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onset diabetes, to identify those who may benefit from surveillance imaging. With proper validation and
development, AI may be used as an aid for clinicians to detect cancer growth at a curable stage by using
blood-based markers, radiomics and analyzing fecal microbiome composition. In the development of AI
models, ethical and privacy concerns should be carefully addressed before full implementation, including
data protection and discordant conclusions between AI and physicians. Future studies incorporating
federated learning may advance these efforts by assembling large and diverse data while ensuring patient
data privacy. In building AI models for clinical implementation, considerations of transparency about the
model application and in what settings AI should be deployed are critical to ensure proper use for PDAC
early detection and other AI applications.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Tovar DR, Rosenthal MH, Maitra A, Koay EJ
Performed data acquisition and provided administrative, technical, and material support: Tovar DR,
Rosenthal MH, Maitra A, Koay EJ

Availability of data and materials
Not applicable.

Financial support and sponsorship
Maitra A and Koay EJ were supported with grants from NIH (1U01DK126365, 5U01CA200468,
3U01CA196403, 5R01CA218004). Koay EJ was also partially supported by DOD (W81XWH-21-1-0709)
and NIH (U54CA210181, U54CA143837, U01CA214263, P50CA221707, R01CA221971, P30CA016672).
Maitra A and Koay EJ would also like to gratefully acknowledge the generous support from Jennifer and
Wil vanLoh, KWS Foundation, and the Michael C Linn Family Foundation. Rosenthal MH received
funding from the Hale Family Center for Pancreatic Cancer Research at Dana-Farber Cancer Institute, NIH
(NIH/NCI U01CA210171 and U01CA200468), Lustgarten Foundation, and Stand Up to Cancer for related
work. Maitra A is supported by the MD Anderson Pancreatic Cancer Moon Shot Program, the Sheikh
Khalifa Bin Zayed Al-Nahyan Foundation. Maitra A receives royalties for a pancreatic cancer biomarker test
from Cosmos Wisdom Biotechnology, and this financial relationship is managed and monitored by the
UTMDACC Conflict of Interest Committee. Maitra A is also listed as an inventor on a patent that has been
licensed by Johns Hopkins University to ThriveEarlier Detection. Maitra A serves as a consultant for
Freenome and Tezcat Biotechnology.

Conflicts of interest
Koay EJ has consulting agreements with Astra Zeneca, RenovoRx, Quantum Aurea Capital, and iO Life
Sciences. Koay EJ receives royalties for a book on Physical Oncology from Taylor and Francis LLC. Koay EJ
has stock ownership in Quantum Aurea Capital.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.