Cancer produces a significant burden on society with a majority diagnosed at late stages when the chance of cure is low. Early diagnosis improves patient outcomes. Data consisting of lifestyle factors, medications, physical activity, years before conventional cancer diagnosis is also worthwhile for to determine early detection. This is only achievable with longitudinal tracking of a large number of healthy individuals and identifying those who do develop cancer over time.

To conduct a longitudinal cohort study of patients who do not have a malignancy at the time of enrollment and are followed over a 20 year period to see if patients develop a malignancy and associate clinical and lifestyle factors as well as collection of blood. All adults 18 years of age and older undergoing upper or lower endoscopy for routine medical care will be eligible for this study.

Inclusion Criteria:

• All adults 18 years of age of older undergoing upper or lower endoscopy for routine medical care.

Exclusion Criteria:

• Persons with current malignancy
• Persons with history of malignancy and treatment within last 5 years of enrollment, excluding non-melanoma skin cancer or cervical in-situ.
• Persons who are unable or unwilling to provide repeat blood samples and complete follow-up questionnaires
• Persons who lack the capacity to provide consent
• Persons who do not speak English
• Persons who are visually or hearing impaired.

Prospective participants who are to undergo upper or lower gastrointestinal endoscopies as part of their normal medical care and deemed necessary by their physicians