The names read like a roll call of Black excellence: congressman John Lewis, the civil rights icon who walked across the Edmund Pettus Bridge and helped change America; congresswoman Sheila Jackson Lee, the tireless advocate for justice who represented Houston for nearly three decades; Aretha Franklin, the Queen of Soul whose voice defined generations; reverend Dr. Calvin O. Butts III, the prophetic voice from Abyssinian Baptist Church who fought for his community with unwavering conviction; and most recently, D’Angelo, the R&B visionary whose artistry transformed contemporary music.

All taken by pancreatic cancer, and all part of a devastating pattern that the medical establishment continues to ignore.

Pancreatic cancer is an equal opportunity killer with deeply unequal impact. Research from the Cancer of the Pancreas Screening (CAPS) program has demonstrated that surveillance of high-risk individuals can detect pancreatic cancer at earlier stages. With patients diagnosed through screening programs showing a median survival of over five years compared to just eight months in the general population. More remarkably, 50 percent of screened high-risk patients survived five years compared to only 9 percent of those diagnosed through usual care.

Let that sink in. We’re talking about a fivefold improvement in five-year survival. We’re talking about the difference between burying someone within months and watching them see their grandchildren grow up. Yet when I look at current screening guidelines, I don’t see clear, actionable recommendations for African Americans, despite our community’s disproportionate burden from this disease.

Black Americans have higher incidence rates of pancreatic cancer than white Americans. We’re diagnosed at younger ages. We have worse outcomes. And when Representative John Lewis was diagnosed in December 2019, or when Congresswoman Sheila Jackson Lee announced her diagnosis in June 2024, or when Aretha Franklin battled the disease in her final months, they joined thousands of African Americans who face this diagnosis every year, usually far too late for curative treatment.

High-risk individuals undergoing surveillance were significantly more likely to be diagnosed at stage I (38.5 percent) compared to the general population (10.3 percent), and had smaller tumors at diagnosis. This isn’t theoretical. This is lives saved through early detection.

The medical community has accepted that certain populations warrant surveillance. Current guidelines recommend screening for patients with familial pancreatic cancer, genetic syndromes like BRCA mutations, and certain hereditary conditions. These recommendations exist because we know these populations face elevated risk.

But where are the race-specific guidelines? Where is the recommendation that African Americans, especially those with new-onset diabetes after age 50, which has been linked to pancreatic cancer risk, undergo enhanced surveillance? Where is the discussion about community-level screening programs in Black neighborhoods where pancreatic cancer rates are highest?

The silence is deafening and deadly. I can already hear the objections from my colleagues: “We need more studies specifically in African American populations.” “The cost-effectiveness hasn’t been established for race-based screening.” “We don’t want to create health anxiety or overtesting.”

To which I say: How many more John Lewises do we need to lose? How many more Aretha Franklins? How many more community leaders, mothers, fathers, pastors, teachers, and neighbors must die while we wait for the perfect study?

We don’t demand this level of certainty for other screening programs. We don’t wait for perfect data before recommending colonoscopies or mammograms. We make evidence-based decisions that balance benefits and harms, and we adjust our recommendations as we learn more.

For pancreatic cancer specifically, targeted screening has shown dramatic survival benefits, with screened patients living an average of 4.5 years longer than those diagnosed through usual care. If we have tools that work this well in high-risk populations, and we know African Americans are at higher risk, why are we not aggressively pursuing screening pathways for this community?

I’m not advocating for CT scans for every Black person in America. I’m advocating for a rational, risk-stratified approach that recognizes racial disparities as a risk factor worthy of clinical attention.

Current screening protocols for high-risk individuals utilize MRI and endoscopic ultrasound, typically performed annually or alternating between the two modalities. These are established, safe procedures available at major medical centers.

Here’s what a race-conscious screening protocol might include:

• Tier 1 – enhanced surveillance: African Americans with any of the following should be offered annual pancreatic cancer screening starting at age 50 (or earlier with additional risk factors):
  • New-onset diabetes after age 50
  • Family history of pancreatic cancer
  • Known genetic mutations (BRCA1/2, Lynch syndrome, etc.)
  • Chronic pancreatitis
  • Tobacco use combined with any other risk factor
• Tier 2 – risk assessment: All African American adults should undergo pancreatic cancer risk assessment at age 50, with education about symptoms, risk factors, and the importance of prompt evaluation for concerning signs.
• Tier 3 – research and development: Aggressive investment in developing more accessible screening tools (blood-based biomarkers, artificial intelligence analysis of routine imaging, and community-based ultrasound protocols) specifically validated in diverse populations.

This isn’t radical. This is basic public health adapted to population-level risk.

When I think about pancreatic cancer screening guidelines, I don’t think about abstract medical decisions. I think about congressman John Lewis, who spent his life fighting for justice and died from a disease we might have caught earlier with proper screening; I think about Aretha Franklin, whose voice moved millions, silenced by a cancer that grows quietly until it’s too late; and I think about Sheila Jackson Lee, who advocated tirelessly for her constituents but couldn’t advocate for earlier detection of her own disease.

I think about Dr. Calvin Butts, whose prophetic ministry at Abyssinian Baptist Church in Harlem touched thousands of lives. He was diagnosed with pancreatic cancer and died in 2022, another giant brought down by a disease that disproportionately affects our community. And I think about D’Angelo, the most recent loss, a musical innovator whose career was cut short.

These aren’t just celebrities. They’re representatives of the thousands of African Americans diagnosed with pancreatic cancer each year, most at advanced stages, most with limited treatment options, and most with survival measured in months rather than years.

Every one of these lives mattered. Every one might have been saved or extended with earlier detection. And every one raises the question: Why are we not doing more?

The fight for pancreatic cancer screening guidelines that address racial disparities is part of a larger struggle for health equity in American medicine. It’s about whether we’re willing to see patterns of disease in minoritized communities as important as patterns in genetically defined populations. It’s about whether Black lives matter enough to warrant the same aggressive screening protocols we extend to other high-risk groups.

I can’t bring back John Lewis, Sheila Jackson Lee, Aretha Franklin, or Dr. Butts or D’Angelo. I can’t bring back Lisa Byrd or Casper Rabb, teachers at my high school in Augusta, Georgia. I cannot bring back my Uncle Jimmie John Williams, Jr. I cannot bring back my Great-Uncle Arthur Raymond Williams. I can’t undo the years where pancreatic cancer remained unscreened for in the populations most affected by it. I can’t reverse the institutional inertia that prioritizes genetic screening for rare syndromes over population-based screening for common disparities.

But I can speak their names. I can tell their stories. I can demand that their deaths mean something beyond grief, that they catalyze change in how we approach pancreatic cancer in Black communities.

We have clear evidence that screening high-risk individuals for pancreatic cancer saves lives, with dramatic improvements in early-stage diagnosis and five-year survival rates. We know African Americans face elevated risk. What we need is the courage to extend these life-saving interventions to all communities that need them.

The pancreas doesn’t ask for anyone’s permission before it develops cancer. It doesn’t care about your insurance status, your zip code, or your ability to access a major academic medical center. It just grows tumors, quietly and lethally, until symptoms appear, usually too late.

We can do better. We must do better. The next John Lewis is out there right now, maybe with early pancreatic changes that could be detected and treated. The next Aretha Franklin is living her life, unaware that a screening program could give her decades more to share her gifts.

They’re waiting for medicine to catch up with what we already know. They’re waiting for guidelines that acknowledge their risk. They’re waiting for a health care system that values Black lives enough to screen for the diseases that kill us disproportionately.

How much longer will they have to wait?

Earl Stewart, Jr. is an internal medicine physician and Medical Director of Health Equity for WellStar Health System in Atlanta, Georgia. He is a fellow of the American College of Physicians, a 2023 Doximity Digital Health Fellow, and a 2023 Climate and Health Equity Fellow (CHEF) with the Medical Society Consortium on Climate and Health. He can be reached on E.S.J., M.D., LinkedIn, X @EarlStewartJr, and Doximity.