HealthWatch: Some Colon Cancer Screenings May Not Find Disease
SAN FRANCISCO (CBS 5) -- Colon cancer kills 50,000 Americans a year but is one of the most curable cancers if caught early through preventative screening. However one Bay Area family said their mother's screening gave her a false sense of security – with deadly results.
"My mom died as a result of them not looking, not screening as they proclaim to do," said Dawn Hardy. In 2005 her 62-year-old mother, Doris Schoby, went to Richmond Kaiser for a routine cancer screen called a sigmoidoscopy, which uses a flexible tube with a camera to examine the lower 1/3 to 1/2 of the colon.
"And her doctor told her that she was good-to-go for 10 more years," said Hardy.
But there's a problem with sigmoidoscopy – it doesn't reach the upper colon – and that's where Doris Schoby's cancer was hiding.
She died three years later.
"And the frustrating part of this is just knowing this was so preventable."
American Cancer Society - Cancer Detection Guidelines
National Cancer Institute - Colon Cancer Screening
U.S. Preventative Services Task Force
Preventable, because a more complex procedure called colonoscopy examines the entire length of the colon and might have found Schoby's cancer.
So why does Kaiser use sigmoidoscopy over colonoscopy to screen most of its patients?
"Sigmoidoscopy is faster, it's cheaper, it uses fewer personnel," said attorney Kevin Liebeck, who sued Kaiser for the Schoby family. "Kaiser profits by that. Certainly not the patient."
UCSF professor Dr. Alan Venook said it's not so simple. Although colonoscopy is considered the 'gold standard' procedure, he said, "Colonoscopy vs. sigmoidoscopy for screening is a very controversial topic…because it's more difficult to do a colonoscopy."
Dr. Venook said colonoscopy requires a bigger staff, more preparation, and drugs for sedation. The procedure also carries more risk for the patient. What's more, there aren't enough resources to screen everybody using colonoscopy.
"Colonoscopy is a good test," said Dr. Theodore Levin, "but there are lots of other good ways to screen for colorectal cancer." Dr. Levin heads Kaiser's colon cancer screening program for Northern California. He said sigmoidoscopy – and an easy-to-use take-home test to check for blood in the stool – is less invasive and enables Kaiser to screen more people, find more cancers, and save more lives.
"The best screening test is the one patients will get done. And there's not enough evidence to say that one screening test is better than another."
"The point is that some screening is better than no screening," said UCSF's Dr. Venook.
But what about the people those less-invasive tests miss?
After much digging, Doris Schoby's family discovered that her doctor actually did find a possible pre-cancerous growth in her lower colon, but the lab lost the tissue before it could be analyzed – and Schoby's doctor let the matter drop without ordering a full colonoscopy.
"He gambled with my mom's life, and he was wrong," said Schoby's daughter Dawn.
Kaiser never admitted any mistakes in the case but in September, 2010, an arbitrator awarded the Schoby family maximum damages of $250,000. The arbitrator ruled that Kaiser's treatment of Doris Schoby "fell below the standard" of care; and that her cancer "would probably have been cured or at least curbed" with a colonoscopy.
"She would still be alive today," said her daughter, eyes filling with tears. "With us…Watching her grandchildren grow."
In a statement to CBS-5, Kaiser said it does not deny treatment based on cost. The health plan's statement follows:
Kaiser Permanente Response to CBS-5 10/28/10
We want to express our condolences to Mrs. Schoby's family. As an organization, Kaiser Permanente is committed to providing quality care and we regularly review our processes in order to further improve our services.
We could not disagree more strongly with statements made by the Schoby family's attorney. We take special issue with the attorney's broad criticism of Kaiser Permanente screening practices without any factual support for his claims and his assertion of improper financial motivations where none exist.
Kaiser Permanente is recognized as a national leader in colorectal cancer screening. As a result of our aggressive outreach program to screen members in the target age group, our screening rates lead the State and most of the nation (see links below). We follow national guidelines for types and frequency of screening. This year we expect to screen more than 70 percent of our members in the target age group in our fight against colon cancer.
The U.S. Preventive Services Task Force, American Cancer Society, and others advocate screening by any of several techniques, including stool tests (FIT), sigmoidoscopy or colonoscopy. Our goal is to screen the most people possible in the target age group for colon cancer. Not all patients agree to undergo screening, and some may prefer one test over another. Our high screening rates have been achieved by making it as easy as possible for patients to use a screening method that they can accept and tolerate. Kaiser Permanente physicians discuss with their patients the most appropriate screening tool based on the patient's personal situation and family history.
It is a core principle at Kaiser Permanente that sound medical practices and patient well-being come before financial considerations. We constantly review the most current scientific literature, participate in national conferences and contribute significant research work on colorectal cancer screening and prevention—and as knowledge and technology change, so do our practices.
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Links:
California Office of the Patient Advocate (OPA)
http://www.opa.ca.gov/report_card/HMOmeasure.aspx?Category=HMOHEDIS&Topic=CheckingForCancer&Measure=ColorectalCancerScreening
National Committee on Quality Assurance (NCQA)
http://www.ncqa.org/tabid/506/Default.aspx
Background information on colon cancer screening
Regular screening for most people begins at age 50. For those with a family history of polyps or colon cancer, and for those with irritable bowel syndrome, screening is recommended to begin at age 40, or 10 years earlier than the age of onset of polyps or cancer in the earliest affected family member. Kaiser Permanente has an aggressive outreach program to reach those who should be screened, including office visits, phone, e-mail, and direct mail reminders.
We encourage our members to discuss with their physician the most appropriate screening tool, based on the member's personal and family history of risk factors for colorectal cancer, the potential risks from screening, and the inconvenience of the various screening tests.
● FIT Testing (Fecal Immunochemical Testing) every year: Since 2007, we mail a home fecal test annually to every Northern California Kaiser Permanente member between the ages of 50 and 80. This is a relatively easy, non-invasive test. Using this as an initial step increases the number of people being screened and reserves the more invasive testing for those who are at risk or test positive on the FIT. Patients who test positive on a FIT test are immediately referred for a colonoscopy.
● Sigmoidoscopy: Unless otherwise recommended by a patient's physician, sigmoidoscopy is recommended every five years for members over 50 who do not have any other risk factors. It has a high level of accuracy combined with a very low level of patient inconvenience and risk of complications. When adenomatous polyps are found using a sigmoidoscopy, patients are usually recommended to have a colonoscopy.
● Colonoscopy: Colonoscopies are recommended for patients who are at high risk for developing colon cancer (i.e., patients who have symptoms of colorectal cancer, had an abnormal result from another screening procedure or have any other associate high risks). Unless otherwise recommended by a patient's physician, a colonoscopy is recommended every 10 years. Colonoscopy has a high level of accuracy but also a higher level of patient inconvenience and risk of complications.
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