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Colon cancer judgment a real test case

$5 million award shows importance of screenings

Pittsburgh Post-Gazette (PA) May 23, 2000
Section: LOCAL Edition: FINAL

By Christopher Snowbeck, Post-Gazette Staff Writer

A $5 million judgment last week in Allegheny County Common Pleas Court against a local physician who failed to recommend colon cancer screening to a now-cancerous patient is the latest testament to the value of screening tests for the disease.

It also underscores the point that patients need to learn about treatments.

The American Cancer Society recommends that starting at age 50 both men and women have at least a yearly fecal occult blood test as well as a screening test called sigmoidoscopy every five years. The fecal exam involves using an at-home kit to take a fecal sample and sending it to a lab for testing.

Done by a physician, sigmoidoscopy involves inserting a slender, flexible, lighted tube through the rectum into the colon to look for problems.

People at greater risk for colon cancer, such as those with a family history of the disease, might opt -- in conjunction with their doctors -- for more thorough screening tests, such as the colonoscopy or barium enema. They also might elect to do so at an earlier age.

Katie Couric, the host of the "Today" show, waged a high-profile campaign this spring to teach people about the benefits of colonoscopy -- a test that requires patients to drink a gallon of laxatives the night before the procedure, said Dr. Robert Fusco, a gastroenterologist in Moon.

"Nobody's that excited about getting their colon screened," he said.

But Fusco believes current guidelines don't call for enough people to get colonoscopies. Doing just a sigmoidoscopy, Fusco said, "is very analogous to doing a mammogram on your left breast but not your right.

"The real problem is people don't get screened," he said.

In last week's lawsuit, the plaintiff, Robert Renk, 58, of Tampa, Fla., said he wasn't even offered an at-home fecal test. The former South Park resident turned 50 in 1992 and three years later he was diagnosed with colorectal cancer, which by then had spread to his liver and lymph nodes. A colorectal cancer expert from Indianapolis testified that Renk's cancer could have been detected and successfully treated if he had been screened when he turned 50.

Renk's case provides an ironic twist to the usual story involving coverage disputes between patients and health plans. Whereas in many cases consumers want their health plans to give doctors the freedom to perform tests and prescribe drugs, this case saw the consumer saying the health plan should have exerted more influence over the doctor.

HealthAmerica calls on patients and doctors to follow national screening guidelines. It sends this message on a yearly basis in mailings -- but it doesn't force doctors and patients to pay attention, said spokeswoman Kendall Marcocci.

"The art of practicing medicine is left up to doctors -- they're in charge of the screening, treatment and diagnosis," she said. "The most important link in all of this is the patient. ... That's why we try to educate our members so they can be an active participant in their health, not just let others make decisions."

Aetna U.S. Healthcare, UPMC Health Plan and Highmark Blue Cross/Blue Shield all follow similar guidelines for covering the costs of colon cancer screening tests and all encourage members to get them.

Michael Weinstein, the spokesman for Highmark, said that consumers and providers likely are more attentive to the benefits of colon cancer screenings and other tests today than they were in the early 1990s, when Renk developed cancer.

"I think it's fair to say that the migration to managed care has had an impact, because of the nature of those programs -- the emphasis on prevention and preventive benefits," he said.

Neil Rosen, attorney for the plaintiff, said HealthAmerica's guidelines called for preventive screenings for colorectal cancer even in 1992.

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