPCAM mutation. Screening to be initiated at age 45 or 10 years younger than the youngest familymember with pancreatic cancer.

3. Patients with hereditary pancreatitis diagnosed using clinical criteria ordeleterious Serine Protease 1 (PRSS1) mutation. Screening is usually initiated atage 40 years or 10 years younger than the youngest family member with pancreaticcancer 3. New-onset diabetes, age > 50 years with weight loss. 4. Patients who donot meet these CAPS screening criteria but are determined by the site principalinvestigator to be high-risk for pancreatic cancer based upon family history orother risk factors, and are undergoing pancreatic cancer screening will also beincluded in the study. Indication for pancreatic cancer screening and age at whichscreening was initiated will be recorded.

Exclusion Criteria:

• Patients presenting with symptoms suggestive of pancreatic cancer who are undergoingdiagnostic EUS or MRCP e.g. acute recurrent pancreatitis, abnormal imaging