Abstract Patients diagnosed with Stage I pancreatic cancer have a much better outcome than most patients who present with advanced disease. The Cancer of the Pancreas Screening (CAPS) study currently follows a familial/genetic “high-risk” cohort of ~1500 patients undergo regular pancreatic surveillance. Recent results from the CAPS program indicate that most patients who maintain regular surveillance are down-staged, many are diagnosed with Stage I pancreatic cancer and achieve long-term survival. Circulating tumor marker tests are not currently used for pancreas surveillance, but we propose to evaluate blood tests for patients undergoing pancreatic surveillance. We will evaluate the use of tumor marker gene tests to better define an individual’s tumor marker normal reference range. We will evaluate the use of plasma MR spectroscopy as a diagnostic test that utilizes artificial-intelligence methods to detect subtle circulating metabolic changes associated with having pancreatic cancer. We will also determine if blood biomarker changes occur before the diagnosis of pancreatic cancer in our cohort. The addition of annual blood tests to pancreatic surveillance is expected to improve the detection of early-stage pancreatic cancer. We will continue to evaluate the long-term outcomes of patients in our cohort and bank biospecimens for future biomarker studies.